Hysterectomy is unnecessary and is not the easy option
Our Survey Revealed Too Many Patients Not Informed by Their Gynaecologists about Uterine Artery Embolisation. U.A.E. is a procedure which has a success rate of well over 90% and a much lower complication rate than any form of surgery yet it is self-evident that patients are not being informed adequately about the technique by their Gynaecologist. This means that many patients are suffering complications of hysterectomies and myomectomies unnecessarily.
We carried out a survey of 100 middle aged women who I had previously treated using Fibroid Embolisation. This was a highly selective group of people who had either been referred by Gynaecologists sympathetic to Fibroid Embolisation or had managed to fight their way through the system.
We found that of the patients who had U.A.E. treatment, 23% were not informed by their Gynaecologist about the Fibroid Embolisation technique. Of that 23%, 74% of patients obtained information about Fibroid Embolisation through the internet, 13% from friends, 4% from a Sonographer and the rest from other sources. Obviously this is a highly selective group of patients who managed to obtain U.A.E. From this, it must be self-evident that because this is a favourable group in terms of patients obtaining U.A.E., that in the country as a whole far too many patients, and from discussions with other Radiologists and Gynaecologists, I think this figure is likely to be at least 75%, are not being properly informed by Gynaecologists nor are patients having a consultation with an Interventional Radiologist who carries out the procedure. This is despite the fact that this procedure having been recognised by all Colleges in the United Kingdom and United States has been approved by NICE and given an A Rating on the NHS. Further details can be found on this website.
Fibroids often grow large enough to cause the uterus to press on adjacent structures leading to a number of problems including bloating and severe pain.
The world experience would indicate a very high success rate for fibroid embolisation. The main complication of the procedure is infection leading to hysterectomy. The incidence of this complication is less than 0.5% which is lower than the incidence of ovarian failure occurring following hysterectomy with conservation of the ovaries. A very small number of patients have stopped having periods altogether following the procedure. In our series we have not had a case of infection in our last 1,700 cases. None of the previous 5 cases were emergencies or required ICU admission.
Mortality The mortality from UFE is almost negligible and is certainly less than 1 in 30-40,000 compared to a mortality for hysterectomy for fibroids of 1 in 1,000-1,500. Non fatal complications In the Guildford/London Clinic series of over 2,400 patients, 5 infective complications have occurred leading to hysterectomy. These were all in our first 500 cases, none were emergencies and none required ICU admission. Although the complication rate of fibroid embolisation is very low and significantly less than any surgical procedure, complications can occur - these are:
- Infection leading to hysterectomy: This is very rare in our series there have been none in the last 1,700 patients and only 5 in the whole series of over 2,200 patients. There have been no emergency hysterectomies or intensive care unit admissions.
- Ovarian failure: Under 45 this is rare with an incidence of less than ½%. Ovarian failure leads to a premature menopause and a patient over 45 would normally then take HRT which these days is very effective. It should be remembered that around 2 -3% of women will go into the menopause under 45 normally.
- Vaginal discharge: This is usually transient and self limiting. Around 5-6% of women will have discharge necessitating hysteroscopy to remove the cause. Patients having fibroid embolisation in Guildford or at The London Clinic are part of an ethically approved observational trial. However, NICE has approved fibroid embolisation as an accepted treatment since 2006 and it is no longer necessary for it to be a trial procedure. Overall the complication rate of fibroid embolisation is significantly less than hysterectomy for fibroids which has a serious complication rate of greater than 4%.
Adenomyosis may coexist with fibroids
Adenomyosis which may coexist with fibroids is a condition in which cells from the lining of the womb (which sheds and bleeds during a period) are present on the muscle of the womb. It causes enlargement of the uterus, heavy periods and pain and tends to be progressive. It may affect fertility and it may also coexist with a condition called endometriosis where these womb lining cells are present in the peritoneal cavity. Adenomyosis usually presents over 35 years of age.
Uterine Artery Embolisation for Symptomatic Adenomyosis - Midterm Results - Bratby MJ, Walker WJ - European Journal of Radiology - February 2008.
Midterm Results of UAE for Symptomatic Adenomyosis: Initial Experience - Pelage JP, Jacob D, Fazel A, Namur J, Laurent A, Rymer R, Le Dref O. - Radiology, March 2005; 234(3):948-953. Epub 2005 Jan 28.
Long Term Results of UAE for Symptomatic Adenomyosis - Kim MD, Kim S, Kim NK, Lee MH, Ahn EH, Kim HJ, Cho JH, Cha SH - Am J Roentgeonol 2007;188(1):176-181.
Uterine Artery Embolisation for Symptomatic Adenomyosis with or without Uterine Leiomyomas with the use of Calibrated Transacryl Gelatin Microspheres: Midterm Clinical and MR Imaging Follow-up - Lohle PNM, De Vries J, Klazen CAH, Boekkooi PF, Vervest HAM, Smeets AJ, Lampmann LEH, Kroencke TJ - J Vasc Interv Radiol 2007;18:835-841