What are uterine fibroid tumors?

Uterine fibroids are noncancerous tumors that develop in the muscular wall of the uterus. Their size and location can cause pelvic pain, heavy bleeding or urinary difficulty in some women. In addition, pregnancy may drastically increase the size of the fibroids. While the exact causes of fibroid development are unknown, research has linked them to genetic predisposition and susceptibility to hormone stimulation.

Who suffers from uterine fibroid tumors?

More than 5 million women ages 20-49 suffer from uterine fibroid tumors and their painful symptoms. In fact, approximately 20-40 percent of women ages 35 years and older have fibroids, particularly women of African-American descent.

What are the symptoms of uterine fibroid tumors?

Symptoms may include:
• Prolonged or unusually heavy menstrual periods, sometimes leading to anemia
• Pelvic pain
• Urinary difficulties, caused by bladder pressure
• Constipation and bloating
• Heaviness or pelvic pressure
• Pain during sexual intercourse
• Unusually enlarged abdomen
• Pain in the back or legs

How will I know if I have uterine fibroid tumors?

The diagnosis can be made in several ways, including a gynecologic internal exam, a pelvic exam, an abdominal ultrasound, and imaging techniques such as magnetic resonance imaging (MRI).

What is Uterine Fibroid Embolization?
It is a revolutionary, non-surgical procedure performed by GBI’s Interventional Radiologists. This minimally-invasive therapy delivers amazing results, without surgical removal of the uterus. Best of all, the treatment is covered by most insurance companies.

UFE is a specialized procedure that is performed to shrink fibroids, which are benign (non-cancerous) tumors in the uterine wall. Also known as myomas or leiomyomas, fibroids are frequently painful and can cause heavy menstrual bleeding.

If the fibroids are not causing symptoms, they do not need treatment. However, fibroids that are causing symptoms can be treated in several ways, including the traditional methods of hormone treatment or surgery. GBI patients now may take advantage of a new non-surgical procedure called uterine artery embolization (UAE).

With UAE, an interventional radiologist guides a small tube into the artery that supplies the fibroid and uses it to inject tiny beads to block the flow of blood to this area. When the blood supply is blocked, the fibroid loses its supply of oxygen and nutrients, causing it to shrink. That shrinkage relieves the symptoms for most patients.

Uterine fibroid embolization (UFE) should not be done in women who have no symptoms from their fibroid tumors; when cancer is a possibility; or when there is inflammation or infection in the pelvis. Uterine fibroid embolization also should be avoided in pregnant women and when the kidneys are not working properly—a condition known as renal insufficiency. A woman who is very allergic to contrast material containing iodine should receive another treatment option.
At present, it remains difficult for women in some parts of the country to learn about uterine fibroid embolization or make arrangements to have the procedure. Not all gynecologists are familiar with this relatively new method of treating uterine fibroids and rely instead on the conventional approach—surgery.

Uterine fibroid embolization is carried out in an angiography suite equipped with an x-ray machine, where sterile conditions are maintained. Your heart rate, blood pressure, electrocardiogram, breathing and blood oxygen level will be monitored constantly during the procedure, which typically takes 60 to 90 minutes.

After injecting a sedative to make you sleepy and a local anesthetic to numb the skin at the groin, the interventional radiologist will make a small nick in the skin less than a quarter-inch long and thread a thin tube (catheter) into the femoral artery. Using x-ray guidance and periodic injections of radiographic contrast material to map the blood vessels, the catheter is threaded into the uterine arteries. Under x-ray observation, the particles are injected until blood flow in the uterine arteries is blocked. In most cases, both uterine arteries can be treated through a single catheter insertion. After completing uterine fibroid embolization, the site of skin puncture is cleaned and bandaged.

The procedure, which takes about 45 minutes, does not require stitches and does not produce visible scarring.

