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Surgical Alternative to Hysterectomy for Women with Symptomatic Uterine Fibroids


For the 25 percent of American women who suffer excessive menstrual bleeding and severe abdominal pain because of uterine fibroids, a non-surgical procedure now offered at University of Utah Hospitals & Clinics may be an effective solution to their problem.

This procedure, uterine artery embolization (UAE), was brought to the nations attention last November when U.S. Secretary of State Condoleeza Rice underwent the treatment. Uterine fibroids are benign, common tumors and usually are harmless. But for some women, the tumors cause pain and other symptoms that can necessitate hysterectomy (surgical removal of parts of or the entire uterus). More than 200,000 U.S. women undergo hysterectomies every year because of uterine fibroids.

"Uterine artery embolization is a viable alternative to hysterectomy," said James G. Carlisle, M.D., assistant professor in the University of Utah School of Medicine Department of Radiology, who specializes in UAE. "More and more, its becoming the first-line therapy for many patients."

Carlisle, an interventional radiologist, was recruited by the U last summer because of his expertise in UAE. He was affiliated with Akron General Medical Center and Northeastern Ohio Universities College of Medicine before moving to Utah. In addition to Carlisle, Allene S. Burdette, M.D., an interventional radiologist with the radiology department, also performs the procedure at U Hospital.

Uterine artery embolization, an outpatient procedure that requires only a nick in the skin, involves blocking the arteries that supply blood to the fibroids with injectable plastic particles. Without blood supply, the fibroids shrink.

Patients are given a sedative and a local anesthetic during treatment and pain medication after the procedure. Uterine artery embolization has up to 95 percent success rate in controlling excessive menstrual bleeding and in eliminating abdominal cramping and pain, said Carlisle. UAE has a lower risk of complications and faster recovery than traditional surgery. It is also less expensive.

The procedure originally was used in obstetrics and gynecology to treat postpartum hemorrhage. It was first used as an alternative treatment to myomectomy, or surgical removal of fibroids, in 1995.

There had been concerns in the past about UAEs effectiveness, but last year, the American College of Obstetricians and Gynecologists (ACOG) issued an opinion endorsing use of the procedure among appropriate candidates with symptomatic fibroids. The organization recommended that women considering UAE have "a thorough evaluation with an OB-GYN to help facilitate optimal collaboration with interventional radiologists and ensure that the procedure is appropriate."

There has been some debate about whether the procedure affects fertility. "This is something that needs to be studied, but the experience of women who have had UAE has been favorable, so far," said Carlisle.