By Alicia Armeli
If you have uterine fibroids and need treatment, you’re not alone. Around three out of four women will have fibroids by age 50 and as many as half will seek treatment for symptoms like heavy periods, pelvic pain and pressure, and incontinence.1,2
Sifting through treatment options, you’ve decided you want a procedure that allows you to keep your uterus. Uterine Fibroid Embolization (UFE) and myomectomy are both effective uterine-sparing options. But before you decide which is right for you, it’s important to understand the benefits and drawbacks of each treatment.
Myomectomy Versus UFE: Understanding the Procedure
Myomectomy is the surgical removal of fibroids and is performed in a hospital under general anesthesia by a gynecologic surgeon. A myomectomy is most commonly done via a large abdominal incision (open myomectomy). It can also be performed through a scope inserted into the vagina (hysteroscopic myomectomy) or through small incisions made in the abdomen (laparoscopic myomectomy). Although myomectomy allows you to retain your uterus, there are still risks involved.
“During a myomectomy, the blood supply to the uterus is left intact, so there’s a significant risk of hemorrhage,” explains Dr. Bruce McLucas, OB-GYN and Founder of Fibroid Treatment Collective in Beverly Hills, Calif. “In fact, the larger the fibroid uterus, the higher that risk is and the higher the risk of conversion from myomectomy to hysterectomy. Requiring a blood transfusion is also an associated risk.”
On the other hand, UFE is a minimally invasive procedure typically performed by an interventional radiologist and is usually completed in less than an hour. Under conscious sedation, UFE begins with a small nick in the wrist or groin area. A slim, flexible tube called a catheter is inserted and guided to the uterine arteries. Tiny embolic particles that resemble grains of sand are then injected, blocking the blood vessels that supply fibroids. Deprived of oxygenated blood, fibroids shrink and die. As this occurs over time, a woman’s symptoms dramatically improve or resolve completely, usually within three months post-UFE.
According to Dr. McLucas, who’s qualified to perform both surgery and UFE, there’s virtually no blood loss associated with embolization and it doesn’t carry the risk of converting to hysterectomy during the procedure. Rare complications include premature menopause among women over age 45 and fibroid expulsion from the uterus, but studies show the rate of major complications after UFE is significantly lower than that related to surgery.3
From Recovery to a Cure: What to Expect After Both Procedures
Just as UFE and myomectomy differ in how they treat fibroids, they also have distinctive recovery periods and clinical outcomes.
Unlike abdominal myomectomy that requires hospitalization and an approximate six- to eight-week recovery period, UFE is an outpatient procedure that sends you home the same day with just a Band-Aid. And although every woman is different, recovery time after UFE generally lasts less than a week. Some patients experience pain and nausea during the first 24 hours, but these symptoms quickly resolve and can be treated with oral medication.
As discussed, UFE and myomectomy treat fibroids differently, which can translate into whether a woman will remain fibroid-free following a procedure or need additional treatments in the future. That being said, myomectomy is a local therapy that typically can’t address all fibroids in one procedure, resulting in many fibroids being left behind after surgery.
Research has shown the rate of fibroid recurrence five years post-myomectomy to be a staggering 62.1%.4 But it’s debatable whether recurring fibroids are actually new or are small fibroids left behind from the initial myomectomy. “When you perform a myomectomy, remaining small fibroids will grow into large fibroids with time,” Dr. McLucas says. “If you’re under 35 years of age, the chance of fibroids recurring increases.” Consequently, these remaining fibroids leave many women symptomatic again within approximately three to five years—often leading to another myomectomy. It’s not uncommon for this process to be repeated until a woman agrees to have a hysterectomy.
In contrast, UFE is a global therapy that treats all fibroids in the uterus, commonly in a single procedure. In the months following UFE, fibroids are seen to shrink by half their size, alleviating both bulk symptoms and heavy bleeding.5 “UFE is 90% effective,” Dr. McLucas clarifies. “That means symptom relief and no fibroid recurrence.”
How Will My Fertility Be Affected?
How each procedure could potentially affect fertility is a concern for many women seeking treatment. Myomectomy is the traditional therapy for women wishing to conceive, even though fertility rates for UFE and myomectomy are similar, holding at 58.1% and 57%, respectively.6
Although some research has shown reproductive outcomes to favor myomectomy within the first two years following treatment, data published earlier this year referred to UFE as a “fertility restoring procedure.”7,8 Researchers noted successful pregnancies post-UFE among women with fibroids who were unable to conceive—including women who had undergone previous myomectomy.8
Even though fertility rates may be comparable, a major difference between UFE and myomectomy is the suggested window of opportunity to become pregnant following each procedure. Gynecologists will often recommend women take advantage of the six-month ‘golden period’ after myomectomy to become pregnant.
