Drugs, ultrasound may be new alternatives to hysterectomy.(Gynecology)

TORONTO -- Treating uterine fibroids may eventually be as simple as prescribing a pill, or zapping the benign growths with high-intensity focused ultrasound--two of several promising nonsurgical alternatives to the roughly 300,000 fibroid-related hysterectomies performed annually in the United States.

"[Hysterectomy] is the gold standard in fibroid treatment.... The problem is that it's a big operation, and the patient loses her uterus. For some women, that just is not an acceptable solution," said Dr. R. Torrance Andrews in an interview after his presentation at the annual meeting of the Society of Interventional Radiology.

Uterine fibroids, or leiomyomas, may cause infertility or premature delivery and in rare cases may become malignant. They affect about 30% of reproductiveage women, most commonly between the ages of 35 and 45 years, and particularly African American women, whose incidence rate is up to nine times higher than that of white women.

Dr. Andrews, chief of vascular and interventional radiology at the University of Washington Medical Center, Seattle, discussed mainstream fibroid treatments like hysterectomy, laparoscopic myomectomy, and uterine fibroid embolization (UFE), as well as emerging therapies like high-intensity focused ultrasound (HIFU), asoprisnil, and other methods.

In terms of recommending one treatment over the other, Dr. Andrews was frank: "I think it's a big mistake for interventional radiologists to tell patients authoritatively that they should have an embolization, instead of [a surgical] treatment.

"Similarly, unless a gynecologist is really well versed in embolization and patients selection, they should not tell patients that they are not embolization candidates. I think it needs to be a collaborative effort."

After hysterectomy, myomectomy and UFE are the main recommended fibroid therapies, both with their own benefits and disadvantages.