March 1, 2011 -- Women who sought treatment to relieve the pain, heavy bleeding, or other symptoms caused by uterine fibroids report a better quality of life after their procedure, a new study shows.
But several years after recovering from one of three different interventions -- an abdominal hysterectomy, uterine artery embolization (UAE), or an MRI-guided focused ultrasound procedure, patients who had a hysterectomy said that, looking back, they might put off having that procedure almost two months longer than women who had the less invasive treatments.
That ranking, something doctors call a waiting trade-off, is a way to measure how long someone might opt to continue to live with their symptoms, rather than go through a procedure involving some discomfort, risk, and healing.
“Basically, we asked patients that knowing what they now know about the treatment that they had, how long would they put off having it?” says study researcher Fiona M. Fennessy, MD, MPH, a radiologist at Brigham and Women’s Hospital in Boston.
The 62 women in the study who had abdominal hysterectomies, in which the uterus is removed through an incision on the stomach, said they put off having that procedure an average of 21 weeks.
The 74 women who'd had a UAE, in which a catheter is threaded through the arteries to the fibroid and particles are injected that starve the fibroid of blood, said they’d put off having that procedure for about 14 weeks.
The 61 women who had an MRI-guided focused ultrasound procedure, in which a patient lies on an MRI table while ultrasound waves are used to pinpoint and destroy the fibroids, said they’d also wait an average of about 14 weeks.
The study will be published in the May issue of the journal Radiology.
“I think the study’s good because in some ways it quantifies for us kind of the risk-benefit analysis that patients do when we present them all the options for their fibroids,” says Catherine A. Sewell, MD, MPH, an assistant professor of gynecology and obstetrics and director of the Johns Hopkins Fibroid Center, in Baltimore.
“The results are pretty clear that people prefer to do the least invasive thing possible to get the biggest benefit,” says Sewell, who was not involved in the study. “And for most people, unless they’re really having a lot of trouble with their fibroids or have dealt with them for a long time, for most people, hysterectomy will be their last choice.”
Dealing With Fibroids
Fibroids are benign masses that grow in and around the uterus.
Most of the time, they are very small and cause no symptoms.
But in some cases they can be large, sometimes weighing several pounds each, and they may cause problems with heavy and prolonged bleeding, pain, difficulty urinating, and abdominal bloating or fullness.
Studies estimate that as many as seven in 10 women will have fibroids at some point in her life.
“Fibroids are very, very, very common,” says Lisa Jane Jacobsen, MD, an obstetrician and gynecologist at Tufts Medical Center in Boston. “Most of them are asymptomatic and don’t really cause any issue.”
Jacobsen says women typically seek treatment when fibroids cause irregular bleeding or heavy bleeding, or when the uterus has gotten so big from the fibroids that pelvic discomfort has become an issue. Fibroids can also cause infertility.
Only about one in three women, however, will need treatment.
Choosing a Treatment
Often, the kind of treatment a person is eligible for will depend on her age, the size and number of her fibroids, and whether or not she still wants to have children.
For example, Sewell tells WebMD that UAE isn’t usually a good idea for people who have fibroids that are growing on stalks into the cavity of the uterus, “where a baby would be,” she says.
Also, if a scan shows that the fibroids don’t have a good blood supply, then UAE may not be effective.
When it comes to MR-guided focused ultrasound, which was approved by the FDA in 2004, “They’re still establishing who’s a good candidate for that procedure,” Sewell says. “But if someone has lots of fibroids in disparate locations, that may not be the best treatment option because they may need multiple treatments, or if someone has had prior abdominal surgery and there's a lot of scarring, the energy might focus on the scar tissue instead of the fibroid.”
One weakness of the study, which is acknowledged by the authors, is that it only focused on abdominal hysterectomies, which involve an incision on the stomach to remove the uterus.
“They are comparing the most invasive surgical option with minimally or noninvasive interventional radiology options,” Sewell says. “So they’re comparing a big incision with no incision.”
But there are also less invasive ways to remove their uterus, either laparoscopically or vaginally, which may be more acceptable to patients.
Fibroids can also sometimes be treated medically, with birth control pills, for example.
“Birth control pills sometimes help people,” Jacobsen says, “but often not. Medical therapies aren’t the best, but they’re fairly low cost, and they may be useful if someone is trying to avoid a bigger procedure.”