Sixteen years ago, Hodges — a yoga instructor who planned to have children soon — chose to treat her fibroids with the least-invasive option at the time, a myomectomy, in which individual fibroids are surgically removed and the uterus sewn back up. In the months leading up to the surgery, injections of Lupron shrank the fibroids and also gave Hodges menopausal symptoms (in her case, hot flashes and a loss of bone density), which persisted long afterward. But her surgeon could not remove all the fibroids — "which infuriated me," she recalls — and scar tissue from the surgery landed her in the hospital a second time with a bowel obstruction, a rare but serious complication.
Ten years after her myomectomy, Hodges was again contending with fibroid symptoms. Her distended abdomen made her look four months pregnant, and a fibroid was pressing on her sciatic nerve, causing shooting pains. This time she opted for a hysterectomy. "I was too old to have kids, and back pain for a yoga instructor is a big problem," Hodges says. "This seemed like the most reasonable and definitive alternative."
Hysterectomy remains the best choice for some women, especially those who have very large fibroids or those who continually have new growths and who don’t plan on having more children. Ten months after her hysterectomy, Hodges has a much smaller abdomen and no pain.
The Fix: Blocking local blood circulation
The Deciding Factor: "I wanted to avoid abdominal surgery."
The Woman: Micaela Englander, 49
Englander, a market researcher, was another veteran of fibroid treatments. She chose to have a myomectomy the first time she was diagnosed. Eighteen years later, after she had had two kids, symptoms returned in the form of urinary frequency and a protruding abdomen.
In her consultations with doctors, Englander kept hearing of a new procedure: uterine artery embolization (UAE), also known as uterine fibroid embolization, which would reduce the size of her fibroids by half. "That sounded good," she says. "Although the procedure was supposed to be somewhat painful, I figured it was nothing compared with abdominal surgery or a C-section, which I’d already had."
The idea behind UAE is to starve the fibroids by blocking their blood supply. With the patient mildly sedated, an interventional radiologist — the only type of physician trained to do this procedure — inserts a catheter into a blood vessel in the groin through a tiny incision. The eventual target is the arteries that supply blood to the uterus. There, tiny particles (usually clear acrylic microspheres or small bits of polyvinyl alcohol foam) are released into the arteries and smaller blood vessels that feed the fibroids. The particles clump together and block the blood flow; eventually, the fibroids shrink.
During and after UAE, some fibroid tissue dies, resulting in pain similar to severe menstrual cramps. It is usually treated with anti-inflammatory medicine and narcotics. Patients generally stay overnight in the hospital. Some women have pain for a week; a few may be uncomfortable longer.
Englander’s pain wasn’t bad. She was back at the gym within five days, no longer bothered by the pressure she had felt in certain positions. A follow-up MRI six months later showed that her largest fibroid had shrunk 50 percent and the size of her uterus had decreased by 75 percent. Her symptoms gradually decreased. "It’s probably not a good procedure for someone who wants a quick fix," she says.
UAE is most often recommended for women who have large fibroids or heavy bleeding and who don’t have the goal of becoming pregnant. Symptoms usually decrease, but the results are not always permanent. One complication is ovarian failure due to lack of blood supply. "That pushes you into menopause," notes James D. Spies, MD, of Georgetown University, in Washington, D.C. The most common aftereffect, occurring in three to seven percent of cases, is the expulsion of fibroids from the uterus. This may involve bleeding or infection, or even require a D&C to completely remove the tissue. UAE is offered at several hundred centers in the United States.