NEW YORK (AP) — Arleen Chatman's mother had a hysterectomy. Her grandmother had a hysterectomy. So did her sister, two aunts and a cousin, who was only 32 when the family problem uterine fibroids struck her as they do millions of women every year.

Chatman, 57, was determined to buck her history, fight through her fibroid-related pain and find a way to avoid a hysterectomy, despite five miscarriages and periods so heavy she used a box of sanitary napkins combined with tampons in a single day.

``I got very anemic and was missing work,'' said the elementary school librarian in Los Angeles. ``I grew up in the old school of `It's just a woman's curse and you have to put up with it.' Then I started reading and everybody was talking about hysterectomies being done that weren't needed, saying there should be alternatives.''

The alternative Chatman chose three years ago is a relatively new treatment that allows women to avoid the risks and lengthy recovery periods of surgery. It's called uterine artery embolization, and it's done by interventional radiologists not gynecologists.

Under local anesthesia accompanied by pain medication, a quarter-inch incision is made in the groin. A catheter the circumference of spaghetti is threaded into the two arteries that supply blood to the uterus and feed blood-dependent fibroids.

Guided by bursts of die projected by X-ray imaging, plastic particles the size of sand granules are injected into the vessels, blocking blood to the tumors while allowing the uterus to receive nourishment from other sources.

Fibroids slowly deteriorate over three months to a year after embolization, offering women an average 40 percent to 60 percent reduction that appears to be permanent, said Dr. Robert Worthington-Kirsch, a Philadelphia radiologist who has performed a little more than 600 uterine artery embolizations, the most in the United States. The procedure usually takes care of multiple fibroids, not just the prominent ones unlike surgery.

About 4,500 women have undergone the procedure in the United States, and 6,000 to 8,000 worldwide. The procedure is successful in easing symptoms in about 90 percent of cases, Worthington-Kirsch said.

Recipients are screened by gynecologists prior to embolization to rule out uterine cancer, detect infections that could lead to complications and determine whether other problems such as endometriosis are severe enough to lead to hysterectomy anyway.

Most women spend a night or less in a hospital and resume their lives within a few days, compared to weeks of recovery after surgery. The downside is painful cramps that hit some women for a day or two after the embolization. And much more study is needed to gauge long-term effects of the procedure on fertility, among other factors.

``I was on my feet in a day and I haven't had any problems since. My fibroids almost disappeared,'' said Chatman, the mother of two grown sons who was among the first patients in the United States, at the University of California Medical Center in Los Angeles.

Around the country, about 500 radiologists perform uterine artery embolization. They're seeing many women seeking treatment for fibroids that grew back after myomectomy, a surgery to remove the tumors while leaving the uterus, Worthington-Kirsch said.

Twenty percent to 40 percent of American women over 35 have fibroids, which lead to at least 33 percent of the 670,000 hysterectomies performed every year in this country, he said.

Fibroids grow from cells of the uterine muscle. They can go undetected at the size of a pea for years or grow rapidly to the size of a bowling ball, multiplying as time passes. They often enlarge the uterus, making women appear pregnant when they aren't and contributing to premature labor when they are.

The growths appear to be driven by estrogen. Because a woman's estrogen levels usually drop with menopause, doctors often advocate a wait-and-see approach to fibroids absent serious symptoms. Like Chatman, many women who seek the procedure are beyond their childbearing years.

Thousands of women have fibroids with no symptoms. A big problem among the thousands more who are not that lucky are extremely heavy and painful periods lasting up to several weeks, sapping them of iron and leaving them severely anemic.

Some experience constipation from bowel compression and the constant need to urinate due to fibroids pressing on the bladder and other abdominal organs.

``Month by month I just got better and better and better,'' said Leslie Miles, another embolization patient who traveled to Los Angeles from her home in Hawaii to have the procedure nearly 2{ years ago and got pregnant soon after. ``It's a fantastic alternative to hysterectomy. I felt so much better, so much healthier. So many people are told, that's all you can get, hysterectomy, take it out.''

A French gynecologist, Dr. Jacques Henri Ravina, and some colleagues stumbled on the procedure as a promising fibroid treatment about 10 years ago.

Embolization to stop life-threatening bleeding after childbirth or surgery has been done for more than 20 years, but Ravina noticed that women who were embolized as a precaution against heavy bleeding prior to hysterectomy and myomectomy experienced a shrinkage in their fibroids, eliminating the need for surgery.

Worthington-Kirsch said many gynecologists know little or nothing about embolization as a fibroid treatment and don't inform patients of it because they consider it ``experimental.'' Many insurance companies don't pay for the procedure as a fibroid treatment for the same reason.

Women seeking alternatives to surgery and treatments that usually provide only short-term relief through scraping, burning or freezing of fibroids are taking to the Internet to share information about embolization after receiving none from their gynecologists, forming support groups and networks with radiologists.

The skepticism among gynecologists ``is understandable,'' Worthington-Kirsch said.

``About 40 percent of the income of a gynecologist comes from fibroid surgery,'' he said. ``There's also ignorance, a natural conservatism and a significant fear of losing control, having the patient go somewhere and never come back.''

Dr. Bruce McLucas, one of the UCLA gynecologists involved in the pioneering fibroid embolization program there, said a little skepticism about new techniques is healthy. But he stressed that embolization for other problems has been around for more than 20 years.

``We have to be able to educate other gynecologists. Embolization is not experimental. Everyone involved in this phenomenon is saying it works.''

Some terms and explanations:

Fibroid, a usually benign tumor of the uterus formed from cells of the uterine muscle. Little is known about the cause of fibroids, believed to be estrogen-dependent. They can take many years to grow and may disappear with menopause, when natural estrogen levels drop. Fibroids can cause debilitating symptoms, including heavy bleeding and painful cramps, or remain asymptomatic.

Uterine artery embolization, the blocking of vessels supplying blood to uterine fibroids, using a catheter inserted in the groin and X-ray imaging. The procedure appears to offer a permanent solution to fibroids, eliminates the need for general anesthesia and shortens recovery time when compared to surgery.

Hysterectomy, the surgical removal of the uterus, sometimes including the cervix and ovaries. Twenty percent to 40 percent of American women over 35 have fibroids, which lead to at least 33 percent of the 670,000 hysterectomies performed every year in the United States.

Myomectomy, the surgical removal of fibroids, leaving the uterus intact. Myomectomy has a high rate of return growth and may cause problematic adhesions, prompting the need for additional surgery.

Copyright 2000 The Associated Press. All rights reserved.