NEJM: Uterine fibroid embolization offers alternative to hysterectomy

Uterine fibroid embolization (UFE) is highlighted as an appropriate treatment for women in a clinical therapeutics article in the Aug. 13 issue of the New England Journal of Medicine.

“UFE, or uterine artery embolization, is a safe, effective and minimally invasive option for women to consider,” said co-author Scott C. Goodwin, MD, an interventional radiologist. “This is especially significant news for the more than 300,000 U.S. women who have hysterectomies performed annually to treat symptomatic uterine fibroids. Many of these women can confidently choose UFE, and this could significantly decrease the hysterectomy rate in the United States.”

Publishing this information…will further prompt physicians to discuss all treatment options for symptomatic uterine fibroids—including UFE," he said. “UFE may be one of those options, and the best way to determine this is for the patient and her gynecologist or primary care provider to consult with an interventional radiologist," added Goodwin, who is professor and chair of radiological sciences at the University of California at Irvine.

Interventional radiologists use MRI to determine if fibroids can be appropriately embolized, detect possible alternate causes for the symptoms, rule out misdiagnosis, identify which treatments are best suited for each patient and avoid ineffective treatments, according to Goodwin and co-author James B. Spies, MD, professor of radiology and chair of the radiology department at Georgetown University Medical Center in Washington, D.C.

"Nonsurgical uterine fibroid embolization is truly a major advance in women's health," noted Society of Interventional Radiology (SIR) President Brian F. Stainken, MD. “Women considering surgical treatment should also get an opinion from a provider knowledgeable about UFE to determine if they are candidates for the interventional radiology treatment," said Stainken, an interventional radiologist who is also president of the Imaging Network of Rhode Island and chair of the diagnostic imaging department at Roger Williams Medical Center in Providence, R.I.

"UFE is widely available, and SIR identifies interventional radiologists with expertise in this area in its online physician directory," Stainken added.

In the article, the authors noted that the American College of Obstetricians and Gynecologists (ACOG) considers UFE a "safe and effective option for appropriately selected women."

ACOG said that women who want to choose UFE "should have a thorough evaluation with an obstetrician-gynecologist to help facilitate optimal collaboration with the interventional radiologist and to ensure the appropriateness of therapy, taking into account the reproductive wishes of the patient."

"Women can and should be confident about uterine fibroid embolization as a treatment option. Interventional radiologists can provide a second opinion and assess whether UFE is a treatment option," said Goodwin

The NEJM article begins with a case vignette that includes treatment recommendations, including a review of treatment benefit, major clinical studies, the clinical use of this treatment and potential adverse effects, and ends with the co-authors' clinical recommendations.

In this case, a gynecologist had recommended a hysterectomy for a African-American 45-year-old woman who had had an abnormally heavy and prolonged menstrual period and severe uterine pain during menstruation over the past 10 years. The patient did not want a hysterectomy and sought alternatives. She was referred to an interventional radiologist who ordered an MRI exam.

Women typically undergo an ultrasound at their gynecologist's office as part of the evaluation process to determine the presence of uterine fibroids. However, an MRI exam offers additional benefits, Goodwin explained.

Uterine fibroids are benign tumors that can cause prolonged, heavy menstrual bleeding that can be severe enough to cause anemia or require transfusion; disabling pelvic pain and pressure; urinary frequency; pain during intercourse; and miscarriage. Twenty to 40 percent of women age 35 and older have uterine fibroids of a significant size; African-American women are at a higher risk for fibroids.

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