Alternative to hysterectomy for women with painful uterine fibroids

Women with painful uterine fibroids may not know there is an alternative to hysterectomy, says a University of Toronto researcher.

The University of Toronto’s teaching hospitals are all equipped to perform uterine fibroid embolization (UFE), but many women suffering from benign fibroids aren’t aware that there’s a procedure that can spare their uterus, says Gaylene Pron, professor of public health sciences and author of two 2003 studies evaluating the success of the procedure.

“It’s an option that should at least be mentioned and discussed,” says Pron. “One of the barriers is just plain information. Women are just not getting the information.”

Between 20 and 50 per cent of women between ages 35 and 50 develop uterine fibroids. They can cause pain, heavy bleeding and painful intercourse. In the past, women often had hysterectomies to cope with the problems.

UFE is a relatively new and minimally invasive procedure that preserves the uterus. It works by essentially choking off the blood supply to the fibroid. Once the blood supply is blocked, the fibroids shrink and can be expelled from the body. The laparoscopic procedure requires a shorter recovery period than a hysterectomy, an average of two weeks compared with four to six weeks. There is also a low rate of complications associated with UFE.

Pron says UFE results in gradual fibroid reduction, with an average 40 per cent reduction over three months. After a year, a woman has probably reached the maximum level of reduction.

“It should be part of the discussion if surgery is being discussed,” says Pron. “It’s a safer and effective treatment option.”

Part of the problem, says Pron, is that UFE is performed by interventional radiologists, not the gynecologists who usually see women first, so “that slows the diffusion.”

Another stumbling block is the lack of funding for research to document the long-term success of UFE.

“We’re trying to do a five-year follow-up of our study of 550 women, but we have no funding,” says Pron. “With eight hospitals and three universities, this was the only multi-centre study in Canada. We’re absolutely desperate.”

Pron also hopes to have the opportunity to research the effect UFE has on fertility. Many of the younger women don’t want hysterectomies, because they still hope to have children. They would be able to make better decisions if they knew the risks and rewards associated with alternatives, says Pron.

“In the past, women were faced with a terrible choice,” says Pron. “A hysterectomy fixes the immediate problem, but it comes with a lot of other issues, such as the immediate onset of menopause. It’s not a win-win situation.”

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