A multicenter study led by Mayo Clinic researchers shows that women who undergo uterine artery embolization (UAE) for symptomatic uterine fibroids are less likely to need a second procedure compared to women who were treated by magnetic resonance imaging-guided focused ultrasound surgery (MRgFUS). The results are published online in the American Journal of Obstetrics and Gynecology.
While both treatments produced symptomatic improvements that lasted for several years, women who underwent UAE had greater symptom reduction. Additionally, the function of the ovaries as measured directly by antimüllerian hormone (secreted by developing eggs, and a good indicator of ovarian reserve) and indirectly by a woman’s increasing age, appeared to predict which women had the least chance of undergoing a second procedure.
“Our study findings provide important information to the patient and her doctor that will help her decide on the best treatment option for her fibroids,” says the study’s lead author Shannon Laughlin-Tommaso, M.D., a gynecologic surgeon at Mayo Clinic.
Nearly 80 percent of women will develop uterine fibroids in their lifetimes, according to the National Institutes of Health (NIH). Fibroids are common noncancerous growths of the uterus that often appear during childbearing years. They develop in many sizes, and some women may not even know they have them, but other uterine fibroids become large and can cause considerable symptoms such as heavy menstruation and severe abdominal pain.
Both minimally invasive procedures from the study provided significant relief for women with symptoms, making these viable alternatives to a hysterectomy. Uterine ﬁbroids are the leading cause of hysterectomy in the United States, with more than 200,000 hysterectomies performed each year due to uterine fibroid symptoms.
For years, researchers at Mayo Clinic and elsewhere have researched alternative uterine-preserving treatment options for fibroids, but these are often compared with hysterectomy. Head-to-head comparative effectiveness trials of non-hysterectomy options are lacking. This study, called FIRSTT Fibroid Interventions: Reducing Symptoms Today and Tomorrow, is a randomized clinical trial led by researchers from Mayo Clinic and colleagues at Duke University and the University of California, San Francisco, is the first-ever study in the United States which compares MRgFUS to UAE.
“There are many treatment options for fibroids, but many women are not offered alternatives because providers worry about the long-term effects. Studies like this one demonstrate that minimally invasive procedures can have lasting effects with lower risk,” says Dr. Laughlin-Tommaso.
During the study, the participants were randomized to one of two trial arms: UAE or MRgFUS. Women declining randomization were also followed. The researchers compared the outcomes of the two procedures on 83 premenopausal women during a four year period. The study included 43 women who underwent MRgFUS with 27 randomized, while 40 were treated by UAE and 22 randomized. Among the women in the MRgFUS arm of the study, 30 percent underwent a second fibroid procedure compared to 13 percent of the 40 women who were treated with UAE.
After menopause, fibroids naturally shrink and are asymptomatic. Many fibroid treatments aim to reduce symptoms to allow women to transition in menopause. In this study, women who were older or had lower ovarian function/antimüllerian hormone levels before treatment had lower risks of needing a second procedure. These same factors may also help patients and providers make decisions about treatment options.
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