Uterine Fibroid Treatments and Uterine Artery Embolization
Uterine Fibroid Disease – Alternative to Hysterectomy
Uterine fibroids are common non-cancerous growths that develop in the muscular wall of the uterus. In most cases, there is more than one fibroid in the uterus. While fibroids do not always cause symptoms, their size and location can lead to problems for some women, including pain and heavy bleeding.
Fibroids can dramatically increase in size during pregnancy. They typically improve after menopause when the level of estrogen, the female hormone that circulates in the blood, decreases dramatically. However, menopausal women who are taking supplemental estrogen (hormone replacement therapy) may not experience relief of symptoms.
You might hear them referred to as "fibroids" or by several other names, including leiomyoma, leiomyomata, myoma and fibromyoma. Fibroid tumors of the uterus are very common, but for most women, they do not cause symptoms or cause only minor symptoms.
Prevalence of Fibroids
Twenty to 40 percent of women age 35 and older have uterine fibroids of a significant size. African American women are at a higher risk for fibroids: as many as 50 percent have fibroids of a significant size. Uterine fibroids are the most frequent indication for hysterectomy in premenopausal women and, therefore, are a major public health issue. Of the 600,000 hysterectomies performed annually in the United States, one-third are due to fibroids.
Uterine Fibroid Symptoms
Most fibroids don’t cause symptoms—only 10 to 20 percent of women who have fibroids require treatment. Depending on size, location and number of fibroids, they may cause:
- Heavy, prolonged periods and excessive monthly bleeding, sometimes with clots
- Anemia from heavy bleeding
- Pelvic pressure and/or pain
- Pain in the back and/or legs
- Pain during sexual intercourse
- Bladder pressure leading to a frequent urge to urinate
- Pressure on the bowel, leading to constipation and bloating
Imaging Fibroids and Vascular Specialists Image Guided Procedures
Women typically undergo an ultrasound at their gynecologist’s office as part of the evaluation process to determine the presence of uterine fibroids. This often does not show other underlying diseases or all the existing fibroids. For this reason, MRI is the standard imaging tool used by vascular specialists.
Magnetic resonance imaging (MRI) improves the patient selection for who should receive nonsurgical uterine fibroid embolization (UFE) or Uterine Artery Embolization (UAE) to kill their tumors. Vascular specialists can use MRIs to determine if a tumor can be embolized, detect alternate causes for the symptoms, identify pathology that could prevent a women from having UFE and avoid ineffective treatments.
Second Opinion Prior to Hysterectomy
Patients considering surgical treatment should also get a second opinion from a vascular specialist, who is most qualified to interpret the MRI and determine if they are candidates for the interventional procedure.
Uterine Fibroid Treatment
Uterine Fibroid Embolization - An Effective Alternative to Hysterectomy
Uterine fibroid embolization (UFE), also known as uterine artery embolization is performed while the patient is conscious, but sedated and feeling no pain. It does not require general anesthesia.
The interventional radiologist makes a tiny nick in the skin in the groin and inserts a catheter into the artery. Using real-time imaging, the physician guides the catheter through the artery and then releases tiny particles, the size of grains of sand, into the uterine arteries that supply blood to the fibroid tumor. This blocks the blood flow to the fibroid tumor and causes it to shrink and die.
Recovery Time for UAE / UFE
Fibroid embolization can be performed on an outpatient basis. Pain-killing medications and drugs that control swelling typically are prescribed following the procedure to treat cramping and pain.
Your doctor may perform a "nerve block" to help decrease postoperative pain the day of the procedure. This technique allows women to recover in the comfort of their own home. Many women resume light activities in 2-3 days and the majority of women are able to return to their normal activities within seven to 10 days."
Efficacy of UAE / UFE
On average, 85-90 percent of women who have had the procedure experience significant or total relief of heavy bleeding, pain and/or bulk-related symptoms.
The procedure is effective for multiple fibroids and large fibroids. Recurrence of treated fibroids is very rare. Research data shows UFE/UAE to be very effective with a very low rate of recurrence.
Effect on Fertility and Menopause
There have been numerous reports of pregnancies following uterine fibroid embolization. If future fertility is desired and there is a solitary large fibroid or only a few fibroids, myomectomy should be considered.
Less than two percent of patients have entered menopause as a result of UFE. This chance increases the older the woman is, and is more likely to occur if the woman is in her mid-forties or older and is already nearing menopause.