“The recommended time to get pregnant is six months after a myomectomy because it takes six months for the uterus to heal after surgery,” Dr. McLucas notes. “But during those six months, fibroids are growing. Scar tissue can also form which can impede pregnancy.” In the case of multiple myomectomies, women are at an even greater risk of developing scar tissue, reducing fertility with each surgery.
This six-month time constraint may not seem so golden for women who need immediate relief from painful fibroid-related symptoms but aren’t yet ready for a baby. “For a woman who’s just starting a career or somebody who doesn’t have a relationship that’s ready for a baby, that six-month period is a panic mark,” Dr. McLucas continues. “This isn’t the case with UFE. Patients can be symptom-free without the need for immediate pregnancy. In my practice, we’ve seen patients who’ve had UFE, waited five years to get pregnant, and have been able to have a baby.”
A fertility concern that has been linked to UFE is the possibility of premature menopause following the procedure. A hormone called anti-Müllerian hormone (AMH), a marker of ovarian reserve, is seen to decrease in some women over 45 following UFE.9 “There’s research that suggests UFE diminishes ovarian reserve and leads to premature menopause,” Dr. McLucas explains. “But this was rare and mostly seen in women over 45 years of age who are closer to menopause. In women younger than 40, before and after UFE there was no change in AMH.”
Many gynecologists will tell patients that if they’re interested in fertility, they can’t undergo UFE, which is false. If you’re suffering with fibroids and are interested in fertility, it’s important to get a second opinion from a doctor who’s experienced in UFE to better understand personal risks associated with each procedure.
Making a Decision
No matter which treatment you choose, the great news is both UFE and myomectomy have been linked to high quality of life scores following each procedure.10 Familiarizing yourself with each treatment option is the first step, followed by a detailed conversation with your doctor.
“So many times a patient comes in and says her gynecologist never informed her of all treatments. That’s a big problem,” Dr. McLucas adds. “I’m often asked by my patients, ‘What would I tell my daughters?’ And without question, what I like about UFE is it’s a lot less risky for a woman. We often tell our patients, ‘Give us a long weekend. We’ll give you back your life.’”
Alicia Armeli is a medical writer, copywriter, and editor who specializes in medical articles based on research. To learn more about Ms. Armeli, please visit http://AliciaArmeli.com.
This article was reviewed for accuracy and approved by John C. Lipman, MD, FSIR.
REFERENCES
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2. Soliman, A. M., Yang, H., Du, E. X., et al. (2015). The direct and indirect costs of uterine fibroid tumors: a systematic review of the literature between 2000 and 2013. Am J of Obstet and Gynecol, 213(2): 141-160.
3. Memtsa, M., & Homer, H. (2012). Complications associated with uterine artery embolization for fibroids. Obstet Gynecol Int. 2012: 290542.
4. Shiota, M., Kotani, Y., Umemoto, M., et al. (2012). Recurrence of uterine myoma after laparoscopic myomectomy: what are the risk factors? Gynecology and Minimally Invasive Therapy, Nov; 1(1): 34-36.
5. McLucas, B., Voorhees, W. D., & Elliott, S. (2016). Fertility after uterine artery embolization: a review. Minim Invasive Ther Allied Technol, 25(1): 1-7.
6. Pisco J. M., Duarte, M., Bilhim, T., et al. (2010). The Outcome of Pregnancy Following Uterine Fibroid Embolization [Abstract 50]. New University of Lisbon, Lisbon, Portugal. SIR Annual Scientific Meeting, March 13, 2010.
7. Mara, M. Maskova, J., Fucikova, Z., et al. (2008). Midterm clinical and first reproductive results of a randomized controlled trial comparing uterine fibroid embolization and myomectomy. Cardiovasc Intervent Radiol, Jan-Feb; 31(1): 73-85.
8. Pisco, J. M., Duarte, M., Bilhim, T., et al. (2017). Spontaneous pregnancy with a live birth after conventional and partial uterine fibroid embolization. Radiology, Jun; 13: 161495.
9. Spies, J. B., Myers, E. R., Worthington-Kirsch, R., et al. (2005). The FIBROID registry: symptom and quality of life status 1 year after therapy. Obstet Gynecol, Dec; 106(6): 1309-1318.
10. Manyonda, I. T., Bratby, M., Horst, J. S., et al. (2011). Uterine artery embolization versus myomectomy: impact on quality of life–results of the FUME (Fibroids of the Uterus: Myomectomy versus Embolization) Trial. Cardiovasc Intervent Radiol, Jun; 35(3): 530-536.
