JACKSONVILLE, Fla., Dec. 28, 2004 -- Hysterectomy remains the most common treatment for uterine fibroids. However, interventional radiologists at Mayo Clinic in Jacksonville, Fla., say many women with fibroid-related symptoms are candidates for the minimally invasive treatment known as uterine fibroid embolization (UFE).
"Women should be given the option," says Dr. J. Mark McKinney, an interventional radiologist at Mayo Clinic who has been performing UFE since 1999. "The problem is one of communication. Women don't always get the word that this is a therapeutic option for uterine fibroids."
The Society for Interventional Radiology estimates that in 2004, about 200,000 women had a hysterectomy (surgical removal of the uterus) to cure symptoms caused by uterine fibroids. On the other hand, the society estimates only 13,000 to 14,000 women had UFE.
Uterine fibroids are noncancerous growths that develop in the uterine wall. They can be as small as the head of a pin and grow as large as a cantaloupe. Usually, they do not cause problems. However, as women age, they are more likely to experience symptoms, which include pain, bladder pressure, heavy or prolonged menstrual periods and unusual monthly bleeding. An estimated 20 to 40 percent of women over age 35 have fibroids large enough to cause symptoms.
Nine years ago, Darlene Melton had a surgical procedure called myomectomy to remove uterine fibroids. When bothersome symptoms returned, she thought she would need a hysterectomy. Mayo Clinic gynecologist Dr. Paul Pettit referred her to Interventional Radiology. She was elated when McKinney told her she had an alternative.
"I felt there was no need to lose my female organs if it wasn't a life-threatening situation," Melton says. "I can't describe how much better I feel to have found out about this procedure and not to have had a hysterectomy."
"A uterine-sparing procedure is a very personal decision for many women," McKinney says. "UFE and myomectomy are uterine-sparing procedures. One advantage of UFE is it can treat every fibroid, whereas myomectomy can only treat the largest ones or the ones doctors can see during the procedure." Another advantage: UFE has a higher success rate in relieving symptoms than myomectomy. About 85 percent of women experience marked improvement in symptoms following UFE. "I talk about the benefits of each procedure with my patients, even hysterectomy," McKinney says. "I try to have an honest discussion about the various options, and ultimately, the choice of procedure is their decision."
One issue McKinney discusses is future fertility. Myomectomy preserves a woman's fertility; UFE may not. "There are reports in the literature of women who have become pregnant after UFE," McKinney says. "And there are some articles that state that UFE poses an increased risk of pre-term labor and Cesarean sections for those women. But other women have successfully gotten pregnant, carried to term and delivered. We just don't know yet. So I tell women if they plan on future pregnancies, they should consider an alternative."
To undergo UFE, a woman is sedated before doctors make a small incision in the groin above the femoral artery. They insert a catheter into the artery and guide it to one of the uterine arteries. Then they inject tiny plastic spheres, about the size of sand grains, through the catheter and into the artery. The particles lodge in the tiny arteries branching off from the uterine artery, which supplies blood to the fibroids. Doctors then inject the spheres into the opposite uterine artery. The spheres cut off the blood supply, and the fibroids begin to shrink.
Patients stay overnight at St. Luke's Hospital and are given pain and anti-inflammatory medications for discomfort and cramping. These side effects subside in a few days. The physician's office follows up with the patient over the phone once she goes home, and return visits are scheduled in two to four weeks and again at six months.
Women considering uterine fibroid embolization must first be evaluated by a gynecologist to make sure their symptoms are not caused by anything more serious than fibroids. Interested patients may call (904) 296-3867.
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Mayo Clinic is a multispecialty medical clinic in Jacksonville, Fla. The staff includes 320 physicians working in more than 40 specialties to provide diagnosis, treatment and surgery. Patients who need hospitalization are admitted to nearby St. Luke's Hospital, a 289-bed Mayo facility. Mayo Clinics also are located in Rochester, Minn., and Scottsdale, Ariz. Visit http://www.mayoclinic.org/news for all the news from Mayo Clinic.
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