Background

Symptomatic fibroids are a major health concern for women. An estimated 177 000 to 366 000 hysterectomies and approximately 35 000 myomectomies are performed each year in the United States for this problem. In addition, many women receive medical treatment for fibroids and many others suffer symptoms but never undergo treatment. Uterine artery embolization (UAE) offers great promise as a treatment for symptomatic fibroids.

The utility of embolotherapy for fibroid disease was a serendipitous discovery made by the French gynecologist Jacques Ravina and his colleagues at Hopital Lariboisiere in Paris. As such, UAE for fibroids is merely a new indication for a technique that has been used successfully for several decades for the endovascular treatment of female genital tract bleeding of arterial origin. The safety and efficacy of uterine artery embolotherapy for post-surgical and post-partum hemorrhage has been established since the procedure was first reported for these indications in 1979. More recently, the safety and efficacy of uterine embolotherapy has been demonstrated for the treatment of cervical ectopic pregnancy and in the management of some abnormalities of placentation.

The current literature on UAE for fibroids has already demonstrated that it is a safe and effective treatment for fibroid disease, at least in the short to mid term. In the United States and Canada there have been several unsuccessful attempts to conduct randomized prospective studies comparing UAE to either myomectomy or hysterectomy.