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Alternatives to Surgery for Fibroids: Not Yet Ready for Prime Time?

Some early outcomes favored new procedures, but repeat treatments were sometimes necessary.

Uterine fibroids, which often cause heavy bleeding and pressure symptoms, are a major indication for hysterectomy. In two randomized studies of women with symptomatic fibroids, investigators evaluated therapies that have resulted from recent efforts to develop simpler and safer alternatives to hysterectomy.

In a U.K. study, 157 women underwent either bilateral uterine artery embolization (performed by interventional radiologists) or surgery (hysterectomy or myomectomy by laparotomy). Women undergoing surgery experienced more major adverse events, most of which occurred before discharge. Embolization patients had shorter hospital stays and resumed normal activities sooner. At 1 year, no significant differences in quality of life were found between groups; symptom scores were better in the surgical group. Among embolization patients, about 10% underwent repeat embolization or hysterectomy for inadequate symptom relief during the first year of follow-up, and another 10% required reintervention after the first year.

In a Norwegian study, researchers compared clinical outcomes at 6 months in 28 women who underwent bilateral laparoscopic occlusion of the uterine arteries and 28 who underwent bilateral uterine embolization. The two groups had similar reductions in bleeding; overall, about 90% of the women reported reductions. Embolization patients required more postprocedure pain medication than laparoscopy patients. Additional treatment in the 6 months following initial therapy was necessary in more than 20% of all women.

Comment: Uterine artery embolization and focused ultrasound (which was not studied here) are increasingly popular alternatives to hysterectomy for women with symptomatic fibroids. We know that about 20% require additional therapy in the 1 to 2 years after initial treatment, but additional studies are needed to determine just how successful these treatments are for the long term.

— Robert W. Rebar, MD

Published in Journal Watch General Medicine January 24, 2007

Citation(s):

The REST Investigators. Uterine-artery embolization versus surgery for symptomatic uterine fibroids. N Engl J Med 2007 Jan 25; 356:360-70.

• Medline abstract (Free)

Hald K et al. Laparoscopic occlusion compared with embolization of uterine vessels: A randomized controlled trial. Obstet Gynecol 2007 Jan; 109:20-7.

• Medline abstract (Free)

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