WebMD Health News
Louise Chang, MD
Feb. 26, 2008 -- A relatively new treatment for uterine fibroids is a
reasonable alternative to hysterectomy for women who want to avoid surgery, new
Outcomes among patients who had the treatment, known as
uterine artery embolization (UAE) or
uterine fibroid embolization (UFE), were compared to those of hysterectomy
patients in the trial from the Netherlands.
Both groups reported significantly improved health-related quality of life
two years after treatment, but nearly one out of four women initially treated
with UAE ended up having hysterectomies because of treatment failure.
"For those women seeking absolute certainty of being asymptomatic after
treatment, I would recommend a hysterectomy," study researcher Jim A.
Reekers, MD, PhD, says in a news release. "But for women who wish to retain
their uterus and who desire a fast recovery, I would definitely recommend
As many as one in four women have symptoms from uterine fibroids, which are
benign tumors of the uterus.
Symptoms of uterine fibroids can include heavy, painful menstrual bleeding,
pelvic pain or pressure, and
According to the National Women's Health Information Center, uterine
fibroids are the reason for about one-third of the 600,000 hysterectomies
performed in the U.S. each year.
Introduced just over a decade ago, uterine artery embolization is a
minimally invasive catheterization treatment designed to choke off uterine
A small tube is inserted into a leg artery and guided into the blood vessels
feeding the uterus. Tiny particles are then strategically injected to block the
blood supply that feeds the fibroids.
In most cases, the fibroid tissue shrinks or dies, leading to relief of
symptoms. Recovery time after UAE is typically around a week, compared to six
weeks with hysterectomy.
This is also far shorter than recovery times for another surgical fibroid
treatment known as myomectomy, in which the fibroids are removed but not the
Reekers and colleagues report two-year follow-up from their Embolization
versus Hysterectomy (EMMY) trial in the March issue of the journal
The study included 177 women with uterine fibroids and heavy menstrual
bleeding, half of whom were initially randomly assigned to treatment with
UAE and the other half to hysterectomy.
During two years of follow-up, no significant differences in health-related
quality of life were reported among the two treatment groups. Nine out of 10
patients in both groups reported being at least moderately satisfied with the
treatment they received.
However, 24% of women who had undergone embolization did end up having
Georgetown University interventional radiologist James B. Spies, MD, tells
WebMD that the UAE failure rate was higher in the EMMY study than in many
In Spies' own UAE study involving 200 patients, the symptom-recurrence rate
was still 20% with the nonsurgical treatment five years after treatment.
Spies says UAE has proven to be as effective as any uterus-sparing
treatment, including myomectomy, for the long-term relief of symptoms related
"Women now have a choice, and they can weigh the factors that are most
important to them before making a decision about treatment," he says.
Another UAE researcher tells WebMD that myomectomy offers the best chance of
preserving fertility, while hysterectomy is the best choice for patients who
aren't concerned about fertility, recovery time, or surgical complications and
want to make sure their fibroids don't come back.
"Obviously, there is no re-treatment after hysterectomy because once the
uterus is gone, it's gone," Scott C. Goodwin, MD, of the University of
California, Irvine, tells WebMD. "But UAE has been proven very effective
for women who want a shorter recovery time with fewer treatment-related
SOURCES:Hehenkamp, W.J.K., Radiology, March 2008; vol 246: pp 823-832.Jim A Reekers, MD, PhD, interventional radiologist, Academic Medical Centre,
Amsterdam, Netherlands.Scott C. Goodwin, MD, chairman, department of radiological sciences,
University of California, Irvine.James B. Spies, MD, department of radiology, Georgetown University Hospital,
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