Long-Term Data Support Uterine Fibroid Embolization

Uterine fibroids are one of the most common medical problems women ages 35-50 encounter. These benign tumors can cause prolonged, heavy menstrual bleeding that can lead to anemia and transfusions, pelvic pain and pressure, urinary frequency, pain during intercourse, and an abnormally large uterus resembling pregnancy. Twenty to 40 percent of American women 35 and older, and nearly 50 percent of African-American women, have uterine fibroids of a significant size. In the past, these have been frequently treated with hysterectomy, or surgical removal of the uterus. Less invasive, non-surgical procedures such as uterine fibroid embolization (UFE) have become increasingly popular, but many physicians were concerned that long term success data was not available. Now, data presented at the 30th Annual Scientific Meeting of the Society of Interventional Radiology (4/05) showed that UFE had a 73 percent success rate at five years. To put this into perspective, these results are comparable to the success rate for myomectomy, a procedure in which the fibroids are surgically removed, but the uterus itself is left intact. UFE is less invasive than myomectomy and women recover from it more quickly.

UFE is a minimally invasive interventional radiology treatment that blocks the blood supply to the fibroid tumors, causing them to shrink and die, alleviating symptoms.  Because it is minimally invasive, has a much quicker recover time than surgery, and preserves the uterus, this newer treatment has become increasing popular among women.  Uterine fibroids currently account for approximately 200,000 hysterectomies in the United States annually.  The good news is that most women with symptomatic fibroids are candidates for UFE.  

James B. Spies, M.D., professor of interventional radiology at Georgetown University Medical Center and the study's principal investigator explains that "with any of the uterine-sparing treatments, growth of new fibroids is possible." In this study, 182 of 200 patients completed five-year follow-up with data available for analysis, and 18 were lost to follow-up.  Outcomes were assessed by a questionnaire and patient symptom status, interval interventions, and menstrual cycle regularity.  Treatment failure was defined as hysterectomy, myomectomy (surgical removal of the fibroids) or repeated embolization or failure of symptom control for two follow-up intervals. Using this measure, 20 percent of patients had either failed or recurred with new fibroids at 5 years after treatment. Among this group, there were 25 hysterectomies (4 were non-fibroid related), 6 myomectomies and 3 repeated embolizations.  Seventy-three percent of patients had continued symptom control at the 5-year follow-up interval.

Currently, an estimated 13,000-14,000 UFE procedures are performed annually in the U.S.  During uterine fibroid embolization, the interventional radiologist makes a tiny nick in the skin and inserts a catheter into the femoral artery in the groin. Using real-time imaging, the physician guides the catheter through the artery and then releases tiny particles, the size of grains of sand, into the uterine arteries that supply blood to the fibroid tumor. This blocks the blood flow to the fibroid tumor, causing it to shrink and die, and symptoms to subside.  The embolic particles are approved by the FDA with a specific indication to treat uterine fibroid tumors. UFE usually requires a hospital stay of one night. Many women resume light activities in a few days and the majority of women are able to return to normal activities within seven to 10 days.

Created: 4/6/2005  -  Donnica Moore, M.D.