How can my fibroids be treated?

Objectives:

Comparison of medium-term safety and efficacy of hysterectomy and uterine artery embolisation (UAE) for symptomatic uterine fibroids.

Design:

Multicentre retrospective cohort.

Setting:

18 UK NHS hospital trusts. PARTICIPANTS: Four hundred and fifty nine women who had hysterectomy within a national audit during 12 months from October 1994 (VALUE study) (average follow up of 8.6 years) and 649 women receiving UAE from 1996 to 2002 (average follow up of 4.6 years).

Methods:

Clinical data from existing hospital records and patient completed postal questionnaires.

Main Outcome Measures:

Complication rates, side effects of embolisation, satisfaction with treatment, relief from symptoms and requirement for further fibroid treatment.

Results:

Fewer complications were experienced by women receiving UAE (19 versus 26% hysterectomy, P = 0.001), the adjusted odds ratio for UAE versus hysterectomy was 0.48 (95% CI 0.26-0.89). One-third of women undergoing UAE experienced anticipated general side effects associated with the procedure. More women in the hysterectomy cohort reported relief from fibroid symptoms (95 versus 85%, P < 0.0001) and feeling better (96 versus 84%, P < 0.0001), but only 85% would recommend the treatment to a friend compared with 91% in the UAE arm (P = 0.007). There was a 23% (95% CI 19-27%) chance of requiring further treatment for fibroids after UAE. Twenty-seven women who had had UAE reported 37 pregnancies after treatment resulting in 19 live births.

Conclusions:

UAE results in fewer complications than hysterectomy. Side effects after embolisation should be anticipated, and almost one-quarter of women having UAE were likely to require further treatment for fibroid symptoms. Both treatments appear to be safe and effective over the medium term, and the choice of treatment may be a matter of personal preference for each individual woman.

Please click on the required question.

• 1 Pelvic Pain. Is this a common problem?
• 2 What are the common causes of pelvic pain in women?
• 3 What are the more common gynaecological causes of pelvic pain?
• 4 What are the more common non-gynaecological causes of pelvic pain?
• 5 What are primary and secondary dysmenorrhoea - painful periods?
• 6 What is retrograde menstruation?
• 7 How can dysmenorrhoea - painful periods be treated?
• 8 What are ovarian cysts?
• 9 How do ovarian cysts cause pain?
• 10 How are ovarian cysts diagnosed?
• 11 How are ovarian cysts treated?
• 12 I think I may be pregnant and I have some pelvic pain. What should I do?
• 13 What is pelvic inflammatory disease and how can it be treated?
• Mittelschmertz

FIBROIDS

•  What are fibroids?
•  I have fibroids. What difficulties might they cause for me?
•  How are fibroids diagnosed?
•  How could my fibroids be treated?

  ENDOMETRIOSIS

•  What is endometriosis?
•  How prevalent is endometriosis?
•  What causes endometriosis?
•  How can my endometriosis be treated?
•  How can my doctor determine the cause of my pelvic pain?
•  What investigations might be recommended by my gynaecologist to investigate my pelvic pain?
•  What is laparoscopy?
•  What are pelvic adhesions?
•  I have chronic pelvic pain. Could this be related to adhesions?
•  What is uterine retroversion (retroverted uterus)
•   Does a retroverted uterus cause symptoms?
•  How is a retroverted uterus treated?
•  What is pelvic congestion?
•  What causes pain associated with sexual intercourse (dyspareunia)
•  How can painful sexual intercourse (dyspareunia) be treated?
•  What is a pelvic mass?

  IRRITABLE BOWEL SYNDROME - IBS

•  What is irritable bowel syndrome?
•  How can we find out if I have irritable bowel syndrome?
•  Is irritable bowel syndrome (IBS) a common condition?
•  What causes IBS?
•  What is the pain associated with IBS like?
•  Can IBS be mistaken for gynaecological problems?
•  How can my IBS be treated?
•  What other treatments are available for IBS?
•  What can be done to reduce the amount of bowel gas(flatus)
•  What is constipation?
•  What causes constipation?
•   How can constipation be treated?
•  How could we summarise the treatments that are available for my pelvic pain?
•  Where can I obtain more information?
•  Pelvic Pain Support Groups.
•  Endometriosis Support Groups.
•  IBS Support Groups.




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This is the personal website of David A Viniker MD FRCOG, Consultant Obstetrician and Gynaecologist at Whipps Cross University Hospital, London - Specialist Interests - Reproductive Medicine including Infertility, PCOS, PMS, Menopause and HRT.

I do hope that you find the answers to your women's health questions in the patient information and medical advice provided.