Description of Treatment/Procedure

Uterine fibroids, or leiomyomata, are benign tumors in the smooth muscle wall of the uterus. Fibroids are usually accompanied by pelvic pain, low back pain, heavy or prolonged menstrual bleeding, infertility, and pregnancy complications. It is estimated that approximately 20% to 40% of women in their 30s and 40s have fibroids. The goal of uterine artery embolization (UAE) is to eliminate the blood supply to the fibroids which, in turn, leads to their infarction and reduction in size. The procedure is ideally done by an interventional radiologist in collaboration with a women's health care physician. UAE offers the advantages of avoiding surgery, preserving the uterus, and shortening hospitalization and recovery times. However, the fibroids are not removed, there is the potential for malignant cancer (e.g., uterine, endometrial) to develop in the future, and radiation is involved.

Committee Summary

With regard to uterine artery embolization (UAE) for uterine fibroids, the ICSI Technology Assessment Committee finds:

1. UAE is generally safe in appropriately selected patients. Patients must be aware of the potential for premature menopause following UAE. Hysterectomy was performed in 1.6% to 4.5% of patients following UAE (although not always attributable to failure of UAE).
   
2. The goal of UAE is amelioration of symptoms. In case series completed to date, 85% to 96% of UAE patients interviewed reported a reduction in bleeding at up to 12 months following UAE and 61% to 93% have reported a reduction in bulk-related symptoms. (Conclusion Grade III).
   
3. A reduction in fibroid size of 17% to 58% has been reported. Since the fibroids are still present, pain and pressure symptoms may persist.
   
4. Uterine volume decreased by 13% to 52% at up to 1 year following UAE.
   
5. There are limited long-term follow-up data. A patient registry has been established.
   
6. There are insufficient data on the safety of pregnancy following UAE; based on current evidence the procedure should be performed only for women not desiring future pregnancy.