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Fibroids may be treated without hysterectomy

NEW YORK (Reuters Health) - Women with symptomatic uterine fibroid tumors, benign tumors inside the uterus that often cause heavy menstrual bleeding, pain and other symptoms, may often be able to avoid hysterectomy by undergoing uterine artery embolization, a “valuable alternative,” according to Dutch researchers.

“Every woman should be offered uterine artery embolization as alternative to hysterectomy, based on our scientific data,” senior investigator Dr. Jim A. Reekers told Reuters Health.

Uterine artery embolization is a minimally invasive procedure, requiring an incision of less than one inch in the groin. A small tube, or “catheter,” is inserted and tiny particles are injected to block the arteries that supply blood to the fibroids causing them to shrink.

In the American Journal of Obstetrics and Gynecology, Reekers and colleagues at the Academic Medical Centre, Amsterdam note that previous studies of uterine artery embolization have not included a comparison group of patients undergoing other treatments, such as hysterectomy.

To compare these approaches, the researchers recruited 177 patients with uterine fibroids and heavy menstrual bleeding. The women were randomly assigned to undergo uterine artery embolization or hysterectomy; 81 and 75 women in the two groups, respectively, actually underwent the procedures.

The patients were then followed for 2 years. By that point, 19 of the 81 women who initially underwent uterine artery embolization had had a hysterectomy.

Further analysis showed that 61.7 percent of women in the uterine artery embolization group were symptom free and 27.2 percent reported a great improvement. Only 3.7 percent were unchanged and none were worse.

“After 2 years,” continued Reekers, “hysterectomy can be avoided in more than 80 percent. About 20 percent of the women are, however, not satisfied enough and still want a hysterectomy.”

He pointed out that while the success of hysterectomy is 100 percent, it is major surgery while uterine artery embolization is only minimally invasive.

Reekers added that “about 9 percent of the women who undergo hysterectomy will have a second operation within 2 years for post-operative complications.”

SOURCE: American Journal of Obstetrics and Gynecology, June 2007.