Studies Question Fibroid Treatment

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Studies Question Fibroid Treatment

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By LAURAN NEERGAARD, AP Medical Writer

An increasingly popular treatment promises to rid women of painful, bleeding

uterine fibroids without standard surgery's risks. But new research has some

doctors questioning how long the treatment helps ‹ and if it's too risky for

women who hope to become pregnant.

Part of the problem is that this new " uterine artery embolization " has never

been fully studied to see how it compares with uterine-sparing surgical

removal of fibroids.

But the controversy highlights a bigger issue: " We really don't know very

much at all about how to manage fibroids, " says Dr. Evan Myers of Duke

University ‹ even though the uterine growths plague more than a million

women a year and are the leading cause of hysterectomies.

Nearly 40 percent of women in their 30s and 40s develop fibroids,

non-cancerous growths of muscle fibers inside the uterus. No one knows what

causes fibroids, and tiny ones usually cause no symptoms. But they can grow

to cantaloupe size, causing severe pain, heavy bleeding and infertility or

pregnancy complications.

More than 150,000 hysterectomies ‹ surgical uterus removal ‹ each year are

due to fibroids.

For women who still want children, options are limited. Drugs shrink

fibroids only temporarily. About 35,000 women a year undergo myomectomy,

where surgeons remove fibroids while leaving the uterus intact. But it's

painful, fibroids sometimes grow back, and women who later become pregnant

usually require Caesarean deliveries.

Uterine artery embolization, or UAE, is a far less invasive alternative.

Doctors squirt tiny plastic pellets into certain uterine arteries, cutting

off the blood supply feeding the fibroids. Over the next three months to a

year, the fibroids shrink.

About 85 percent of patients get relief, fueling UAE's growing popularity.

Some 30,000 embolizations have been performed since UAE was first tried in

1995, says Myers, who calls it a promising procedure.

But studies published this month in Obstetrics & Gynecology raise questions

about how long that relief lasts ‹ and stress that contrary to public

perception, UAE isn't risk-free:

_The University of California, Los Angeles, tracked 59 UAE patients and

another 38 who had a myomectomy. Three years later, 29 percent of the UAE

patients needed further fibroid treatment; only 3 percent of myomectomy

patients did.

_Infection, bleeding and blood-vessel clots are considered serious but rare

risks of UAE ‹ at least two deaths have been reported since 1995 ‹ although

no one knows how often complications occur. So town University

Hospital tracked 400 embolization patients treated there since 1997, and

concluded the overall risk of side effects was a low 5 percent.

Most were minor ‹ but five patients required days of hospitalization for

infection, bleeding or clots. One needed a hysterectomy four months after

her UAE, for heavy bleeding when her body expelled a shrunken fibroid.

_Researchers at Jefferson University analyzed the 50 published cases

of pregnancy after UAE and concluded those women had higher risks of

miscarriage, post-delivery hemorrhage, premature birth, breech babies and

Caesarean sections than do healthy women. Other researchers say infertility

also may be a risk if UAE accidentally blocks blood flow to the ovaries.

They're small studies, all with flaws. For example, UCLA's myomectomy

retreatment rate was lower than other hospitals'. And women with fibroids

already have a higher risk of pregnancy complications ‹ yet no one has

compared whether myomectomy or UAE offers them a better outcome, says

town's Dr. Spies, a leading UAE provider who is pushing for

federally funded research to answer such crucial questions.

In fact, there have never been good studies of just which fibroids are best

treated by UAE, myomectomy or hysterectomy. Part of the reason is a turf

battle: UAE is performed by interventional radiologists, while gynecology

specialists do the uterine surgeries.

Doctors may soon get some better information: A registry at Duke, funded by

the Society for Interventional Radiology, is tracking how almost 3,000 UAE

patients fare.

Meanwhile, any of the options is reasonable for a woman no longer

considering pregnancy, but know that retreatment rates for both UAE and

myomectomy remain in question, Myers says.

If women want to become pregnant, they " really need to know they're taking a

chance " with UAE, he adds. town's Spies recommends myomectomy in

particular for anyone wanting a baby within two years, because UAE shrinks

fibroids so slowly.

And " do a little digging " before picking a doctor, adds Pearson of

the National Women's Health Network, which urges better fibroid research.

" No matter how fabulous things were at town, a woman can't assume her

results will be the same " if her doctor hasn't performed many UAEs.