New York Times Examines Alternatives To Hysterectomies For Treatment Of Fibroids

In the New York Times' "Personal Health" column on Tuesday, Jane Brody examined treatment options for women with uterine fibroids -- benign tumors of the reproductive tract that can cause prolonged menstrual periods, chronic pelvic pain or pressure, pressure on the bladder, infertility, miscarriage or other pregnancy complications. Brody reports that as many as 300,000 women undergo hysterectomies to remove the fibroids each year at a cost of more than $21 billion. She notes that this figure "does not include the price millions of women pay in diminished quality of life."

Brody continues that there are several treatments for fibroids but that many gynecologists are unfamiliar with the newer options and might not inform patients of possibilities other than hysterectomy. Hysterectomy is a major surgery that requires a two- or three-day hospital stay and a six week follow-up visit, "but is unquestionably effective at curing fibroid-caused symptoms," Brody writes. Hysterectomy usually is recommended for women who have completed childbearing.

One option for women who may wish to become pregnant is a myomectomy, in which the fibroids are removed and the uterus tract is left intact. However, there is a significant likelihood that the fibroids will grow back, according to Brody. Another less invasive option is medication, such as nonsteroidal anti-inflammatory drugs that can be taken on their own or with hormone medicines to reduce bleeding. An intrauterine device containing progesterone is another nonsurgical possibility that can provide temporary relief.

Women who do not wish to become pregnant might opt for embolization, a nonsurgical procedure that involves cutting off the blood supply to the fibroids by inserting tiny particles into the uterine arteries via a catheter. The process causes the fibroids to reduce in size, "though not necessarily disappear," according to Brody. The treatment duration is short, but the "fibroids can regrow or new ones can develop, and in clinical trials one-fifth to one-quarter of patients had to repeat the procedure or have a hysterectomy," Brody writes.

One of the newest treatment options is an MRI-guided ultrasound to "direct high-intensity ultrasound beams to the fibroids, heating them and destroying their outer layers," Brody says. She notes, however, that the procedure is not commonly covered by health insurance and could cost women as much as $10,000 (Brody, New York Times, 10/13).


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