Uterine fibroids are
very common, non-cancerous tumors that arise
in the muscle wall of the uterus. The can
vary in size from about the size of a dime
to the size of a grapefruit. When they occur,
there is usually more than one fibroid tumor
in the uterus. In this situation, with multiple
fibroids, the uterus can grow to the size
of a late-term pregnancy.
Twenty to forty percent of women age 35
and older have uterine fibroids of significant
size. Uterine fibroids are the most frequent
indication for hysterectomy in premenopausal
women. Of the 600,000 hysterectomies performed
annually in the United States, about 1/3
of these are done for fibroid disease.
Most fibroids do not cause symptoms and
only about 10-20% of women who have fibroids
will require treatment. Symptoms may vary
and depend on the number, size and location
of these benign tumors
Symptoms
include:
-Long, prolonged menstrual
periods, often with clot formation. This can
lead to anemia
-Pelvic pain and pressure, excessive menstrual
pain
-Bladder pressure, leading to frequent urge
to urinate
-Pressure on bowel, leading to constipation
and bloating
-Protruding abdomen
-Infertility
What
is uterine fibroid embolization?
Uterine
fibroid embolization (UFE) has been an option
for many women with symptomatic fibroids.
About 25, 000 UFE procedures have been performed
worldwide. Suitability for fibroid embolization
is determined after consultation with an interventional
radiologist. Usually MRI or ultrasound of
the pelvis is performed to evaluate the number,
size and location of the fibroids. This imaging
is also used to further exclude other possible
causes of the patient’s pain.
UFE is performed with the patient awake, but
sedated. The interventional radiologist makes
a small nick in the skin at the top of one
leg and inserts a small plastic tube, a catheter,
into the artery at the top of the leg. Under
x-ray guidance, the catheter is directed into
the arteries supplying the uterus and its
fibroid tumors (figure 1). Once the catheter
is positioned, tiny particles are injected
through the catheter and into the arteries,
blocking blood flow to all of the fibroids
in the treated area, causing them to shrink.
These specialized particles have been approved
by the FDA, based on comparative studies,
which show similar efficacy and lower complications
as compared with hysterectomy and myomectomy.
Most patients are admitted
to the hospital the day of the procedure and
typically spend one night in the hospital,
although some patients can be discharged the
same afternoon. Some cramping is typical after
the procedure and medication to control cramping
and discomfort are used as needed. Most patients
resume light activity in a couple of days
and are able to resume normal activities in
about one week.
Outcomes
Approximately 90 percent
of women who undergo UFE will experience significant
or total relief of bleeding or other symptoms.
Recurrence of fibroids is very rare. In one
study in which patients were followed for
six years, no fibroid that was embolized was
seen to re-grow.
A.
B.
Figure
2 - MRI performed before (A) and 6
weeks following fibroid embolization
in a 38-year-old woman with severe
bleeding and pain during menstrual
periods. The largest tumor (arrow)
at the top of the uterus has markedly
decreased in size in this short interval.
Excessive bleeding and pain has resolved.
Decreased brightness of the benign
tumor is reflective of obstruction
and cessation of blood flow to the
tumor.
UFE is a very safe method for treatment of
fibroids and, like other interventional procedures
can have significant advantages over conventional
surgical treatments. While complications are
rare, they are not non-existent. There is
a very small risk of infection, which can
typically be easily controlled with antibiotics.
Complications that could lead to need for
hysterectomy occur in less than 1% of cases.
Less than 2% of patients will enter menopause
after UFE. These are typically patients in
their mid-forties or older, who are already
nearing menopause.
Uterine fibroid embolization does leave the
uterus intact and preserves the ability to
bear children. There have been numerous reports
of pregnancy following UFE. Although more
extensive studies are needed to clarify the
effects of UFE on fertility, one small study
did document several couples that were able
to become pregnant for the first time following
the embolization procedure.
Alternatives
Traditional surgical alternatives
to UFE include hysterectomy and surgical myomectomy.
Hysterectomy is the surgical removal of the
uterus, typically requiring a hospital stay
of 3-4 days and an average recovery period
of about six weeks. Myomectomy can be an option
depending on the size and location of the
fibroids and in some cases may be the best
option for certain types of fibroids. The
procedure can be performed as an open surgery
or may be performed endoscopically and involves
the removal of specific fibroids, while leaving
the uterus intact. As most patients have multiple
fibroids, it is often not possible to remove
all of the tumors from the uterus via the
myomectomy procedure. While myomectomy is
about equal to UFE in controlling symptoms,
fibroids may recur in several years in about
10-30% of patients.
Uterine
fibroid embolization (UFE) has been an option
for many women with symptomatic fibroids.
About 25, 000 UFE procedures have been performed
worldwide. Suitability for fibroid embolization
is determined after consultation with an interventional
radiologist. Usually MRI or ultrasound of
the pelvis is performed to evaluate the number,
size and location of the fibroids. This imaging
is also used to further exclude other possible
causes of the patient’s pain.