Women with noncancerous tumors that cause pain and profuse bleeding are beginning to seek out a new, nonsurgical treatment that spares many from having a hysterectomy.

The tumors, called uterine fibroids, affect up to 80 percent of women at some point in their lives, and they can be particularly troubling to women during childbearing years, often causing infertility. Many women opt to have hysterectomies, which can cost more than $40,000 and require a six-week recovery.

The new treatment, now available in North Carolina only at Duke University Medical Center, uses focused ultrasound, which aims high-intensity sound waves on the tumor to create heat that destroys the tissue. The procedure requires no surgical cuts, and patients can go back to normal activities immediately. It's also half as expensive as a full hysterectomy, although insurance coverage is still not assured, despite the procedure winning approval from the Food and Drug Administration in 2004.

Other hospitals are evaluating the technology but have not committed to establishing programs. It's available at fewer than 20 hospitals across the country.

Dr. John F. Steege, an obstetrician at University of North Carolina, Chapel Hill, said the procedure would benefit only a subset of patients -- women past childbearing age, whose fibroids are in certain parts of the uterus, and who have few tumors.

"It's going to be a niche solution," he said.

But the prospect of a surgery-free solution was enough to lure Jackie Grissom, 51, to come from Kannapolis, N.C., to Durham for treatment.

Last week, Dr. Millie Behera, a Duke obstetrician and gynecologist, used the ultrasound procedure to kill the 3-inch tumor inside Grissom's uterus. Grissom, who learned about the procedure and Duke's new center on the Internet, went from the three-hour appointment to lunch and house-hunting with her 23-year-old daughter. She expects her insurance to pay for the procedure.

"As soon as I got off the table, nothing hurt," said Grissom, whose fibroid had become so uncomfortable she was spending most evenings on a heating pad. "Nothing's hurt since then."

Doctors don't know why fibroids develop, but they do know the tumors are common, affecting a third of women of childbearing age. African-Americans are even more prone to them.

Often, fibroids are small and don't cause problems. But about a quarter of women with the tumors experience symptoms such as heavy menstrual periods, abdominal pain, a need to urinate often and problems with infertility. Some women bleed so freely they become anemic. A few even need transfusions.

There are many ways to treat fibroids, but most have drawbacks.

Burning off the lining of the uterus controls heavy bleeding but renders a woman unable to bear children. A procedure that cuts off the blood supply to fibroids is effective but it can also starve a woman's ovaries of blood, causing them to stop working. Surgery to remove tumors, while leaving healthy tissue intact, takes a week or more of recovery, and typically dictates that any future pregnancy be delivered by cesarean section.

Focused ultrasound isn't perfect either. The technology is relatively new, and it's not clear what unforeseen effects it may have on the uterus.

Nothing Is Permanent
No treatment, however, including ultrasound, offers a permanent solution. Tumors grow back in up to 30 percent of women, requiring repeat procedures.

That's why hysterectomy, in which all or part of the uterus is surgically removed, has remained popular, despite being radical. Removing the uterus ensures the tumors won't come back. Fibroid treatment accounts for about one-third of the 600,000 hysterectomies done in this country each year, according to the National Women's Health Resource Center.

"It's the only definitive solution," said Behera, the Duke doctor. She is director of Duke's focused-ultrasound treatment program for fibroids.

Grissom, who experienced heavy periods that led to anemia, said the gynecologist she initially saw was adamant that hysterectomy was the best option for her. "He was rather cut-and-dried about it," Grissom recalls. "He didn't offer anything else as a possibility."

Grissom did not want a hysterectomy. She had no desire to rush into menopause -- removing the uterus triggers the change -- and she did not want to leave her work as a family and individual counselor for six weeks to recover.

Many other women have similar objections, Behera said. She thinks ultrasound will be an attractive option for some of them.

"There's no one right answer for all women," Behera said. "But it's great to have the opportunity to offer it."

Jean Fisher can be reached at jean.fisher@newsobserver.com or (919) 829-4753.

Source: The News & Observer, Raleigh, N.C. Distributed by McClatchy-Tribune Information Services. Powered by Yellowbrix.

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