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Fibroid embolization 'fails' more in young women

August 2, 2012

Last Updated: 2012-07-31 13:30:22 -0400 (Reuters Health)

By Amy Norton

NEW YORK (Reuters Health) - Young women who have a minimally invasive treatment for uterine fibroids are more likely to have a recurrence than older women are, a new study finds.

Fibroids are non-cancerous growths that form from muscle cells and other tissue in the wall of the uterus.

In the new study, Italian researchers looked at long-term results from one fibroid treatment option: uterine artery embolization, in which tiny particles are injected into blood vessels leading to the uterus, cutting off the fibroids' blood supply and shrinking them.

They found that of 176 women treated with embolization, the "clinical failure" rate was 18 percent over seven years.

That meant that the women's symptoms came back after initially getting better -- typically after three years.

And women age 40 or younger accounted for a large share of those recurrences: They were almost six times more likely to see their symptoms come back, versus women who underwent embolization after age 40.

Dr. Giovanna Tropeano and colleagues at Catholic University of the Sacred Heart in Rome report the findings in the journal Obstetrics & Gynecology.

It's not surprising that younger women have more recurrences, according to Dr. James Spies, a professor of radiology at Georgetown University Medical Center in Washington, D.C., who was not involved in the study.

Women who have fibroids treated after age 40 are closer to menopause, when fibroids will usually shrink on their own. But younger women have a longer time period in which a recurrence can happen, Spies explained in an interview.

On top of that, fibroids that arise at a young age are typically more severe.

According to Spies, women who need fibroid treatment should talk with their doctor about all their treatment options. The "right" therapy, he said, will largely depend on where you are in your life.

FIBROID REMOVAL VS. EMBOLIZATION

Uterine fibroids are very common. In the U.S., it's estimated that up to 70 percent of white women and 80 percent of African Americans will develop fibroids at some point by age 50.

Often, the growths cause no problems. But at least one-quarter of women have symptoms like heavy menstrual periods, bleeding between periods, and abdominal or back pain. For some women, fibroids make it hard to get pregnant.

The most common treatment is a hysterectomy, or surgical removal of the uterus.

But women who want to avoid a hysterectomy have other options. Besides embolization, they can have a myomectomy, in which just the uterine fibroids are removed. There's also endometrial ablation, in which the lining of the uterus is removed (which, like hysterectomy, renders you infertile.)

"For women in their 30s who want to become pregnant, myomectomy should be considered first," Spies said.

That's because, at least in the first few years after treatment, women's fertility seems to be better after myomectomy versus embolization.

If a woman is done having children, though, embolization has the advantage of a shorter recovery time, Spies said.

As far as fibroid recurrence, the odds may be similar, or somewhat higher, with myomectomy. Spies pointed to one study of women who were part of a large Washington State HMO: Of 628 women who had a myomectomy, 23 percent needed a repeat procedure -- most often a hysterectomy -- after five years.

The 18 percent recurrence rate in the current study is actually a little lower than what's been seen in others. In his own study of 200 embolization patients, Spies found that 20 percent had a recurrence within five years.

When a woman has a fibroid recurrence, she can get a repeat embolization. "It works as well the second time around," Spies said.

In this study, though, nearly all of the women who had a repeat procedure had a myomectomy or hysterectomy. The authors did not respond to requests for comment.

The costs of the three procedures -- hysterectomy, myomectomy and embolization - vary depending on where you live, but they are fall within a similar range. In the U.S. all three range from between $6,000 and $7,000 at the lower end, to between $12,000 and $15,000.

"It's still the default in this country to offer hysterectomy," Spies said. He suggested that if you want to avoid that, ask your gynecologist about the other options.

SOURCE: http://bit.ly/MQekrg Obstetrics & Gynecology, August 2012.

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