Fibroid Embolization Less Effective In Women Under 40

    Fibroid Removal or Embolization: Which Is The Best Choice For You?

    Fibroids often don’t cause problems. But many women with fibroids often have more problematic symptoms, such as heavy menstrual periods, bleeding between periods, abdominal or back pain, and abnormally large fibroid growth that can interfere with other organs, such as increased bladder/bowel pressure. For some women, fibroids make it hard to get pregnant.

    The most common treatment is a hysterectomy, or surgical removal of the uterus. But women who want to avoid a hysterectomy have other options. Besides embolization, they can have a myomectomy, where only the uterine fibroids are removed. There’s also endometrial ablation, in which the lining of the uterus is removed (which, like a hysterectomy, causes infertility).

    “For women in their 30s who want to become pregnant, myomectomy should be considered first,” Spies said.

    That’s because, at least in the first few years after treatment, women’s fertility seems to be better after myomectomy versus embolization. However, if a woman is done having children, though, embolization has the advantage of a shorter recovery time, Spies said.

    As far as fibroid recurrence, the odds may be similar, or somewhat higher, with myomectomy. Spies pointed to one study of women who were part of a large Washington State HMO: Of 628 women who had a myomectomy, 23 percent needed a repeat procedure — most often a hysterectomy — after five years.

    The 18 percent recurrence rate in the current study is actually a little lower than what’s been seen in others. In his own study of 200 embolization patients, Spies found that 20 percent had a recurrence within five years.

    When a woman has a fibroid recurrence, she can get a repeat embolization. Spies pointed out that the procedure works as well the second time around.

    “It’s still the default in this country to offer hysterectomy,” Spies said. He suggested that if you want to avoid that, ask your gynecologist about the other options.

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