Uterine Fibroids and Hysterectomy - Other Procedures

Effect on Fertility. In general, UAE is considered an option only for those who have completed childbearing. Although UAE may protect fertility in many women, the procedure does pose some risk for ovarian failure and infertility. In 2004, the American College of Obstetricians and Gynecologists issued an opinion statement advising women who wish to have children that there were insufficient data regarding pregnancy outcomes for this procedure. A 2005 British study of 671 women who underwent UAE found that the procedure did not interfere with fertility. The study did find a slight increase in caesarean section delivery.

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Complications and Postoperative Effects. Serious complications occur in less than 0.5% of cases, and no deaths have been associated with the procedure.

Pain. Abdominal cramps and pain after the procedure are nearly universal and may be intense. It usually begins soon after the procedure and typically plateaus by six hours. On-demand painkillers may be required. The pain usually improves each day over the next several days, but some patients may experience pain for as long as two weeks after treatment.
Ovarian Failure.
Fibroid Slough. A few patients experience fibroid slough, in which fibroid material becomes trapped in another area (like the cervix) as it is being expelled. This can cause intense labor-like pain and also increase the risk for infection.

Success Rates. Studies on uterine artery embolization are showing high patient satisfaction (over 90%) and low complication rates. In 2003, a study of eight Canadian medical centers reported 83% improvement in heavy bleeding, 77% reduction in menstrual cramps, and 85% improvement in urinary symptoms. Results from the first long-term UAE study, presented at the 2005 annual scientific meeting of the Society of Interventional Radiology, reported that 73% of women experienced symptom relief that lasted for five years. The success rate for UAE was comparable to that of myomectomy. For 20% of women, symptom control failed or fibroids reoccurred. The study suggested that women with large fibroids are not good candidates for UAE. Similarly, a small French study found that 17% of women who undergo UAE experience fibroid reoccurrence within 30 months. Fibroid size and number were the main predictors of reoccurrence.

Endometrial Ablation or Resection

In either endometrial ablation or endometrial resection, the entire lining of the uterus (the endometrium) is removed or destroyed. These procedures are useful for women with severe heavy menstrual bleeding, including some with fibroids. They are generally not useful for large fibroids. Standard resection uses an electrosurgical wire loop to surgically remove the lining. With ablation, uterine tissue is usually vaporized using a thin powerful laser beam or high electric voltage. Newer ablation procedures including balloon ablation (ThermaChoice) and techniques that use electric wands, freezing, hot saline, lasers, microwaves, and radiofrequency.