Hope Offered Against Hysterectomy

By: Kathleen Fackelmann

NEW YORK (AP) — Arleen Chatman’s mother had a hysterectomy. Her grandmother had a hysterectomy. So did her sister, two aunts and a cousin, who was only 32 when the family problem uterine fibroids struck her as they do millions of women every year.

Chatman, 57, was determined to buck her history, fight through her fibroid-related pain and find a way to avoid a hysterectomy, despite five miscarriages and periods so heavy she used a box of sanitary napkins combined with tampons in a single day.

“I got very anemic and was missing work,” said the elementary school librarian in Los Angeles. “I grew up in the old school of ‘It’s just a woman’s curse and you have to put up with it.’ Then I started reading and everybody was talking about hysterectomies being done that weren’t needed, saying there should be alternatives.”

The alternative Chatman chose three years ago is a relatively new treatment that allows women to avoid the risks and lengthy recovery periods of surgery. It’s called uterine artery embolization, and it’s done by interventional radiologists, not gynecologists.

Under local anesthesia accompanied by pain medication, a quarter-inch incision is made in the groin. A catheter the circumference of spaghetti is threaded into the two arteries that supply blood to the uterus and feed blood-dependent fibroids.

Guided by bursts of die projected by X-ray imaging, plastic particles the size of sand granules are injected into the vessels, blocking blood to the tumors while allowing the uterus to receive nourishment from other sources.

Fibroids slowly deteriorate over three months to a year after embolization, offering women an average 40 percent to 60 percent reduction that appears to be permanent, said Dr. Robert Worthington-Kirsch, a Philadelphia radiologist who has performed a little more than 600 uterine artery embolizations, the most in the United States. The procedure usually takes care of multiple fibroids, not just the prominent ones, unlike surgery.

About 4,500 women have undergone the procedure in the United States, and 6,000 to 8,000 worldwide. The procedure is successful in easing symptoms in about 90 percent of cases, Worthington-Kirsch said.

Recipients are screened by gynecologists prior to embolization to rule out uterine cancer, detect infections that could lead to complications and determine whether other problems such as endometriosis are severe enough to lead to hysterectomy anyway.

Most women spend a night or less in a hospital and resume their lives within a few days, compared to weeks of recovery after surgery. The downside is painful cramps that hit some women for a day or two after the embolization. And much more study is needed to gauge long-term effects of the procedure on fertility, among other factors.

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.