Highly Effective, Widely Available Interventional Radiology Treatment Often Replaces Need for Hysterectomy
Uterine fibroids are very common non-cancerous (benign) growths
that develop in the muscular wall of the uterus. They can range in size from
very tiny (a quarter of an inch) to larger than a cantaloupe. Occasionally,
they can cause the uterus to grow to the size of a five-month pregnancy. 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.
This is thought to occur because of the increase in estrogen levels during
pregnancy. After pregnancy, the fibroids usually shrink back to their
pre-pregnancy size. 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.
Uterine
fibroids are the most common tumors of the female genital tract. 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 either do not cause symptoms or cause
only minor symptoms.
These develop under the outside covering of the uterus and
expand outward through the wall, giving the uterus a knobby appearance. They
typically do not affect a woman's menstrual flow, but can cause pelvic pain,
back pain and generalized pressure. The subserosal fibroid can develop a stalk
or stem-like base, making it difficult to distinguish from an ovarian mass.
These are called pedunculated. The correct diagnosis can be made with either an
ultrasound or magnetic resonance (MR) exam.
Intramural Fibroids
These develop within the lining of the uterus and expand inward,
increasing the size of the uterus, and making it feel larger than normal in a
gynecologic internal exam. These are the most common fibroids. Intramural
fibroids can result in heavier menstrual bleeding and pelvic pain, back pain or
the generalized pressure that many women experience.
Submucosal Fibroids
These are just under the lining of the uterus. These are the
least common fibroids, but they tend to cause the most problems. Even a very
small submucosal fibroid can cause heavy bleeding - gushing, very heavy and
prolonged periods.
Prevalence of Uterine 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 menstrual periods and unusual monthly bleeding,
sometimes with clots. This can lead to anemia.
·
Pelvic pain and pressure
·
Pain in the back and legs
·
Pain during sexual intercourse
·
Bladder pressure leading to a frequent urge to urinate
·
Pressure on the bowel, leading to constipation and bloating
·
Abnormally enlarged abdomen
Imaging Expertise Enables
Interventional Radiologists to Provide Gynecologists and Their Patients Better
Diagnosis and Nonsurgical Treatment Options
Women typically undergo an ultrasound at their gynecologist’s
office as part of the evaluation process to determine the presence of uterine
fibroids. It is a rudimentary imaging tool for fibroids that often does not
show other underlying diseases or all the existing fibroids. For this reason,
MRI is the standard imaging tool used by interventional radiologists.
Magnetic resonance imaging (MRI) improves the patient selection
for who should receive nonsurgical uterine fibroid embolization (UFE) to kill
their tumors. Interventional radiologists 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.
Using an MRI rather than ultrasound is like listening to a digital CD rather
than a record – the quality is better in every way. By working with a patient’s
gynecologist, interventional radiologists can use MRIs to enhance the level of
patient care through better diagnosis, better education, better treatment options
and better outcomes.
Second Opinion Prior to
Hysterectomy
For true informed consent before surgery, patients should be
aware of all of their treatment options. Patients considering surgical
treatment should also get a second opinion from an interventional radiologist,
who is most qualified to interpret the MRI and determine if they are candidates
for the interventional procedure. You can ask for a referral from your doctor,
call the radiology department of any hospital and ask for interventional radiology
or visit the doctor finder link at the top of this page to locate a doctor near
you.
Nonsurgical Uterine Fibroid
Embolization – A Major Advance in Women’s Health
Uterine
fibroid embolization (UFE), also known as uterine artery embolization, is
performed by an interventional radiologist, a physician who is trained to
perform this and other types of embolization and minimally invasive procedures.
It 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 femoral 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.
UFE Recovery Time
Fibroid embolization usually requires a hospital stay of one
night. Pain-killing medications and drugs that control swelling typically are
prescribed following the procedure to treat cramping and pain. Many women
resume light activities in a few days and the majority of women are able to return
to normal activities within seven to 10 days.
UFE Efficacy
·
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. Short and mid-term
data show UFE to be very effective with a very low rate of recurrence.
Long-term (10-year) data are not yet available, but in one study in which
patients were followed for six years, no fibroid that had been embolized regrew
Additional UFE Facts
·
In 2007, the first gorilla was treated with UFE for her
fibroids.
·
An estimated 13,000-14,000 UFE procedures are performed annually
in the U.S. (as of 2004)
·
Embolization of the uterine arteries is not new. It has been
used successfully by interventional radiologists for more than 20 years to
treat heavy bleeding after childbirth.
·
Embolization has been used to treat tumors since 1966.
Embolization to treat uterine fibroids has been performed since 1995 and the
embolic particles are approved by the FDA specifically to treat uterine fibroid
tumors, based on comparative trials showing similar efficacy with less serious
complications compared to hysterectomy and myomectomy (the surgical removal of
fibroids).
·
Embolization of fibroids was first used as an adjunct to help
decrease blood loss during myomectomy. To the surprise of the initial users of
this method, many patients had spontaneous resolution of their symptoms after only
the embolization and no longer needed the surgery.
·
UFE is covered by most major insurance companies and is widely
available across the country.
·
Most women with symptomatic fibroids are candidates for UFE and
should obtain a consult with an interventional radiologist to determine whether
UFE is a treatment option for them. An ultrasound or MRI diagnostic test will
help the interventional radiologist to determine if the woman is a candidate
for this treatment.
·
Many women wonder about the safety of leaving particles in the
body. The embolic particles most commonly used in UFE have been available with
FDA approval for use in people for more than 20 years. During that time, they
have been used in thousands of patients without long-term complications.
Effect on Fertility
There have been numerous reports of pregnancies following
uterine fibroid embolization, however prospective studies are needed to
determine the effects of UFE on the ability of a woman to have children. One
study comparing the fertility of women who had UFE with those who had
myomectomy showed similar numbers of successful pregnancies. However, this
study has not yet been confirmed by other investigators.
Less than two percent of patients have entered menopause as a
result of UFE. This is more likely to occur if the woman is in her mid-forties
or older and is already nearing menopause.
Risks
UFE is a very safe method and, like other minimally invasive
procedures, has significant advantages over conventional open surgery. However,
there are some associated risks, as there are with any medical procedure. A
small number of patients have experienced infection, which usually can be
controlled by antibiotics. There also is a less than one percent chance of
injury to the uterus, potentially leading to a hysterectomy. These complication
rates are lower than those of hysterectomy and myomectomy.
Surgical Treatments for
Fibroids
Gynecologists perform hysterectomy and myomectomy surgery.
Hysterectomy is the removal of the uterus and is considered major abdominal
surgery. It requires three to four days of hospitalization and the average
recovery period is six weeks.
Depending on the size and placement of the fibroids, myomectomy
can be an outpatient surgery or require two to three days in the hospital.
However, myomectomy is usually major surgery that involves cutting out the
biggest fibroid or collection of fibroids and then stitching the uterus back
together. Most women have multiple fibroids and it is not physically possible
to remove all of them because it would remove too much of the uterus. While
myomectomy is frequently successful in controlling symptoms, the more fibroids
the patient has, generally, the less successful the surgery. In addition,
fibroids may grow back several years later.
Myomectomy, like UFE, leaves the uterus in place and may,
therefore, preserve the woman’s ability to have children.
"Reprinted with permission of the Society
of Interventional Radiology (c) 2004, www.SIRweb.org.
All rights reserved."
