Hysterectomy may have been the prevailing standard for treating uterine fibroids in the past, but times have changed. Abundant research on the subject of fibroids has yielded new advances in treatment modalities for the condition, fueled by the widespread demand from fibroid patients for uterine- and fertility-sparing treatment options. Thanks to this research, numerous alternative therapies are now available for women with symptomatic fibroids, and awareness of non- and minimally-invasive fibroid treatment options is growing among both patients and health care providers. As fibroid research continues, we can expect the number and availability of alternative treatments to further expand.
“It is extremely important for women to know the options available to treatment of uterine fibroids,” says Dr. Elizabeth Stewart, M.D., Chair of Reproductive Endocrinology at Mayo Clinic. “Equally important,” she adds, “is the need to continue to study fibroids to assist in developing better treatments.” The Mayo Clinic is endeavoring to do just that, launching a massive research effort to compare existing treatments for uterine fibroids. With funding from the Patient-Centered Outcomes Research Institute (PCORI) and the Agency for Healthcare Research and Quality (AHRQ), researchers from several institutions, including Duke University, University of California - San Francisco, and Mayo Clinic are establishing an observational registry that includes 10,000 women with diagnosed uterine fibroids. The research initiative, called COMPARE-UF, will look at the factors that most heavily influence the treatment choices of its women participants and will evaluating all available treatment options in terms of those priorities. Recognizing the importance of uterine-sparing and fertility-sparing therapies that has been widely expressed by women with fibroids, researchers will look at a variety of hysterectomy alternatives, including minimally invasive procedures like radiofrequency ablation.
Beyond the COMPARE-UF registry, a slew of other studies are focusing on alternatives to hysterectomy in the treatment of fibroids. Researchers at UCSF, Duke University, and Mayo Clinic are currently conducting research to compare two uterine-sparing procedures, uterine artery embolization (UAE) and MR-guided focused ultrasound. Their “FIRSTT” study, funded by the National Institute of Health, is the first in the U.S. to compare UAE and MR-guided focused ultrasound. The researchers will look at the differences between the two treatments in terms of symptom relief, side effects, impact on quality of life, and recurrence/re-intervention.
Another major fibroid treatment study is also underway at UCSF: the ULTRA study is being conducted to help patients and doctors better understand how radiofrequency ablation (Acessa Procedure) changes fibroid symptoms, affects fertility and pregnancy, and impacts the need for additional fibroid treatment in the future. While the procedure has already received FDA clearance and is being performed with increasing frequency, studies of this nature provide the kind of additional data that facilitate acceptance by major health insurers.
The increasing focus by medical researchers on hysterectomy alternatives stands to benefit more than the patients; the medical community and the U.S. healthcare system could see a significant, positive, long-term impact from the shift. According to Dr. Jay Berman of Wayne State University’s School of Medicine, the medical community’s demand for safer, less invasive and less expensive treatment options is growing. He explains, “while hysterectomy will continue to be a option for the appropriate patient, some alternative techniques appear to save the cost of hospitalization, are organ-sparing, have low re-operation rates, and result in high patient satisfaction… It behooves the decision-makers to look at the overall acceptability of less-invasive, outpatient treatments that keep hospital beds for the sickest of our patients and reduce the demand for future healthcare services.”
For patients and physicians alike, the improved understanding of the condition and its treatment that research produces translates to improved quality and availability of treatment options. Having options is essential, because fibroid treatments are not “one-size-fits-all”. While hysterectomy’s consequences and general invasiveness make it an undesirable approach to many women seeking fibroid treatment, hysterectomy is still the most medically appropriate approach in certain cases. Mayo Clinic’s Dr. Stewart believes the decision on how to best treat a woman’s fibroids should be guided by the nature and severity of her symptoms; her age and health history; and the size, number, and location of the fibroids themselves. The key for women with fibroids is awareness of all the available treatment options, and —thanks to continuing research on the subject —those options will continue to improve in the future.
- Rosen, P. “The Endangered Uterus”, More.com Dec 2008/Jan 2009; 117-121, 157-158
- “Exploring Treatment Options for Women with Fibroids.” Medical Xpress. April 23, 2015. Retrieved May 7, 2015. http://medicalxpress.com/news/2015-04-exploring-treatment-options-women-fibroids.html.
- Berman, Jay M. “Alternative Procedures For the Treatment of Symptomatic Fibroids”, Wayne State University School of Medicine