New Procedure Shrinks Uterine Tumors Without Surgery
For Michele Green, the blood loss was intolerable.
The Wantagh, N.Y., woman found that one menstrual cycle seemed to continue into the next, unabated.
She was anemic and grew weak.
How to cope with what certainly could result in a hysterectomy posed a dilemma, because Green, 47, like many women who experience troublesome fibroids, wanted to avoid the surgery and its debilitating aftermath.
“I really thought I was hemorrhaging at that point; it was kind of scary,” Green recalled of the time a year ago when everything about her usually timely cycle seemed to be out of control. “It was like there was no beginning or end to my period. It would be like my period would last for two weeks, then another would start.
“And I knew my mom had an emergency hysterectomy for the same reason. In my case, the time was coming when I had to make a decision, but I wanted to avoid a hysterectomy.”
Green scanned Internet sites in search of something short of surgery, for something that would help her keep her uterus--and stop the bleeding.
“They’re kind of nonchalant about it with women my age,” Green said of some doctors and hysterectomies. “‘You’re not having any more children so why don’t we rip it all out?’ That’s their attitude.”
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Fibroids are benign tumors made of smooth muscle tissue that invade the walls of the uterus. The growths are common in women age 35 to 55 and are a primary cause of excessive uterine bleeding and pain. In addition, fibroids are why an estimated 200,000 hysterectomies are performed in the United States annually, according to the American College of Obstetrics and Gynecology. Women’s health advocates have complained vigorously, saying too many hysterectomies are performed.
A hysterectomy involves surgical removal of the uterus. In some cases, such as cancer, the Fallopian tubes and ovaries are also removed. A premenopausal patient then has instant menopause.
Another operation traditionally performed to relieve fibroids and preserve fertility is called a myomectomy, in which the surgeon meticulously removes individual growths, leaving the uterus intact. The trouble with myomectomies, doctors say, is that fibroids have a tendency to grow back.
What Green found in her Internet searches surprised even her doctors, because the technique she settled on held the promise of eliminating her fibroids with minimal invasiveness and dramatically less recuperation time.
She decided on a procedure called uterine artery embolization--UAE--a technique so new that Green’s gynecologist had not heard of it. But she was determined to find a doctor who knew how to perform it. That search led to the North Shore-Long Island Jewish Health System, where interventional radiologists already were performing the technique.
UAE involves shrinking fibroids by cutting off their blood supply.
A catheter is inserted into the femoral artery via an incision in the thigh. Using imaging technology, doctors are able to view the catheter as they guide it to the arteries that feed the uterus.
Then, tiny plastic or sponge particles are injected into the two uterine arteries, blocking their blood flow. Blood reroutes and can still feed the uterus but saps nourishment from troublesome fibroids, forcing them to shrink.
“Embolization halts heavy bleeding and pain associated with fibroids because the uterine arteries that nourish them are blocked by very small particles delivered through the catheter,” said Dr. David Siegel, chief of vascular interventional radiology at Long Island Jewish Medical Center.
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Siegel said the inert particles remain in the patient for life. Their presence, he added, does not cause an immune reaction that would lead to rejection, and patients can’t feel the particles.
UAE was first performed for fibroids, Siegel said, in 1991 when a French physician adapted the technique to treat the uterine condition. Long before that, however, doctors worldwide performed uterine embolization to halt hemorrhaging that occurred as a result of childbirth.
Dr. Dan Simon, a member of the interventional radiology team at North Shore University Hospital in Manhasset, N.Y., said fibroids do not shrink immediately after their blood supply is cut off. Instead, he said, “this is a gradual process.”
Nevertheless, he underscored that patients notice changes right away. Excessive bleeding stops and menstrual cycles for most women return to normal. For Green, her recovery from the operation took only a couple of days, and by the next month she experienced a normal menstrual period.
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But Dr. Scott Goodwin, chief of interventional radiology at UCLA, and a pioneer in the technique, said uterine embolization is not completely trouble-free.
There is a 2% failure rate, Goodwin said, and some women cannot undergo the procedure because of anatomical problems. He described one such anomaly as having only one uterine artery instead of the usual two. “You really need both to get a good efficacious effect,” he said. He has seen only one such case, however.
Also, Goodwin does not recommend the procedure to women who hope to become pregnant unless they were not ideal candidates for myomectomy. That’s because some doctors have voiced concerns about particle migration. The ovaries are one possible site of such migration, he said.
Still, Goodwin emphasized, “no one has reported significant problems with the procedure.”
