WebMD Medical News
Daniel J. DeNoon
Louise Chang, MD
Jan. 3, 2008 -- Can women with painful fibroids get long-term relief without
Yes, suggests a study of 1,278 women who underwent uterine fibroid
embolization (UFE, also known as uterine artery embolization or UAE). Three
years after the minimally invasive procedure, fewer than 15% of women needed
surgery or a repeat UFE.
The study was led by UFE pioneer Scott C. Goodwin, MD, who chairs the
department of radiological sciences at the University of California, Irvine.
Goodwin, who prefers the more precise term UAE, says the procedure offers
"very good" long-term outcomes.
"The quality of life after UFE is good. And you have quicker recovery
and fewer complications than with the surgical alternatives," Goodwin tells
Moreover, Goodwin notes that the women in the study were treated at all
kinds of medical centers, not just those highly experienced at performing
"That was important," Goodwin says. "You can conclude that UFE
done by someone with the proper credentials will have the same outcome wherever
it is done."
While 86% of the women who chose UFE said they'd recommend it to a friend or
family member, not all of them remained symptom free. Three years after the
procedure, about 13% of the women underwent surgery for fibroid symptoms and
another 2% underwent another UFE.
That rate is comparable to the rate seen in patients who undergo myomectomy,
surgical removal of fibroids. Each year after myomectomy, about 5% of patients
see their fibroids return.
Worldwide, some 25,000 women undergo UFE each year. Goodwin introduced the
procedure to the U.S. in 1996.
But the procedure is still considered "developmental" by many
gynecologists, including Bryan Cowan, MD, chair of the University of
Mississippi Medical Center department of gynecology and a spokesman for the
American College of Obstetricians and Gynecologists.
"The three-year follow-up is short," Cowan tells WebMD. "I tell
patients repeatedly: I can take your fibroids out but I cannot change you.
After myomectomy, one-fourth of you will see them come back -- but that is five
or six years later. So these people in the Goodwin study have not entered that
Fibroids are benign tumors -- not
cancers -- that grow inside the uterus; doctors call them uterine myomas or
leiomyomata. They usually don't cause symptoms. But when they do,
women may suffer excessive or painful bleeding during menstruation, bleeding
between menstrual periods, abdominal pressure, frequent urination, pain during
sex, and/or low back pain.
Removal of the uterus -- hysterectomy -- is the only sure way to get rid of
fibroids and to make sure they never come back. Fibroids are the reason for up
to 40% of the 150,000 to 200,000 hysterectomies performed each year in the
Hysterectomy results in sterility. If a woman does not want her uterus
removed, and her fibroids are not too numerous or too large, she may opt for
myomectomy -- removal of the fibroids.
Surgery is not the only option. The most commonly chosen nonsurgical
treatment for fibroids is UFE. Other options under development include
destroying fibroids via freezing, microwaves, or focused ultrasound.
During UFE, an interventional radiologist inserts a small tube into a leg
artery and guides it into the blood vessels feeding the uterus. Small plastic
beads released through the tube go inside the uterus and block off the blood
supply feeding the fibroids. This kills the fibroids, which usually are
absorbed back into the body after they die.
"The important thing is that people tend to recover more quickly after
UFE than after surgery," Goodwin says. "You are talking two weeks; that
is a big plus for UFE. And some studies show fewer complications than surgical
Some women appear to do better than others. In the Goodwin study, patients
who reported the best outcomes:
What if a woman needs relief from fibroid symptoms but still wants to become
Cowan says there's only one option: myomectomy.
"If a patient with fibroids wants a pregnancy, I recommend
myomectomy," Cowan says. "And not laparoscopic [minimally invasive]
myomectomy, either. There might be six to 10 doctors who can do it and secure
the uterus intact, but I am not one of them. And I am not willing to compromise
the ultimate outcome for the patient, which is to carry a pregnancy to
What about UFE? Goodwin notes that UFE can lead to failure of the ovaries.
In women in their late 40s, he says, this happens about a third of the time.
But Goodwin says that only 1% of women under age 35 have ovarian failure after
"For younger women, UFE would be a reasonable alternative to myomectomy
for preserving fertility," Goodwin says. "But a woman in her mid 40s --
who will have a lot of fertility problems anyway -- may wish to consider
In its most current policy statement, written in February 2004, the American
College of Obstetricians and Gynecologists argues against UFE for women who
wish to remain fertile. That advice still stands, Cowan says.
Cowan argues that women suffering fibroid symptoms should be under the care
of a gynecologist.
"Yes, I would recommend UFE to patients," he says. "But I sit
down with my patients and discuss all the options. If they want UFE, I back
them 100%. I get them an interventional radiologist, and we will make this
Goodwin agrees that doctors should discuss all fibroid treatment
alternatives with patients. But he says patients often don't learn all the
facts about UFE from their doctors.
That may be changing. Goodwin notes that his report -- and earlier reports
on this study -- appears in Obstetrics & Gynecology, published by
the American College of Obstetricians and Gynecologists.
SOURCES: Goodwin, S.C. Obstetrics & Gynecology, January 2008; vol
111: pp 22-33. "Uterine Artery Embolization," ACOG Committee Opinion,
February 2004; vol 103: pp 403-404. Scott C. Goodwin, MD, professor and chair,
department of radiological sciences, University of California, Irvine. Bryan
Cowan, MD, professor and chair, department of gynecology, University of
Mississippi Medical Center, Jackson.
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