dp A Hope Against Hysterectomy - Treatment for Uterine Fibroids

A Hope Against Hysterectomy

By: Kathleen Fackelmann

When her doctor didn’t have the information she wanted, Kimberly King logged onto the Internet to find out more about a radical, relatively new treatment for uterine fibroids.

In fact, King’s gynecologist had just one recommendation to remove the non-cancerous tumors: a hysterectomy. There’s no doubt that this surgical removal of the uterus would “cure” King’s condition. Remove the uterus and you remove the fibroids growing there, too.

But King wasn’t about to get a hysterectomy.

Instead, she went online and found a doctor who performed a new, less invasive procedure in October 2000.

The procedure shrank the large fibroid tumors in King’s uterus. She is now free of the heavy bleeding caused by the fibroids and she kept her uterus.

No one knows what causes fibroid tumors, which affect one out of three women in the USA and up to half of all black women. For most women, the tumors cause minor problems like bloating or no symptoms at all. But for some women, the tumors can trigger very heavy menstrual periods and clots.

The procedure that King underwent is called uterine artery embolization. It’s so new that many gynecologists either don’t know much about it or don’t recommend it. Yet it offers women a much-needed alternative to a hysterectomy, says John Lipman, an Atlanta radiologist who does the procedure.

An estimated 200,000 women in the USA will get a hysterectomy this year as a treatment for fibroids. Many of them probably didn’t know about the new procedure, Lipman and other radiologists say. That may be changing as news of the procedure spreads. About 20,000 women in the USA have opted for the new procedure since 1997, the year it was introduced here, says the Society of Cardiovascular & Interventional Radiology in Fairfax, Va.

They say uterine artery embolization is safer and offers women a much shorter recovery period compared with a hysterectomy or with another surgical procedure for fibroids called a myomectomy that removes the entire tumor.

Less pain, less hospital time

Women undergoing a hysterectomy or a myomectomy must go to the operating room where the gynecologist makes an incision in the abdomen and then either removes the entire uterus or carefully cuts out the tumor. In either case, it means a three- to four-day stay in the hospital and then six weeks of recovery at home.

In the new procedure, the radiologist makes a small nick in the skin at the top of the leg and inserts a thin, flexible catheter. The doctor pushes the catheter until it gets to the artery supplying the uterus and the fibroid with blood. The radiologist then injects a solution of small plastic particles (each one about the size of a grain of sand) into the blood vessel. These particles plug up the vessel supplying the tumor with blood, but in most cases do not affect the blood flowing to the uterus.

Without a blood supply, the tumor starts to wither away.

Women who undergo the new procedure usually go home the next day and resume their usual activities within a week, Lipman says.

Experts say women with very large tumors may not be good candidates for the procedure. “It’s not a treatment for everyone, but it sure beats a hysterectomy,” says radiologist Paul Kiproff at Allegheny General Hospital in Pittsburgh.

Heavy bleeding from fibroids led Yvonne Brandon to consider a hysterectomy, but she wasn’t eager to undergo that operation. She’d already undergone a myomectomy in 1986, a procedure that left her doubled over in pain for weeks.

Even worse: Brandon’s fibroids grew back. When Brandon found out about the less invasive procedure over a year ago, she jumped at it. She had it done on a Monday, and by Friday “I was out cutting the grass,” she says.

Lipman, Kiproff and other doctors who perform uterine artery embolization are interventional radiologists. They say that the procedure has ignited a turf battle with gynecologists over patients with fibroids.

Michael Wysoki of Yale University School of Medicine in New Haven says many of the women who turn to this procedure just aren’t willing to go along with the standard treatment.

In a small study of how women end up getting the procedure, Wysoki found that 19 out of 21 women had initially been told to get a hysterectomy by their gynecologist. Of those 21 women, nine had a gynecologist that opposed the less invasive option.

Sandra Carson, a gynecologist at Baylor College of Medicine in Houston, says that many gynecologists simply don’t know much about the procedure. She says there’s always a lag between the development of a new technology and widespread acceptance of it.

The rank-and-file gynecologist often follows the lead of the American College of Obstetricians and Gynecologists (ACOG) in Washington, D.C. That group still calls the procedure experimental.

Radiologists have been doing this procedure for only a few years, says ACOG spokesman Jimmy Moore. It has yet to be fully tested, he says.

Yet uterine artery embolization does show promise, he says.

A study in the July issue of Obstetrics & Gynecology by James Spies, a radiologist at Georgetown University Hospital in Washington, D.C., suggests that for most women the procedure works well — at least in the short term.

Spies and his colleagues studied 200 women who underwent the new procedure. Their analysis showed that 90% of the women said their heavy bleeding had improved a year later.

“Serious complications are very rare,” Spies says. The team found only one in their study — a blood clot that was treated before it could do any harm.

Some worries

That study, although a step in the right direction, doesn’t really prove that the procedure is safe, points out Amy Allina of the National Women’s Health Network in Washington, D.C. No one really knows the impact of this procedure over the long run, she says.

For example, scientists don’t know whether young women who get the procedure will suffer from fertility problems, she says.

Some women have died of complications related to this procedure, adds Nora Coffey, president of the HERS Foundation, an anti-hysterectomy group in Bala Cynwyd, Pa. Her group recommends no treatment at all for women with mild fibroid problems. For those with serious bleeding and other symptoms, Coffey recommends a myomectomy.

Any medical procedure like this one involves some risk, experts say. But Spies says just four women worldwide have died because of the procedure, a rate that indicates the procedure is very safe, he says.

The Food and Drug Administration has approved the devices used in this procedure for the treatment of tumors in other parts of the body, but it has yet to specifically OK their use as a treatment for fibroid tumors.

The general approval, however, means doctors can and do use the procedure on uterine fibroids — even though scientists have yet to fully prove that it works safely, Allina says.

She says there are some important unanswered questions about this new procedure, despite the enthusiastic reviews by doctors who perform it. For example, doctors really don’t know whether the fibroids will return five years down the road, she says. Furthermore, they don’t have any data that compares the new procedure with a hysterectomy or a myomectomy.

Yet Allina says that women should consider this new procedure along with the othe
r treatments for fibroids. But for some women, the risks don’t compare with the benefits offered by the new, less invasive treatment for fibroids.

Brandon says she didn’t want to spend six weeks in bed recovering from a hysterectomy, yet felt she had to do something to control the heavy bleeding that she suffered every month.

She said every month she battled fatigue and the fear that she wouldn’t have enough protection with her.

After getting the procedure, the fatigue and worries vanished. “It has literally changed my life,” she says.

For the original version of this article: A Hope Against Hysterectomy

As an educational service, members of the FTC provide questions and answers regarding fibroids. Please note that the questions and answers are not medical advice and there is no substitute for diagnosis and, where appropriate, treatment by a qualified and licensed physician of your own choosing.

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