Uterine Fibroids (UFE)
What are uterine fibroids?
Fibroids are the most common type of abnormal growth in the uterus and the most common reason for hysterectomy in U.S. women.
Although fibroids are benign, or non-cancerous, they can cause symptoms related to their size or location in the uterus. Fibroids are also referred to as leiomyoma, leiomomata, myoma and fibromyoma.
The exact cause of fibroids is unknown, but experts suspect the female hormone estrogen plays an instrumental role in the formation of fibroids. Typically, fibroids can enlarge during pregnancy and grow as a woman enters her 30s and 40s. When estrogen levels drop at menopause, fibroids usually shrink.
How common are uterine fibroids and what are their symptoms?
Approximately 20 to 40 percent of women age 35 and older have uterine fibroids of a significant size. The incidence of fibroids in African-American women is three times that of Caucasian women. Of the 600,000 hysterectomies performed in the United States each year, approximately one third are due to fibroids.
More than 50 percent of patients with fibroids do not have any symptoms. The symptoms vary bsed on the size, location and number of fibroids. Some fibroids may cause heavy bleeding leading to anemia. Bulk related symptoms may manifest as pelvic pressure or pain, back pain, bladder pressure/ frequent urination, constipation, and pain during sexual intercourse. Uterine fibroids may also impact fertility by distorting the endometrium – the mucous membrane lining the uterus.
How are uterine fibroids diagnosed?
A woman's medical history is very important in diagnosing uterine fibroids. Typically, women with uterine fibroids are premenopausal and have suffered from prolonged regular bleeding during menstruation. The most common test for uterine fibroids is ultrasound. Ultrasound often does not show other underlying diseases well or all of the existing fibroids Magnetic resonance imaging (MRI) is able to precisely depict the fibroid's location within the uterus, and is the standard imaging preferred by interventional radiologists.
An endometrial biopsy, where a uterine tissue sample is removed through a small tube and examined surgically, may sometimes be recommended prior to undergoing uterine artery embolization to exclude other causes of bleeding.
What is uterine artery embolization (UAE)?
Uterine artery embolization, also called uterine fibroid embolization, is a less invasive treatment for uterine fibroids performed by an iInterventional radiologist. In this procedure, blood supply to the fibroid tumors is blocked, causing them to shrink. As an alternative to hysterectomy, uterine artery embolization preserves a woman's uterus, maintains her hormonal cycles and requires far less recovery time.
Patients considering surgical treatment or hysterectomy should get a second opinion from an interventional radiologist, who is most qualified to interpret the MRI, determine if they are candidates for the interventional procedure, and explain the risks and benefits of uterine artery embolization.
How should I prepare for the procedure and how will I get my results?
Before the procedure, you may have blood tested to determine how well your kidneys and your blood clotting are functioning. You should inform your doctor of all medications you are taking, including any herbal supplements. Inform us of any allergies, particularly to local or general anesthetic medications or to contrast materials (sometimes called X-ray dye) or to latex gloves. Always inform your doctor if you are or may be pregnant.
Eat a light meal the evening before. You will be instructed not to eat or drink after midnight before the procedure, and if you are diabetic you should receive instructions from your doctor about adjusting medications and insulin dose on the day of the procedure. You will be asked to remove your clothing and wear a gown during the procedure. You will also need a ride home with a friend or relative.
The interventional radiologist will be able to inform you whether the procedure was technically successful. Your gynecologist may order follow-up imaging if your symptoms do not improve in two to three months.
How is UAE performed and what is recovery like?
The procedure is performed under conscious sedation and the patient is usually awake. General anesthesia is not required. The procedure usually takes less than one hour. A thin tube, called a catheter, is inserted through a blood vessel in the leg and guided by live X-ray images to the blood vessels that feed the uterus. Tiny particles are then injected to stop blood flow to the fibroids, causing them to shrink.
UAE is often performed on an outpatient basis. Patients usually experience cramping and pain that improves after the first 12 to 18 hours. Pain medication and anti-inflamatory drugs are usually prescribed to treat these symptoms. Some women may experience nausea that is easily controlled with medication.
Most women resume light activities two to three days after the procedure and most patients are able to resume their normal level of activity in 10 to 14 days.
What are the risks and benefits?
Uterine artery embolization is a very effective procedure. On average, 85 to 90 percent of patients experience significant or total relief of heavy bleeding, pain, or bulk related symptoms. The procedure is effective for multiple fibroids and large fibroids. Recurrence is rare, but more common in younger patients.
There have been many reports of successful pregnancies following uterine artery embolization, however, the published data is limited. If future pregnancy is desired and there is a solitary large fibroid or only a few fibroids, myomectomy should be considered. Early menopause is a potential side effect of UAE. This happens less than three percent of the time in patients less than 45 years old. Early menopause is more common after UAE in women over 45 and has been reported to occur in up to 15 percent of patients.
Serious complications are rare. Infection of the fibroids or uterus can occur in two to three percent of patients. Need for hysterectomy is rare, but happens in less than 1 percent of patients. Passage of fibroids can occur in 5 percent, and sometimes requires another procedure if it remains within the uterine cavity.
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