Is embolisation actually a better treatment for uterine fibroids?

Uterine fibroids are a very common disease amongst women. Approximately 30 % are affected, and symptoms may include heavy menstrual bleeding, bowel obstruction, pain, and pressure on the bladder.

Usually, fibroid removal requires hysterectomy or a myomectomy, (In the UK, it is estimated that gynaecologists perform some 12,000 hysterectomies due to fibroid disease every year), but both are invasive treatments and hysterectomy is clearly not suitable for anyone still planning a family. Uterine Artery Embolisation (UAE) can offer treatment for fibroid disease, but is currently only widely practiced in the USA, UK and France, and many women in Europe still do not have widespread access to this procedure. A quick scan of the web reveals why- there has been little conclusive proof about its effectiveness, notably long term.

However, the results of two randomized studies comparing the results of hysterectomy and embolisation in treating uterine fibroids were presented at the last CIRSE meeting in Rome in September. Both the Dutch EMMY trial and the Scottish REST study were performed independently, and both show a similar quality of life for patients following both the surgical and the embolisation procedures. The EMMY study also showed that this was maintained after a two year follow up period.

This is the first time results indicating the success of UAE have been proved in randomized studies, and there is now scientific proof that embolisation is an effective alternative to hysterectomy. Both studies even went further, revealing that embolisation procedures are almost 40 % cheaper than the surgical option.

These trials represent another siginificant step in cementing interventional radiology treatment as a viable and mainstream alternative in procedures where surgery may not be an option, and can offer a less invasive and even more cost effective alternative.

Uterine fibroids can also be an obstacle to successful conception and child-bearing and, as such, along with endometriosis, are of interest to gynecologists and reproductive endocrinologists, as well as interventional radiologists.

For those women for whom surgery is not an option, a non-invasive alternative is available in the form of injections of a Gn-RH agonist, such as Lupron Depot, which down-regulates production of estrogen and shrinks fibroids. Although effective, critics point out that loss of estrogen produces some undesirable side-effects, such as 'hot flashes', mood swings, and vaginal dryness, but these effects can be successfully managed in many patients by low doses of progesterone.These study results, together with a large body of clinical evidence from the U.S. show that UAE is a viable option for treatment of uterine fibroids in women for whom radical surgery and medications are not options.