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Is uterine artery embolisation better than hysterectomy?

Q: My 44 years old aunt has recently been diagnosed with two intramural uterine fibroids, one being a 16 mm x 15 mm in the anterior wall and the other a 25 mm x 23 mm in the posterior wall. She has heavy menses. Does she require surgery for these fibroids? Is uterine artery embolisation a better alternative than hysterectomy?

A:Fibroids cause bleeding problems only if they are located within or occupying cavity of the uterus. These fibroids are called submucous fibroids.

Intramural fibroids are those, which are within the body of uterus. These fibroids do not cause bleeding problems. The size of fibroids, which your aunt has - is very small. It is very unlikely that these fibroids will cause any symptoms. The bleeding problems which your aunt has, is likely to be because of some other problem e.g. hormonal problems. She certainly does not need hysterectomy or embolisation.

There are a few options for her - either she tries taking oral progestogens (which her gynaecologist can prescribe). She can either take them in a cyclical fashion in which she will get her periods every month or continuously for a period of three months. While she is on it, she should not have any bleeding at all but will get withdrawal bleeding on stopping the pills. After a break of around 5 days, she can recommence the pill again for a further three months. At some point she can stop the pills completely and see if her periods have returned back to her original pattern.

Alternatively, she can try Mirena intrauterine coil - which acts locally on the lining of womb and shrinks it to reduce the amount of bleeding. This is very effective and needs removing after 5 years.

If these conservative measures fail, she can then opt for surgical treatment in which there are a range of options - of which hysterectomy is the last resort. We can discuss them later if the above measures fail.

Fibroid embolisation is relatively new method of treating fibroids. I do not know if there is any centre in India, which does it. In the UK - especially in and around London, it is available in very few specialised centres. It is still not a very popular method of treating fibroids. I do not think that is an option to consider in your aunt's situation.

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