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Alternatives to Hysterectomy for Women with Uterine Fibroids: A Brief Review of the Evidence

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Posted August 23, 2019

Uterine fibroids are an extremely common condition in reproductive-aged women. Women who have lived with fibroids know that they can cause a number of issues, like heavy menstrual bleeding and pelvic pain. Because most cases of fibroids are diagnosed by a surgically-trained gynecologist, women are often offered hysterectomy as a first-line treatment for their fibroids.

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The decision to be hysterectomized is not a trivial one, and less invasive, clinically proven options are available that are just as effective as a hysterectomy. These alternative options include myomectomy and uterine fibroid embolization (UFE), among others. To help enlighten the debate between hysterectomy and alternative fibroid treatment options, we provide a quick overview of how each therapy measures up against hysterectomy, and use evidence from peer-reviewed clinical studies to inform our commentary.

Hysterectomy vs. Alternatives

Hysterectomy

Hysterectomy involves the partial or complete removal of the uterus, removing the fibroids along with it. Hysterectomy is a clinically proven approach to resolve fibroid symptoms, and is the only treatment available that completely ‘cures’ fibroids. But this major surgery is not without its drawbacks. One of the biggest downsides of hysterectomy is that it eliminates the potential for any future pregnancy. This can be especially challenging for women who have several childbearing years left, as they may later regret being hysterectomized. Despite these limitations, hysterectomy is still the most common procedure used to treat uterine fibroids, accounting for 65% of all fibroid interventions. [1]

  • Invasiveness: major surgery, can require a blood transfusion
  • Patient Satisfaction: around 85% of patients are happy with their result
  • Hospital Stay: 1 to 3 days depending on surgical technique
  • Recovery Time: 2 to 6 weeks depending on surgical technique
  • Pregnancy Possible: no
  • Chance of recurrence: none

Myomectomy

Myomectomy is another major surgical procedure that is used to treat fibroids. Unlike hysterectomy, myomectomy removes the fibroids without removing the uterus, so it’s still possible to get pregnant afterwards. [2] There are a number of different myomectomy techniques, including: hysteroscopic, laparoscopic, abdominal, vaginal, and robotic-assisted. In terms of clinical outcomes, myomectomy is equivalent to hysterectomy according to comparative clinical studies. [3]

  • Invasiveness: major surgery, can require a blood transfusion
  • Patient Satisfaction: around 85% of patients are happy with their result
  • Hospital Stay: 1 to 3 days depending on surgical technique
  • Recovery Time: 2 to 6 weeks depending on surgical technique
  • Pregnancy Possible: yes
  • Chance of recurrence: 10% of cases see recurrence at 2 years

Uterine Fibroid Embolization (UFE)

The uterine fibroid embolization (UFE) procedure involves the injection of micro sized beads into the arteries that feed the fibroids. Fibroids rely on blood supply from the uterine arteries to maintain their size and continue to grow, so eliminating this blood supply causes them to ‘starve’ and shrink. [3] While hysterectomy and myomectomy are usually performed by a gynecologist or a general surgeon, fibroid embolization is performed by a vascular specialist, a doctor that is specially trained in navigating the vasculature of the body with minimally invasive techniques. UFE provides fibroid relief that is equivalent to hysterectomy or myomectomy, but with faster recovery time. [3]

  • Invasiveness: minimally invasive procedure, performed through a single puncture in the arm or leg
  • Patient Satisfaction: around 85% of patients are happy with their result
  • Hospital Stay: none
  • Recovery Time: 1 to 2 weeks
  • Pregnancy Possible: yes
  • Chance of recurrence: 10% of cases see recurrence at 2 years

Prescription Medications

Drugs such as progestogens (birth control) or Gn-RH agonists may be prescribed to women with uterine fibroids with the goal of suppressing bleeding symptoms and/or reducing fibroid size. While medical treatment will not eliminate fibroids to the effect of interventional treatments (embolization, myomectomy), they may be used to help manage fibroid symptoms or as a pre-operative treatment to improve intervention outcomes. [4] We encourage our readers to consult with a physician prior to taking any new medications.

Dietary Supplements

Early animal and clinical studies have shown that green tea extract (EGCG) or vitamin D supplements (25-OH-D3) may help to shrink fibroids, [5,6] but these findings have not been substantiated. In general, more evidence is needed to verify the efficacy of supplements, and dietary supplements are not recommended as a substitute for evidence-backed treatments like myomectomy or fibroid embolization.

Summary

Hysterectomy is a tried and true, evidence-backed remedy for uterine fibroids, but it’s not without its downsides – downslides that lead many women to seek alternatives. Myomectomy and uterine fibroid embolization are well-studied alternatives that have demonstrated equivalent outcomes to hysterectomy. Both of these treatments have the added advantage of keeping the uterus intact and healthy, and preserving the possibility of future pregnancy. Uterine fibroid embolization is certainly becoming a more popular choice amongst women, because it requires the least trauma and provides the fastest recovery.

If you’ve been told that you need to have a hysterectomy, we encourage you to continue exploring your treatment options before deciding on what makes the most sense for you. Hysterectomy is final, after all. And if you’re a practicing medical professional, we encourage you to investigate alternatives to hysterectomy if you haven’t already, especially for patients of yours that express concerns about their ability to become pregnant in the future.

Source: Interventional and Vascular Care

References

[1] Bonafede, M. M., Pohlman, S. K., Miller, J. D., Thiel, E., Troeger, K. A., & Miller, C. E. (2018). Women with Newly Diagnosed Uterine Fibroids: Treatment Patterns and Cost Comparison for Select Treatment Options. Population Health Management, 21(S1), S-13-S-20.

[2] Karlsen, K., Hrobjartsson, A., Korsholm, M., Mogensen, O., Humaidan, P., & Ravn, P. (2018). Fertility after uterine artery embolization of fibroids: a systematic review. Archives of Gynecology and Obstetrics, 297(1), 13–25.

[3] Gupta et al. (2014). Uterine artery embolization for symptomatic uterine fibroids ( Review ). Cochrane Library, (5).

[4] Singh, S. S., & Belland, L. (2015). Contemporary management of uterine fibroids: focus on emerging medical treatments. Current Medical Research and Opinion, 31(1), 1–12.

[5] Al-Hendy, A., Roshdy, Rajaratnam, Maitra, Sabry, M., & Ait Allah. (2013). Treatment of symptomatic uterine fibroids with green tea extract: a pilot randomized controlled clinical study. International Journal of Women’s Health, 477.

[6] Baird, D. D., Hill, M. C., Schectman, J. M., & Hollis, B. W. (2013). Vitamin D and the Risk of Uterine Fibroids. Epidemiology, 24(3), 447–453.

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