Thursday, January 25, 2007

Embolization for Fibroids Leads to Faster Recovery

(HealthDay News) -- Women with uterine fibroids who are treated with embolization, a minimally invasive procedure, may get out of bed and back to work faster. But after a year, their quality-of-life scores are about the same as for women who had surgery to treat the non-cancerous growths, a new study found.

In the Jan. 25 issue of the New England Journal of Medicine, Scottish researchers report that hospital stays for embolization average just a day, compared to about five days for surgical treatments.

"The choice is essentially up to the patient. Hysterectomy has a very high success rate, but longer recovery. Embolization has a slightly lower success rate, but faster recover, and you keep your uterus," said the study's lead author, Dr. Jonathan Moss, a consultant interventional radiologist at Gartnavel Hospital in Glasgow.

A fibroid is a non-cancerous growth that develops in the uterus. As many as 20 percent of women of child-bearing age have one or more fibroids, according to the U.S. National Institutes of Health. The incidence of fibroids increases with age. Most fibroids don't require treatment, but some cause excessive bleeding and may cause pain.

When fibroids cause symptoms, treatment options may include hormone therapy, surgery or uterine-artery embolization. Surgical options include hysterectomy, the surgical removal of the entire uterus, or myomectomy, which is the removal of each individual fibroid. Embolization is a minimally invasive procedure that reduces the blood supply to the fibroids, causing them to shrink. For women who may still want to have children, myomectomy is currently the recommended treatment.

Because embolization is a relatively new technique -- it was introduced in 1995 -- the researchers wanted to assess how it compares to surgical options.

For the study, 157 women were randomly assigned to undergo embolization or surgery. One hundred and six women had embolization, 43 had hysterectomies and eight had myomectomies.
The average hospital stay was one day for embolization, compared to five days for surgery. Those who underwent embolization also got back to their daily activities faster than women in the surgical group. Women in the embolization group were able to drive a car after an average of eight days, compared to 34 days for the surgical group.

The embolization group was back at work, on average, 20 days after the procedure, versus 62 days for the surgery group. And women in the embolization group were able to resume sexual activity within an average of 21 days, compared to 53 days for those who had surgery, the researchers said.

The complication rates were similar overall, with 15 percent of those in the embolization group and 20 percent of those in the surgery group reporting serious adverse events.

Yet, after one year, there were no statistically significant differences in quality-of-life scores.
"The biggest problem of surgery, whether myomectomy or hysterectomy, is the time to recover from the operation. This was much faster following embolization," Moss said. "The other problem with hysterectomy is not every woman is happy with that option. The biggest problem with embolization is that it doesn't always work. Ten to 20 percent of patients will ultimately need it repeated or to have a hysterectomy."

Dr. William Romano, an interventional radiologist at William Beaumont Hospital in Royal Oak, Mich., said he would have liked to have seen more women in the myomectomy group, because women today are often choosing between embolization and myomectomy. He said he was surprised by the larger numbers of hysterectomies in this study.

For women who know they don't want to have any more children, Romano said, "Patients should consider embolization as a first-line procedure, because, in many situations, it may be all they need."

For women who still want to have children, embolization is rarely considered because its safety for pregnancy hasn't been well-studied, he said.

"The data doesn't support embolization as a viable primary option for women interested in childbearing," Romano said.

Still, he added, it could be an option for women who are afraid to have surgery or for women with many fibroids, because myomectomy can be a more difficult procedure for multiple fibroids.

More information
To learn more about uterine fibroids and their treatment, visit the U.S. National Library of Medicine.

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