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Uterine Artery Embolization for Fibroids (Myoma)

Friday, April 6th, 2012

I have been asked many times the best approach to the treatment of myoma (the correct term for the common term “fibroid”. There are many approaches, most include surgery, i.e., hysterectomy or myomectomy. Recently, a less invasive management has been offered and should be considered prior to surgery. It is Uterine Artery Embolization.

Uterine Artery Embolization (UAE) as another alternative treatment for fibroids (myoma): This latest less radical approach to reducing myoma (fibroids) was first tried in France and has been available in the United States for over a decade.

The procedure entails inserting a catheter (long hollow tube) in the major arteries of the thigh (femoral artery) and threading the catheter to the area of the fibroids. Using an inert material (polyvinyl alcohol) in the form of beads or particles, this material essentially cuts off the blood supply to the growing myoma (fibroid) resulting in shrinkage of the fibroid. Interventional radiologists have promoted this procedure as opposed to gynecologists who have proceeded with much more caution. The known side-effects have been serious systemic infection, excessive bleeding from the catheter insertion site, chronic pelvic pain after the procedure and, in some patients, early onset of menopause. Uterine artery embolization has been associated with decreased fertility.

In August, 2010, the conclusion of a 5-year outcome study from the embolization versus hysterectomy randomized clinical trial (EMMY) was that UAE is a well-established alternative to hysterectomy about which patients should be counseled.

So, if you are a candidate for myomectomy or hysterectomy because of myoma, perhaps a discussion about UAE would be helpful.

——Yvonne S. Thornton, MD, MPH