Uterine artery embolization is as effective as hysterectomy and myomectomy

Uterine artery embolization, a less-invasive treatment for uterine fibroids, is as effective as hysterectomy and myomectomy, according to a study published in the Jan. 25 issue of the New England Journal of Medicine, the Washington Post reports (Washington Post, 1/25).

Uterine artery embolization -- which involves a small abdominal incision and local anesthesia -- has a lower rate of complications and requires less recovery time than hysterectomy and is usually covered by health insurance (Kaiser Daily Women's Health Policy Report, 11/7/06). For the study, Richard Edwards of Gartnavel General Hospital in Glasgow, Scotland, and colleagues randomly assigned 106 women with uterine fibroids to receive uterine artery embolization and 51 to receive surgery -- most of which were hysterectomies while some were myomectomies, a procedure that removes fibroids while leaving the uterus intact. After the procedures, the participants -- admitted in 27 hospitals across the United Kingdom -- rated pain levels, mental health, the recovery process and other factors. The study found that the uterine artery embolization group recovered faster, with a median hospital stay one day, compared with five days for the participants in the surgery group. About 13% of women in the uterine artery embolization group were readmitted to the hospital after one year, including 10% who needed to repeat the procedure or needed a hysterectomy because of recurrent symptoms, the study found (Chang, AP/South Florida Sun-Sentinel, 1/24). One year after the treatment, 93% of the participants who underwent surgery said they would recommend that option, while 88% who received uterine artery embolization said they would recommend the procedure, according to the study (Emery, Reuters, 1/24). According to the Post, surgery cost about $2,500 more than uterine artery embolization (Washington Post, 1/25).

"The results of our study make clear that the choice between surgery and [uterine artery embolization] for symptomatic uterine fibroids involves trade-offs," the researchers wrote, adding that longer follow-up is necessary to asses the need for repeated uterine artery embolization procedures and "to inform future decision making." In a related NEJM editorial, Togas Tulandi of McGill University said that a key factor in choosing uterine artery embolization is whether the woman wants to become pregnant. The effect of the treatment on pregnancy is unclear, so surgery "should be the first line of treatment for women with symptomatic uterine fibroids who wish to conceive," Tulandi writes, adding that for women with diffuse fibroids, uterine artery embolization should be considered (Reuters Health, 1/24).

The study is available online.