Fibroid Recurrence After UFE: Who’s Most At Risk?
By Alicia Armeli

Fibroid-Recurrence

Uterine fibroid embolization (UFE) can provide nonsurgical long-term relief to women with symptomatic fibroids, but up to 18 percent of women who undergo the procedure will eventually experience symptom recurrence, reports a study in Obstetrics & Gynecology.1

Dr. Giovanna Tropeano and a team of researchers at Catholic University of the Sacred Heart in Rome, Italy, investigated the rate of symptom recurrence after UFE among 176 women with the goal of identifying factors that put women at a higher risk.

Results showed that the rate of symptom recurrence climbed from 3 percent at 1 year post-UFE to 7 percent at 3 years; 14 percent at 5 years; and 18 percent at 7 years. These results are lower than earlier studies that reported rates of symptom recurrence of up to 28 percent after 5 years.1

Specific factors were found to increase the risk of symptom recurrence. UFE was less likely to provide long-term relief if blood supply to the fibroids wasn’t blocked completely, if new fibroids grew after the procedure, or if other gynecologic conditions existed simultaneously. The authors also noted that in rare cases, despite a “technically successful procedure,” symptoms still recurred for unknown reasons. The risk of recurrence increased six-fold for women 40 years of age and younger.

“Younger women may be more likely to have blood supply to the fibroids from blood vessels in addition to the uterine arteries. For UFE to be successful at relieving symptoms, it requires that nearly all of the blood flow to the fibroid is stopped,” explained Dr. Meghal Antani, Interventional Radiologist and Medical Director at the Center for Interventional Medicine in Springfield, Va., who was not involved in the study. “Younger women may also have other conditions that cause very similar clinical symptoms of pain and bleeding like endometriosis.”

Uterine fibroids are noncancerous tumors that are most common among women in their 40s and early 50s.2 If younger women suffer from fibroids, these women might be at a higher risk of having a more severe form of the disease and, therefore, a higher risk of recurrence after treatment.1

Fibroid severity was seen to explain why women with a history of prior myomectomy, or surgical removal of fibroids, are almost four times more likely to experience symptom recurrence post UFE. Younger women also have more time until menopause which is when fibroids are seen to naturally shrink on their own, causing the numbers in this age group to be higher.1

Symptom recurrence is a risk, but clinical literature has also shown UFE to have a nearly 90 percent cure rate.3 And for the remaining women, symptom recurrence may happen gradually, which can offer temporary relief while also providing time before resorting to more invasive measures of treatment.

Some women may even be candidates to try embolization again. “If UFE is not successful the first time, then repeating the procedure may be successful if on a follow up MRI, the fibroids are shown to still have blood flow to them,” Dr. Antani told Ask4UFE. “This would suggest that there are other blood vessels supplying blood to the fibroids, such as branches of the ovarian arteries. If these other vessels are blocked again by UFE, then the patient may have greater benefit.”

If symptoms still recur, other options do exist. With any course of action, factors that need to be considered include age—and how close a woman is to the clinical benchmark of menopause— whether she wants to have children, and if she is open to interventions like surgery.

At this time, myomectomy—which has a comparable or even higher rate of recurrence than UFE, is the recommended fibroid treatment for women who want children.

“All of these factors are valid and should be considered. Myomectomy and hysterectomy are still options that a patient can consider if she undergoes UFE and it doesn’t work adequately,” Dr. Antani said. “In other words, undergoing UFE doesn’t always prevent a person from having a hysterectomy or myomectomy later, but those can still be used as back-up plans.”

ABOUT THE AUTHOR Alicia Armeli is a Health Freelance Writer, Registered Dietitian Nutritionist, and Certified Holistic Life Coach. She has master’s degrees in English Education and Nutrition. Through her writing, she empowers readers to live optimally by building awareness surrounding issues that impact health and wellbeing. In addition to writing, she enjoys singing, traveling abroad and volunteering with her local animal shelter.

ABOUT THE DOCTOR Meghal Antani is an interventional radiologist and Medical Director at the Center for Interventional Medicine in Springfield, VA. With 20 years of combined patient care and research, Dr. Antani’s other specialties include, but aren’t limited to, vascular radiology, minimally invasive treatments for women’s health, and interventional pain medicine. Dr. Antani is dedicated to improving the patient experience by working to create a treatment plan that fits each person individually.

REFERENCES

1. Tropeano, G., Di Stasi, C., Amoroso, S., Vizzielli, G., Mascilini, F., & Scambia, G. (2012). Incidence and risk factors for clinical failure of uterine leiomyoma embolization. Obstetrics & Gynecology, 120:269-276. doi: 10.1097/AOG.0b013e31825cb88e
2. Office on Women’s Health, U.S. Department of Health and Human Services. Uterine fibroids fact sheet. Retrieved March 19, 2016, from http://www.womenshealth.gov/publications/our-publications/fact-sheet/uterine-fibroids.html

McLucas, B., Voorhees Iii, W. D., & Elliott, S. (2015). Fertility after uterine artery embolization: a review. Minimally Invasive Therapy & Allied Technologies, 2: 1-7.