Uterine Fibroids: Latest Options for Treatment

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 small (a quarter of an inch) to as large as 7 or more inches in diameter. While they do not always cause symptoms, their size and location can lead to complications for some women, including pain and heavy bleeding. Roughly 10-20 percent of women actually require treatment.

The degree to which uterine fibroids impede fertility is the subject of ongoing research and study. Generally the most important factor attributed to fertility obstruction is the anatomical location of the uterine fibroid(s). It is possible that the fibroid itself can compress the fallopian tube, preventing the entry of sperm to the uterus. Particularly large fibroids may block the fertilized egg from implanting in the uterus.

Symptoms:

• Heavy, prolonged menstrual periods and unusual (sometimes with clots) monthly bleeding
• Pelvic pain and pressure
•  Pain in the back and legs
• Pain during sexual intercourse
• Bladder pressure
• Constipation and bloating

Diagnostic Imaging

Newer and more sophisticated imaging technology enables interventional radiologists to provide gynecologists and their patients with a clearer diagnosis and nonsurgical treatment options. Women typically undergo an ultrasound at their gynecologist’s office, but this tool alone is inadequate in evaluating the full extent of the fibroids. Magnetic resonance imaging (MRI) is the standard diagnostic tool used by interventional radiologists to identify patients who would benefit from nonsurgical uterine fibroid embolization (UFE) to eradicate their fibroids.

According to Richard Baum, MD, Chief of the Division of Angiography and Interventional Radiology at Brigham and Women’s Hospital in Boston, “Interventional radiologists use MRIs to determine if the fibroids can be embolized, and identify pathology that could prevent women from having UFE.” This diagnostic tool is invaluable in helping women avoid unnecessary surgery, such as hysterectomies, which can come with significant risks and recovery times.

Patients considering surgical treatment should also get a second opinion from an interventional radiologist, who is best qualified to interpret the MRI and determine if they are candidates for the interventional procedure.

Treatment Options:

UFE

Also known as uterine artery embolization, UFE 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, a catheter is guided through the artery and then releases tiny plastic or gelatin 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 disappear.

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. At Brigham and Women’s Hospital, 85 percent of patients reported a significant improvement, even up to five years after the procedure.

Risks

UFE is a safer option and, like other minimally invasive procedures, has significant advantages over conventional open surgery. However, there are some associated risks, as there are with any surgical procedure. A small number (2.6 percent according to a study published in the New England Journal of Medicine) of patients have experienced infection, which can generally 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.

UFE Recovery Time

Fibroid embolization usually requires a hospital stay of one night. 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.

Outcomes

Based on long- and short-term outcomes, UFE is a safe and effective option for women to consider. Women can and should be confident about their decision to consider UFE as a treatment option. 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.

Surgery

Gynecologists are trained in surgery and can perform a hysterectomy; this involves 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. Myomectomy, like UFE, leaves the uterus in place and may, therefore, preserve the woman’s ability to have children.

There are many factors to be considered when identifying the best treatment for uterine fibroids. Fertility preservation, size and location of the fibroids, severity of symptoms, and overall health must be taken into account. You and your gynecologist can work together to explore all of the options and decide which treatment is most appropriate for you.

To learn more about uterine fibroids please click here.