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For release Monday, March 27

FERTILITY MAY NOT BE AFFECTED IN YOUNGER WOMEN WHO HAVE FIBROID EMBOLIZATION

SAN DIEGO -- Promising early evidence suggests that fibroid embolization, a minimally invasive alternative to hysterectomy to treat uterine fibroids, may not adversely affect fertility in women younger than 45, according to research being presented here today at the 25th Annual Scientific Meeting of the Society of Cardiovascular & Interventional Radiology (SCVIR).

Research has shown that a small percentage of women age 45 or older, who may be on the verge of menopause, stop menstruating after fibroid embolization; however, early research suggests the ovarian function of younger women does not appear to be affected by the procedure. Several of the more than 20 studies on the procedure being presented at the SCVIR meeting include patients who have become pregnant.

"While our results are preliminary, they suggest that ovarian function is rarely affected in women under age 45," said James B. Spies, M.D., chief of interventional radiology and vice chairman of the department of radiology at Georgetown University Medical Center, Washington, D.C.

From 20 percent to 40 percent of women age 35 and older and as many as 50 percent of African-American women have uterine fibroids of a significant size. A prevalent treatment is hysterectomy, with more than a third of the 600,000 hysterectomies each year performed because of fibroids. Women who wish to maintain their fertility often are steered to myomectomy, the surgical removal of the fibroids. Typically, however, the more fibroids a patient has, the less successful the surgery. Additionally, fibroids grow back several years after the surgery in 10 percent to 30 percent of cases.

Now women who want to preserve their fertility may have another option in fibroid embolization, also known as uterine artery embolization. Fibroid embolization is a non-surgical alternative to myomectomy, in which interventional radiologists cut off blood flow to the fibroid, causing it to shrink.

In the Georgetown University ovarian function study, 4 of 27 women (15 percent) age 45 or older had a change in hormone levels into the peri-menopausal range three months after embolization. In contrast, only 1 patient among 35 patients under age 45 (3 percent) had a significant change in hormone level to near the peri-menopausal range 3 months after embolization, and the level returned to baseline by 6 months after the procedure. None of the patients in this study stopped having menstrual periods, including those with significant hormone level changes.

"In a fibroid embolization study conducted at Northwestern University (Chicago), ovarian failure occurred in 7 of 21 patients (33 percent) who were 45 or older, but in none of the 45 women who were younger than 45," noted Dr. Spies.

In another Georgetown study, results on 169 patients were reported, with 6-month follow- up available on 114 patients. Ninety five of 110 patients (86 percent) with heavy periods reported improvement and 85 of 91 patients (93 percent) with pelvic pressure and pain were improved. Of those patients who failed to respond to embolization, 4 went on to have either hysterectomy or myomectomy. There were no hysterectomies performed for complications of treatment.

Embolization Also Benefits Women With Adenomyosis

Other studies at the meeting indicate that uterine artery embolization may benefit some women with adenomyosis, a benign condition with symptoms similar to fibroids. Adenomyosis is an overgrowth of glands between the muscle fibers of the uterus and it can lead to heavy menstrual bleeding, pain and other debilitating symptoms. The most common treatment used in patients with adenomyosis is hysterectomy.

"It can be difficult to distinguish between fibroids and adenomyomas on an ultrasound examination, whereas magnetic resonance imaging (MRI), typically performed before fibroid embolization procedures, can differentiate between them," said Gary P. Siskin, M.D., assistant professor of radiology at Albany Medical College, Albany, New York. "In our experience, MRI examinations of patients being evaluated for the fibroid embolization procedure have demonstrated adenomyosis with or without fibroids in approximately 10 percent of patients. Although the success of embolization on these patients is mixed, when it's successful, it is dramatically successful."

At Albany Medical College, 14 patients with adenomyosis (9 of whom also had fibroids) were treated with embolization. After 3 months, 12 of 13 patients (92 percent) reported significant improvement in their symptoms, including decreased bleeding, pain and cramping.

In the fibroid embolization technique, an interventional radiologist makes a small nick (less than 1/4 inch) in the skin of the groin, places a catheter in the femoral artery and guides it to the uterus while watching the progress of the procedure via a moving X-ray (fluoroscopy). The interventional radiologist then injects small plastic and/or gelatin sponge particles into the vessels supplying blood to the fibroid to cut off the blood flow, or embolize it. The right and left uterine arteries generally are embolized during the procedure.

Co-authors of the study on ovarian function being presented at the meeting by Dr. Spies are: S.M. Walsh, R.N.; and A.M. Roth, B.S.

Co-authors of the study on the success of fibroid embolization being presented by Dr. Spies are: E.B. Levy, M.D.; J. Gomez-Jorge, M.D.; B.J. Wood; M.D.; A.M. Roth, B.S.; and S.M. Walsh, R.N.

Co-authors of a study on adenomyosis being presented by Dr. Siskin are: M.E. Tublin, M.D.; B.F. Stainken, M.D.; K. Dowling, M.D.; J. Ahn, M.D.; and E.G. Dolen., M.D.

An estimated 5,000 people are attending the Annual Scientific Meeting in San Diego, Calif., of SCVIR, a professional society based in Fairfax, Va., for physicians who specialize in minimally invasive interventional procedures.

An interventional radiologist is a physician who has special training to diagnose and treat illness using miniature tools and imaging guidance. Typically, the interventional radiologist performs procedures through a very small nick in the skin, about the size of a pencil tip. Interventional radiology treatments are generally easier for the patient than surgery because they involve no surgical incisions, less pain and shorter hospital stays.

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Editor's note: Study numbers are current as of March 15, and may change.