For 15 years, Dawn Vann planned her life around her period.

"The pain was so intense, and the bleeding so ungodly that it would almost shut me down for the first three days," says the 35-year-old Chester, Pa., customer-service representative. "I used to run track and dance, but it got to be where I was a prisoner in my own house."

Vann's menstrual problems were caused by fibroids -- rubbery, non-cancerous tumors that afflict 30 percent to 40 percent of American women. For years, she had popped painkillers and hormones to ease her symptoms.

Then, suddenly, Vann's fibroids began to grow, eventually swelling her uterus to the size of one in a woman 12 weeks pregnant. A hysterectomy seemed the only solution -- until a sympathetic co-worker let Vann in on a controversial medical secret that many gynecologists don't share, a way to shrink fibroids without surgery.

This revolutionary remedy -- called uterine artery embolization (UAE) -- is performed by an interventional radiologist in less than an hour with the patient under local anesthesia.

Available in the United States for about five years, UAE is gaining popularity as women seek less-radical alternatives to hysterectomy, the only permanent cure for fibroids. About 4,500 women in the United States have undergone uterine embolization, which is said to ease symptoms in about 90 percent of cases.

"We get many patients who hear about (UAE) from the Internet or a friend. There's almost an underground movement," says Dr. Gary Siskin, assistant professor of radiology at Albany (N.Y.) Medical College, who has performed 165 uterine embolizations.

"It's not something that is presented to every woman (who goes to the gynecologist for) fibroid treatment. In our area, however, the gynecologists are presenting it as another option," he says.

Proponents like Vann's Pennsylvania radiologist, Dr. Robert L. Worthington-Kirsch, say the procedure is less invasive, has a lower risk of complications and a faster recovery time than surgery.

Medical establishment wants more studies

Critics call such claims premature.

The American College of Obstetricians and Gynecologists considers UAE experimental and says further study is needed before embolization can be declared a safe and effective fibroid treatment.

"It may be a promising procedure, but it should be studied," says Dr. John F. Steege, chief of the division of advanced laparoscopic surgery and pelvic pain and a professor in the School of Medicine at the University of North Carolina at Chapel Hill.

"I believe it is being over-sold to the public, and I worry that it is being used ... without adequate evaluation of the reasons for (a patient's) pain and bleeding problems," he says.

During the procedure, a catheter is inserted into the main arteries of the legs and guided by X-ray images to the blood vessels that feed the fibroids in the uterus. Tiny plastic or spongelike particles are injected to stop blood flow to the fibroids.

With the blood vessels blocked, the fibroids shrivel by up to 70 percent in six months, radiologists report.

Most women experience some nausea and cramping after the procedure. But most leave the hospital the next day and resume normal activities within two weeks, compared to a two-month recovery period after a hysterectomy.

Uterine fibroids account for more than one-third of the 600,000 hysterectomies performed in the United States each year.

No one is sure what causes fibroids. But this much is known: Fibroids develop from cells in the uterine walls and in some cases can grow as big as basketballs, making a woman appear to be in the late stage of pregnancy. They are most common during the childbearing years.

Besides pain, heavy menstrual periods and frequent urination, fibroids have been linked to repeated miscarriage, premature labor and infertility.

Questions about effect on fertility

Radiologists concede it's too early to know how uterine embolization affects fertility, and Siskin reminds his patients that it could hasten menopause. But Worthington-Kirsch, who has done close to 700 embolizations -- the most in the United States -- says several of his patients have delivered healthy babies after UAE.

"Whether or not UAE decreases or enhances fertility is unclear -- we simply do not have enough information," he says. Roughly half the women who choose a third treatment -- surgical removal of fibroids, or myomectomy -- remain fertile. But fertility drops dramatically with repeat surgeries because fibroids tend to reappear after the surgery.

Embolization isn't for everyone. Women who have infections, uterine cancer or problems that might otherwise result in a hysterectomy, such as endometriosis, are not considered candidates for UAE. Some insurers don't cover the procedure, which costs about $15,000, about the same as a hysterectomy.

A decade of experience with UAE in Europe indicates that embolized fibroids don't grow back to uncomfortably large sizes. But it won't make them disappear. And, with the uterus intact, new growths can develop.

"I tell my patients to think of their fibroid like a sponge," Siskin says. "If you take a wet sponge and squeeze it, you'll eliminate some of the water, but there will still be a certain amount of sponge left." Embolization will, in effect, "squeeze the life out of a fibroid" but won't dissolve it. The decrease in size, however, is enough to make many women feel better.

"If you want a procedure that will allow you to never have to worry about developing new fibroids in the future, then you should have a hysterectomy," he adds.

For Vann, who hopes to have children, that wasn't an acceptable choice.

Taking her friend's advice, she underwent uterine embolization in mid-January and says her quality of life improved immediately. Her periods are normal now. And the constant bladder pressure that woke her several times a night with an urgent need to urinate is gone. Her energy has rebounded, too.

"I didn't want anything invasive or a long period of recovery," she says. "I stayed in the hospital overnight, and in two weeks, I was fine. It gave me my life back."

(From HealthScout)