Treating fibroids without surgery

Dr. Scott Goodwin takes a new approach to an age-old problem for women

Nearly 600,000 hysterectomies are performed each year in the United States—a rate unchanged since World War II. Uterine fibroids, benign tumors in and around the uterine walls, account for half these procedures.

UCI Health radiologist Dr. Scott Goodwin wants to change that.

"The interventional radiologist has a tool that may be able to spare women the pain, the bleeding and, sometimes, the infertility that come with uterine fibroids," says Goodwin, chair of UC Irvine's Department of Radiological Sciences. The “tool” is uterine fibroid embolization (UFE) and it does not require invasive surgery.

UFE involves threading a catheter from a woman's femoral artery to the uterine arteries, where the radiologist releases tiny, inert plastic spheres. The fibroid shrinks when enough spheres block its blood supply. The procedure takes about 90 minutes and usually requires an overnight hospital stay, Goodwin says. Most patients recover fully in about two weeks. Compare that to five days in a hospital and a recovery period of up to six weeks for the removal of the uterus in a traditional hysterectomy. 

Goodwin's journey to becoming one of the nation's pioneers in UFE began on Thanksgiving Day in 1994, when a UCLA Medical Center colleague sought his help to stop a gynecological patient’s internal bleeding. Goodwin successfully used the embolization technique, which French physicians had introduced a few years earlier. By 1997, he had adapted it for use in treating uterine fibroids.

“Acceptance of the procedure grew gradually from there,” says Goodwin, who recently published an article about UFE in the New England Journal of Medicine. He’s currently working with the physicians at UCI Health Women’s Healthcare Center to make it more widely available. 

“Our goal is to offer each woman all the options for treating her condition without promoting any single one,” says Dr. Manuel Porto, head of UCI Health obstetrics and gynecology services, which is ranked among America’s top gynecological service providers by U.S. News & World Report. “Fibroid embolization gives some women a wonderful opportunity for a less invasive procedure, and Scott is a pioneer in the field,” Porto says.

Another option women with uterine fibroids can choose at UC Irvine Medical Center is myomectomy, a minimally invasive procedure that involves shaving fibroids from the walls of the uterus. There is no incision or loss of fertility, but the technique is limited by a fibroid’s location. It cannot be performed if fibroids are inside the uterine wall or outside the uterus. 

Fibroid embolization also is not for everyone and Goodwin cautions that its long-term effects are still being studied. Although UFE spares the uterus and some doctors have reported cases of patient becoming pregnant and giving birth after having the procedure, researchers don’t yet have sufficient data to determine whether UFE hinders a woman’s ability to have children. 

“About half the people referred to me don’t get UFE,” Goodwin says. “They may undergo a myomectomy or a hysterectomy. But a woman who doesn’t plan on getting pregnant has many options, including UFE.”

—John Murray, University Communications