Less-Invasive Fibroid Treatment May Be ‘Under-Used’

A minimally invasive procedure for uterine fibroids may be “under-used” in U.S. hospitals, compared with surgery, a new study suggests.

The study looked at a national sample of hospitals and found that fewer fibroid patients are undergoing hysterectomy — surgical removal of the uterus.

But hysterectomy remains much more common compared with a less-invasive procedure called embolization.

Fibroids are non-cancerous growths in the wall of the uterus that are usually harmless. But when they cause problems — such as persistent pain and heavy menstrual bleeding — treatment may be necessary.

For women with severe symptoms, the go-to has traditionally been hysterectomy, or sometimes surgery to remove the fibroids only.

There are other options, though. One is embolization, which involves injecting tiny particles into the small uterine arteries supplying the fibroids. The particles block the fibroids’ supply of nutrients and cause them to shrink.

Embolization has been a widely accepted treatment for 10 to 15 years, said Dr. Prasoon Mohan, lead researcher on the new study.

Yet, his team found, it still lags far behind hysterectomy. From 2012 through 2013, hysterectomies were performed 65 times more often than embolization at U.S. hospitals.

When embolization was done, it was usually at a large medical center. Few women treated at smaller or rural hospitals had the procedure, the study found.

That points to a discrepancy in women’s access to the treatment, said Mohan, an assistant professor of interventional radiology at the University of Miami.

How often “should” embolization be done? There’s no way to define that, but Mohan said it seems clear that it’s not offered often enough.

“I think it’s definitely under-used, considering it’s minimally invasive, has a shorter hospital stay and is less expensive,” he said.

On average, Mohan’s team found, total hospital charges for embolization were about $21,600, versus $33,100 for hysterectomy.

According to the U.S. National Institutes of Health, up to 80 percent of women develop fibroids — most often in their 40s and early 50s. Usually, fibroids cause no symptoms. But some women develop pelvic or low back pain, heavy menstrual bleeding or frequent urination.

Short of surgery, women can use pain relievers or hormonal drugs to help shrink the fibroids. Another less-extensive procedure is endometrial ablation — where the lining of the uterus is removed.

The best choice for any one woman depends on her personal situation and preferences, Mohan said.

“Every patient should be told about all of her options, so she can make an informed decision,” he suggested.

For the study, Mohan’s team used a national database on U.S. hospital stays. Between 2007 and 2013, the annual number of women undergoing a hysterectomy for fibroids dropped by more than half: from more than 168,000, to just under 78,200.

Still, the surgery remained far more common than embolization. For the years 2012 and 2013, there were fewer than 2,500 embolization procedures for fibroids, the researchers found.

Dr. Anne Hardart is an assistant professor of obstetrics, gynecology and reproductive science at Mount Sinai’s Icahn School of Medicine, in New York City.

Hardart agreed that embolization is an “important minimally invasive option for some women with symptomatic fibroids.”

But not all women are good candidates for embolization, said Hardart, who wasn’t involved in the study.

“The size, number and location of fibroids can all affect how well (embolization) works,” she explained.

Plus, Hardart said, the findings from smaller and rural hospitals highlight another issue. Those centers may simply lack the resources for the procedure.

Overall, Mohan’s team found, only 0.4 percent of all embolization procedures were done at rural hospitals, while 8 percent were performed at “small hospital systems.”

“Embolization requires specialized equipment and interventional radiologists to perform it,” Hardart said. “And most of these specialists are located in more-populated areas where their services can be accessed by a larger number of patients.”

Mohan agreed that embolization is not for everyone. For example, if a woman wants to become pregnant after treatment, surgical removal of the fibroids is a better choice, he noted.

What’s important, Mohan said, is that women know the benefits and risks of all their options.

He added that one longer-term risk from embolization is “ovarian failure” and earlier menopause, because the procedure may also disrupt the ovaries’ blood supply.

Mohan was scheduled to present the findings Monday at the Society of Interventional Radiology’s annual meeting, in Washington, D.C. The data and conclusions should be considered preliminary until published in a peer-reviewed medical journal.

More information

The U.S. Office on Women’s Health has more on uterine fibroids.

Source: HealthDay

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