Fibroid Embolization Less Effective In Women Under 40

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Young women who have a minimally invasive treatment for uterine fibroids called embolization are more likely to have a recurrence than older women are, according to a new study report in Reuters Health.

Fibroids are very common, non-cancerous growths that form from muscle cells and other tissue in the wall of the uterus. It’s estimated that up to 80 percent of Black women will develop fibroids at some point by age 50.

In the new study, Italian researchers looked at long-term results from uterine artery embolization, in which tiny particles are injected into blood vessels leading to the uterus, cutting off the fibroids’ blood supply and shrinking them. Researchers found that out of 176 women treated with embolization, the “clinical failure” rate was 18 percent over seven years.

In other words, the fibroids grew back – typically after three years.

Women age 40 or younger were almost six times more likely to see their symptoms come back, versus women who underwent embolization after age 40.

Dr. Giovanna Tropeano and colleagues at Catholic University of the Sacred Heart in Rome report the findings in the journal Obstetrics & Gynecology.

It’s not surprising that younger women have more recurrences, according to Dr. James Spies, a professor of radiology at Georgetown University Medical Center in Washington, D.C., who was not involved in the study.

Women who have fibroids treated after age 40 are closer to menopause, when fibroids will usually shrink on their own. But younger women have a longer time period in which a recurrence can happen, Spies explained in an interview. On top of that, fibroids that arise at a young age and/or in Black women are typically more severe.

According to Spies, women who need fibroid treatment should talk with their doctor about all their treatment options. The “right” therapy, he said, will largely depend on where you are in your life.

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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