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Procedure treats fibroid tumors

Catheter used to cut off blood supply to tissue

Debby Rogers sounds a bit like a fired-up evangelist when she talks about one of the better-kept secrets of the gynecologic-health world, a procedure called uterine fibroid embolization.

Instead of invasive surgeries including hysterectomy or myomectomy, an interventional radiologist runs small beads through a catheter into the uterine arteries, cutting off the blood supply to benign tumors called fibroids that in extreme cases like Rogers' can grow to grapefruit size or better.

For eight years, Rogers, a senior producer at KSL TV, battled a condition that included pure misery, uncontrollable bleeding and dangerous anemia. She tried medications, let doctors give her a shot to put her into simulated menopause and contemplated having a hysterectomy before she discovered the procedure, which has been done for almost five years in the Salt Lake Valley, with little fanfare. Even many physicians aren't aware of it, she discovered.

On her journey, one of her physicians discounted it as "experimental" and unproven, though insurance companies cover the cost of the procedure, which has been used for more than a decade in other parts of the country and the world.

Later, she said, one doctor admitted that she just hadn't known enough about it to recommend it.

Uterine fibroids are one of the most common types of benign tumors, their incidence increasing as women age until they reach menopause. It's thought that as many as 80 percent of all women have uterine fibroids, though many of them will never even know it. Most of the time, said Dr. Peter Hathaway of St. Mark's Hospital, an interventional radiologist, the fibroids cause no symptoms and don't need to be treated.

Deseret News graphicDNews graphicUterine fibroid embolizationRequires Adobe Acrobat.

The growths can be inside or outside the uterus but are always connected to the uterus by tissue and blood supply. The type that is just under the uterine lining causes the most bleeding, but is, fortunately, the least common type, said Dr. Michael Webb of McKay-Dee Hospital in Ogden, also an interventional radiologist.

No one knows the exact cause of fibroids, though hormones seem to be involved, he said. African-American women are more likely to have symptomatic fibroids than Caucasian women. Because they are "hormonally sensitive tumors," they "regress in a lot of women after menopause."

Symptomatic fibroids, though, can be miserable, as 5.5 million American women can testify. They can cause excessive bleeding, pelvic pain, bloated abdomen, anemia, leg pain and put pressure on other organs. They're usually diagnosed during pelvic exams or ultrasound exams by a gynecologist.

In cases where excessive bleeding, bloating and other problems occur, if medication doesn't take care of it, the solution has traditionally been either hysterectomy or myomectomy. In the former, the uterus is removed. In the latter, surgeons cut the fibroids out of the uterus. Nearly half the 600,000 hysterectomies performed in the United States each year are for uterine fibroids. Both hysterectomies and myomectomies involve long recovery periods.

UFE (it's also sometimes called UAE for uterine arterial embolization) is based on procedures used to deal with other types of severe pelvic bleeding and trauma.

The patient is generally sedated but not knocked out. The catheter, a slender, hollow tube, is inserted in the artery in the upper leg, much as doctors do for an angiogram. But instead of dye, particulate matter is fed into the uterine arteries. Many doctors use a product called Embospheres, by Biosphere, tiny pieces of medical-grade plastic sponge calibrated to block the blood flow. The uterus still gets blood, but the supply to the fibroids is blocked and they begin to die. The catheter is removed and the patient has to lie still for a few hours with pressure on the artery until the hole seals. In most cases, she stays overnight to receive pain medication to deal with initial cramps, then goes home with oral pain medicines.

The women are generally told to take a week off from work because they'll feel like they have a mild flu. Rogers said she simply felt a "little puny" for a few days.

"Then they're back and feeling great, usually," Hathaway said. Within six months, most women have total relief.

Most of the physicians also order an MRI before the procedure and one about six months after.

Studies of patients five years out show women aren't coming back for repeat treatments because their fibroids aren't recurring. It's believed much of the so-called recurrence of fibroids is actually just tiny fibroids already there that have not grown up. UFE kills the blood supply to those, as well.

The procedure's not for everyone, and those who perform it take a great deal of time explaining options and potential risks and benefits to the patient, said Dr. Colleen Harker of LDS Hospital, who is also an interventional radiologist.

Doctors tend not to recommend it for younger women who might want to have children in the future unless a hysterectomy is her only other option, because the effect on fertility isn't proven, she said. But all of the doctors have had UFE patients who went on to have children. There's zero chance of pregnancy after a hysterectomy.

The embolization can create a bruise at the site where the catheter is inserted in the groin. Though that's usually a "nuisance" complication, Webb said, it can create significant bleeding. Infections can occur. And in rare cases, especially in women approaching menopause age, menopause can begin about the time of the procedure, though it's "not clear if it triggers it," he said. In far fewer than 1 percent of cases, the blood supply to the uterus itself can be compromised, resulting in the need for a hysterectomy.

Besides that, many women experience cramping and pain as the blood supply to the fibroids is cut off. That passes quite soon in most cases, the doctors said.