Alternative To Hysterectomies?

Each year hundreds of thousands of women have hysterectomies in the United States to rid themselves of benign fibroid tumors in the uterus.

Now, a new treatment for women is proving to be a safe and effective alternative to major surgery. Dr. Robert Min, an interventional radiologist at Weill Medical College of Cornell University, explained on The Early Show that the new approved procedure, uterine fibroid embolization, delivers tiny particles of plastic into the blood vessels feeding the fibroid, cutting off its blood flow and causing it to shrink.

Dr. Min says although the procedure has been available for some time, it was approved by the FDA specifically for fibroids this year. He says, generally, the patient spends the night in a hospital after the embolization.

Uterine fibroids are benign growths in the uterus. Fibroids can appear on the outer surface of the uterus, within its wall or inside it, or they may be attached by a stem-like structure. Most remain very small, but some may reach 5 to 6 inches in width. As they grow, they can warp or stretch the uterus or completely fill the abdomen. Most are not cancerous -- fewer than half of 1 percent of fibroids become malignant.

Dr. Min says fibroids can cause major problems for women, including heavy or painful menstrual bleeding, bleeding between periods, lower back pain and frequent urination. They can interfere with sexual relations and may cause infertility or miscarriage.

They may result in as many as 50 percent of the hysterectomies performed in the United States each year.

Fibroids can add to discomforts of pregnancy, leading to pain and the sensation of pressure. The growths may increase the risk of miscarriage, pre-term births or breech birth, when the baby is in a position other than head down. Dr. Min also says if the growths are large enough, they may interfere with a woman's chances of conceiving.

The American College of Obstetricians and Gynecologists estimates that the growths may be found in perhaps 1/5 to 1/4 of American women. Other estimate that as many as 80 percent of women may develop them at some time in their lives.

Dr. Min says thousands of women live normal lives never realizing they have them. In many cases, they are very small and do not cause problems. Fibroid problems most often develop when a woman is in her 30's. They become less of a problem after menopause, when the uterus shuts down its natural production of estrogen.

Dr. Min says the cause of fibroids is not fully understood, but growth seems to be linked to the hormones estrogen and progesterone. Changes in hormone levels can increase fibroid growth rate, and they may grow rapidly during pregnancy, when hormone levels are high. Genetics also seems to play a role. Mutations have been identified in two genes that seem to play some sort of role in fibroid development.

Many fibroids cause no symptoms at all, says Dr. Min. If they become a problem, there are several choices of treatments.

Non-steroidal anti-inflammatory drugs like Ibuprofen may be prescribed for abnormal bleeding. Other drugs, including birth control pills, can reduce hormone production and shrink fibroids temporarily.

Dr. Min says for years, the surgery of choice was hysterectomy, the removal of the uterus. If women are near the end of their reproductive years and do not wish any more children, physicians may still recommend this approach.

For younger women who have not yet started a family, surgeons may suggest laparoscopic myomectomy, a minimally-invasive technique that removes only the fibroids leaving the uterus intact. Surgery uses minute incisions and probes, or with a hysteroscope (the same instrument used for hysteroscopy), specially adapted for surgery. Dr. Min says with myomectomy, there is a chance that the fibroids may grow back later.

In some of the studies, women have been able to get pregnant after having the embolization procedure done, but it is no guarantee and more study needs to be done to assess the fertility rate is after the procedure. There are ongoing studies to see what those rates are compared to other treatments.