New options available for women with uterine fibroids

Procedures provide alternatives to invasive surgery

Health & Fitness

November 23, 2003|By Mary Beth Regan | Mary Beth Regan,SPECIAL TO THE SUN

Shenna Ross knows she has a high likelihood of developing uterine fibroids.

Consider her family history.

Ross's grandmother had a hysterectomy at 31 because of uterine fibroids. Her mother had a hysterectomy at 47 for the same reason. Ross, 31, hasn't noticed symptoms yet, but she wants to stay informed in order to avoid having a hysterectomy too.

"I need to keep up on the research," says Ross, who lives in Bowie and recently attended a Johns Hopkins Medicine women's health conference. "I want to know what my options are."

Many women are in Ross's situation. Roughly 40 percent of women 35 or older have uterine fibroids, one of the largest health problems facing American women. The tumors, almost always non-cancerous, range in severity from hardly noticeable to very painful. In some cases, they can cause serious problems, such as infertility.

It used to be that the only treatment for troublesome fibroids was a hysterectomy, the removal of the uterus. But medical advances in recent years have created new options for women, making decisions more complicated and confusing.

"A woman has to listen to all of her options," says Dr. Anthony Scialli, professor of obstetrics and gynecology at Georgetown University Hospital. "Then she needs to make a choice for herself."

For many, that will mean doing nothing. Only between 10 percent and 20 percent of women with fibroids have symptoms severe enough to warrant treatment, according to the Society of Interventional Radiology. The rest are harmless and should be left alone. Or doctors can prescribe oral contraceptives to control bleeding.

Still, some fibroids cause major problems. Sometimes even pea-sized fibroids can cause a woman to bleed continuously for months, leading to anemia. Large fibroids the size of melons can press on internal organs, causing complications. Or the tumors can cause pelvic pain, constipation and urinary problems.

Doctors say they don't know what causes fibroids. But they suspect genetics and hormones.

Women with more estrogen exposure, through early onset of menstruation, late menopause or no pregnancies, are at higher risk for tumors. Fibroids usually shrink after menopause, when estrogen levels naturally decline.

Race plays a factor too. For example, between 50 percent and 80 percent of African-American women have fibroids, studies show.

Choosing surgery

For many, surgery remains the only option. Imogene Butterfield, 58 and a mother of two, decided on a hysterectomy four years ago. She suffered from discomfort and bleeding for years.

"For me, there was no other option," says Butterfield, who lives in Connecticut but was in Maryland recently visiting her daughter. She's hopeful that her daughter, Vernee, 25, already diagnosed with two small, asymptomatic fibroids, will not have to take the same action.

Today U.S. doctors perform 650,000 hysterectomies each year, three times as many as in European countries. Almost 40 percent of those are to treat uterine fibroids, according to the National Center for Health Statistics. Many doctors worry that this number is too high.

Hysterectomies are major surgery, often requiring a four- or five-day hospital stay. Recovery can be up to six weeks.

For younger women, such as Vernee Butterfield, doctors often recommend a myomectomy, a surgical procedure to remove fibroids. This option usually retains the integrity of the uterus, making pregnancy possible.

"For women of childbearing age, the myomectomy is still the preferred route," says Judy Lee, assistant professor of gynecologic services at Johns Hopkins Medical Institutions.

Depending on size and location, doctors can perform myomectomies in three ways: abdominal surgery, laparoscopically, which is through a small incision in the navel, or hysteroscopically, through the cervix.

Some fibroids, such as those growing in the muscular uterine walls, require major surgery and short hospital stays. Unfortunately, fibroids can grow back, so even these procedures are not guaranteed to solve the problem.

Cutting off blood supply

In the last 10 years, however, interventional radiologists have pioneered a technique called Uterine Fibroid Embolization (UFE), or Uterine Artery Embolization (UAE). They say this less-invasive technique is showing promise in younger women too.

A French doctor in the 1990s adapted the technology, used in other surgeries, to treat fibroids.

Radiologists make a small incision in the patient's groin and insert a catheter into the uterine artery. Then, they inject tiny plastic or gelatin sponge particles into vessels leading to fibroids, blocking the blood supply. These particles stay in a woman's body permanently, causing the tumors to shrink and sometimes die. Women are lightly sedated during the procedure and sometimes stay in the hospital overnight.

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