Uterine Fibroid Embolization: An Alternative to Hysterectomy

Understanding your options

Before a woman decides to undergo a hysterectomy she should carefully explore all of her options. Many of these conditions can be successfully treated with alternative methods and procedures. Less invasive surgeries, pharmacological treatments, and observation have not only shown great promise, but also carry lower risk, a quicker recovery and are less expensive.

More than 600,000 American women have hysterectomies each year, making it the second most common surgical procedure performed in the United States. A hysterectomy is typically performed as a result of abnormal uterine bleeding and non-cancerous growths of muscle tissue in and around the uterus. It may also be performed if a woman’s uterus falls from its normal position into or outside of the vagina, or as a life-saving operation for women with certain types of cancer or uterine hemorrhage.

Unnecessary hysterectomies are performed regularly in the United States provoking most insurance companies to require a second opinion before giving approval. Research indicates that 90 percent of these surgeries are classified as ‘elective’ surgery or surgery performed by choice and not as a lifesaving procedure.

Non-surgical procedure to remove fibroids

Uterine fibroids, also referred to as leiomyomas, are common non-cancerous growths in the uterus that are often removed through a hysterectomy. Approximately one-third of all hysterectomies performed in the United States each year are due to fibroids.

However, there is now an alternative to hysterectomy that patients with uterine fibroids should consider. Uterine fibroid embolization (UFE) – also called uterine artery embolization (UAE) – is a non-surgical procedure that blocks the arteries that supply blood to the fibroids.

During the UFE procedure, a radiologist threads a catheter from the groin into the uterine artery. The radiologist then injects a dye into the artery and views the flow of blood to the fibroids via moving X-ray images. Tiny particles, called embolic agents, are then injected through the catheter to the uterine artery. This is done to block the blood supply to the fibroids, forming a clot around the embolic agents.

UFE requires a 23-hour hospital stay, while a hysterectomy requires patients to remain hospitalized for four to five days. In addition, hysterectomies typically carry a 25-day recovery period, while most UFE patients recover in only three to five days. A substantial cost difference also exists, with UFE costing less than half as much as a hysterectomy.
For many women, the most important benefit of this procedure is that the uterus remains intact, meaning they may still be able to bear children. However, more research is needed before physicians are positive that women could become pregnant as well as carry a baby to full term.

Like many other procedures, UFE is not without risk. Infection, ovarian failure leading to early menopause, and expulsion of the fibroid from the uterus at a later date, are all possible. Physicians still lack the data on the long-term safety and effectiveness of this procedure, but women should not totally discount it because so many positive aspects do exist.

Hysterectomies are sometimes the only option for patients, as is the case for women who have certain types of cancer. However, studies suggest that the surgery is performed too often in this country. Women who have the option to explore other means of treatment should first become educated on all their choices and then consider a hysterectomy as a last resort.

by Clayton Yamada, MD, interventional radiologist, Scripps Memorial Hospital La Jolla