Harvard Women's Health Watch

Fibroid embolization and surgery have similar five-year outcomes

Every year in the United States, hundreds of thousands of women are treated for fibroids — noncancerous growths that form in the uterus. Fibroids can cause pelvic pain, lower abdominal pressure, and heavy menstrual bleeding. Fibroids usually shrink after menopause, and before menopause, symptoms can sometimes be managed with medications. For women with severe bleeding who can't or don't want to "wait it out," the usual approach has been surgery — myomectomy (which removes only the fibroids) or hysterectomy, which removes the uterus (and ends childbearing).

Since 1995, an alternative treatment has been available for women wanting to avoid surgery — uterine artery embolization (UAE), a minimally invasive procedure that shrinks fibroids by cutting off their blood supply. Short-term studies (one to two years) have shown that UAE and surgery produce similar improvement in symptoms and quality of life. Now, a controlled study has found that the same is true even after five years, although women receiving UAE are more likely to require further treatment. Results were published online in BJOG: An International Journal of Obstetrics and Gynaecology (April 12, 2011).

The study. Investigators with the Randomised Study of Embolisation and Surgical Treatment for Uterine Fibroids (REST) compared five-year outcomes in 157 women with fibroids who were assigned to receive either UAE (106 women) or surgery (43 women had hysterectomies and eight women had myomectomies). At one year, both groups had reported improvements in quality of life and comparably high levels of satisfaction with the treatment. On average, women receiving UAE spent less time in the hospital and returned to work earlier. But 10 women who received UAE and only one who received surgery had to be treated again within the first year to address persistent symptoms.

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