You'll be asked to fast for several hours before the procedure, You may take most of your usual medications as prescribed—with the exception of any blood-thinning medications, including aspirin and ibuprofen. You should abstain from taking such blood-thinning drugs for minimum of five days before your procedure.

Benefits:

Minimally invasive:
Uterine fibroid embolization (UFE) is less invasive than either open surgery to remove fibroid tumors or surgically removing the uterus itself. Patients ordinarily can resume their usual activities weeks earlier than if they had a hysterectomy. Blood loss during uterine fibroid embolization is minimal, the recovery time is much shorter than for hysterectomy, and general anesthesia is not required.

Relief of symptoms:
Follow-up studies have shown that approximately 85 percent of women who have their fibroids treated by uterine fibroid embolization experience either significant reduction or complete resolution of their fibroid-related symptoms. This is true for women with heavy bleeding and for those with bulk-related symptoms such as pelvic pain or pressure. Overall, fibroids will shrink to half their original size six months after uterine fibroid embolization.

Durable effect:
Follow-up studies lasting several years have shown that it is rare for treated fibroids to regrow or for new fibroids to develop after uterine fibroid embolization. This is because all fibroids present in the uterus, even small early-stage masses that may be too small to see on imaging studies, are treated during the procedure. UFE is a more permanent solution than another option, hormone therapy, because when hormonal treatment is stopped the fibroid tumors usually grow back. Regrowth also has been a problem with laser treatment of uterine fibroids.

Risks:

Catheter-related risks:
Any procedure that involves placement of a catheter inside a blood vessel, including uterine fibroid embolization, carries certain risks. These risks include damage to the blood vessel, bruising or bleeding at the puncture site, and infection. When performed by an experienced interventional radiologist, the chance of any of these events occurring during uterine fibroid embolization is less than 1 percent.

Allergy to x-ray contrast material:
An occasional patient may have an allergic reaction to the x-ray contrast material used during uterine fibroid embolization. These episodes range from mild itching to severe reactions that can affect a woman's breathing or blood pressure. Women undergoing uterine fibroid embolization are carefully monitored by a physician and a nurse during the procedure, so that any allergic reactions can be detected immediately and reversed.

Passage of fibroid tissue:
From 2 percent to 3 percent of women may pass small pieces of fibroid tissue after uterine fibroid embolization. This occurs when fibroid tissue located near the lining of the uterus dies and partially detaches. Women with this problem may require a procedure called D & C (dilatation and curettage) to be certain that all the material is removed so that bleeding and infection will not develop.

Early onset menopause:
In the majority of women undergoing uterine fibroid embolization, normal menstrual cycles resume after the procedure. However, in approximately 1 percent to 5 percent of women, menopause occurs shortly after uterine fibroid embolization. This appears to occur more commonly in women who are older than 45 years when they have the procedure.

Need for hysterectomy:
Although the goal of uterine fibroid embolization is to cure fibroid-related symptoms without surgery, some women may eventually need to have a hysterectomy because of infection or persistent symptoms. The likelihood of requiring hysterectomy after uterine fibroid embolization is low—less than 1 percent.

X-ray exposure:
Women are exposed to x-rays during uterine fibroid embolization, but exposure levels usually are well below those where adverse effects on the patient or future children would be a concern.

Future fertility:
The question of whether uterine fibroid embolization reduces fertility has not yet been answered, though a number of healthy pregnancies have been documented in women having the procedure. Because of this uncertainty, physicians may recommend that a woman with symptom-producing fibroids who wishes to have more children consider surgical removal of the individual tumors rather than uterine fibroid embolization. A majority of women who have uterine fibroid embolization are no longer interested in childbearing. In some women, however, fibroid tumors are the cause of infertility and the best treatment may be to embolize them. For each individual it is difficult to predict whether the uterine wall will be weakened enough by uterine fibroid embolization to pose a problem during delivery of an infant. It may well be worthwhile to do an ultrasound study in a pregnant woman who has had the procedure so as to assess the state of the uterus.