Trade-offs in fibroids treatments

A minimally invasive procedure to cure uterine fibroids was less expensive, but also less effective, than surgery in a new study.

Uterine fibroids are benign tumors that can cause pain and heavy bleeding.

Hysterectomy is the only sure cure for fibroids, but that procedure ends a woman’s reproductive capacity. Alternatively, doctors can surgically remove only the fibroids. In a third, newer approach, called uterine-artery embolization, a doctor shrinks the fibroids by inserting barriers within small arteries that supply the fibroids with blood.

Researchers identified 157 women with fibroids embedded in the uterine wall and randomly assigned 106 to get embolization, 43 to get hysterectomies, and 8 to undergo surgical removal of fibroids.

The patients getting either type of surgery averaged 5 days of hospitalization, whereas embolization patients were in the hospital just a single day. Rates of complication were similar for the procedures.

But 10 of the women getting embolization required a further procedure—either surgery or another embolization—when fibroids recurred during the first year. One surgical patient, who underwent fibroid-only removal, subsequently needed a hysterectomy.

One year after any of the initial procedures, measurements of a woman’s quality-of-life were about the same for the three groups, report Jonathan G. Moss of Gartnavel Hospital in Glasgow, Scotland, and his colleagues in the Jan. 25 New England Journal of Medicine.

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