By Rick Bonsall, MD (Staff Radiologist with Triad Radiology Associates)
Uterine fibroids are non-cancerous (benign) tumors that arise in the muscular wall of the uterus. They are the most common tumor of the reproductive tract in women and are found in 25-40% of all women ages 35 and older. African-American women are of an increased risk of developing fibroids with as many as 50% having fibroids of a significant size. Fibroids are often multiple in number and can range in size from very small (a quarter of an inch) to the size of a cantaloupe or larger.
Do I have uterine fibroids and if so, what are my treatment options?
Most fibroids are asymptomatic and only 10-20% percent of women who have fibroids require treatment. Symptoms depending on the size, location, and number of fibroids include: heavy, prolonged menstrual periods which may cause anemia, pelvic pain or heaviness, and pelvic pressure on the bladder leading to frequent urge to urinate or on the bowel leading to constipation or bloating.
Fibroids are typically diagnosed using clinical history and gynecologic exam and are confirmed with ultrasound. Hysterectomy is the definitive treatment, and uterine fibroids are the most common indication for hysterectomy in premenopausal women. Over the past 10-15 years, there has been a growing interest in less invasive therapies and treatments that would avoid removal of the uterus. A popular minimally invasive therapy is uterine fibroid embolization.
What is uterine fibroid embolization?
Uterine fibroid embolization is a procedure where an interventional radiologist, a doctor who specializes in targeted, minimally invasive treatments using imaging guidance, makes a small nick in the skin in the groin and inserts a catheter into the femoral artery. Using real time imaging, the physician guides the catheter into the arteries supplying the uterus and releases tiny particles which block blood flow to the uterine fibroids and cause them to shrink.
Prior to the procedure, patients will often undergo an MRI to fully assess the size, number, and location of the fibroids, determine if the tumors can be embolized, and detect alternative causes of the symptoms thus avoiding ineffective treatments.
The procedure takes about two hours and is performed in an interventional radiology procedure room. Patients are awake and comfortable with the use of intravenous sedation. Afterwards, patients are admitted to the hospital for overnight observation and are administered intravenous medications to control pain and cramping. These are changed to oral medications the morning after the procedure, and patients can eat a regular diet. Most women are discharged the day after the procedure, are performing light activities in a few days, and return to normal activity within a week.
What are potential risks of the procedure and how successful is UFE?
Uterine fibroid embolization is a very safe treatment option and, similar to other minimally invasive procedures, has significant advantages over conventional open surgery. As with any medical procedure, there are some associated risks. Potential risks include post embolization syndrome consisting of pain, low grade fever, nausea/vomiting, and fatigue. This usually resolves spontaneously but can be mediated by oral medications and fluid intake. A small number of women experience infection that can usually be controlled with antibiotics.
Uterine fibroid embolization is extremely successful with 85-90% of women reporting significant or complete relief of their heavy bleeding, pelvic pain, or pressure related symptoms. Recurrence of treated fibroids is rare.