Non-Surgical Treatment for Uterine Fibroid Tumors

Society of Interventional Radiology – Uterine Fibroids

What is a uterine fibroid?

Benign tumor of uterine smooth muscle Fibroids are not considered to be pre-cancerous Also referred to as myomas or leiomyomas Types: submucosal, intramural, and subserosal

How common are uterine fibroids?

Estimated that 25 to 50% or greater of all women eventually develop fibroids Fibroids most frequent ages 30s & 40s Most common tumor of the pelvis in females A minority, perhaps 10% to 30% of these women are symptomatic

What causes fibroids?

Exact cause is currently unknown Fibroids are linked to estrogen levels. There is evidence that progesterone may stimulate fibroid growth. There may be a genetic predisposition to uterine fibroids.

What symptoms occur with uterine fibroids?

Heavier menstrual bleeding, sometimes with passage of blood clots. Anemia can occur if bleeding is severe. Pain, pressure, or feeling of fullness in the pelvis, abdomen, or lower back. Frequent urination or constipation. Pain during or bleeding after intercourse. Infertility or miscarriage

How are fibroids diagnosed?

Clinical history and Physical exam, Pelvic Ultrasound (US) including Hysterosonography, Magnetic Resonance Imaging (MRI), Laparoscopy or Hysteroscopy

How are fibroids currently treated?

Small & No Symptoms – follow with US and pelvic exam.Mild Symptoms -conservative, OTC medications, birth control pills. Moderate Symptoms – aggressive hormonal therapy (Lupron.) Severe Symptoms–surgical, most commonly Hysterectomy or Myomectomy. Myolysis and Endometrial ablation less invasive options in select patients. Lupron GNRH agonist blocks ovarian estrogen production. Advantages: Not Invasive, shrinks fibroids, often improves symptoms. Disadvantages: Induces premature menopause and associated symptoms. Fibroids usually return to original size after cessation of therapy. Only used for short periods of time because of side effects. Hysterectomy – surgical removal of uterus and fibroids, performed through abdominal incision or occasionally vaginally, sometimes with a laparoscope. Advantages: 100% Curative, no risk of future cancer, well established procedure. Disadvantages: major surgery with potential surgical complications: infection, hemorrhage, injury to adjacent organs, and adhesions. Loss of child bearing potential with emotional, and sexual implications. Myomectomy – individual fibroids are resected through an abdominal incision or sometimes with a laparoscope or hysteroscope. Advantages: Fertility can be preserved , well established procedure, less invasive if laparoscopic or hysteroscopic. Disadvantages: same potential surgical complications as hysterectomy; only part of uterus is treated and recurrence can occur; 15 to 25 % need repeat procedure, usually hysterectomy; not all fibroids amenable to myomectomy; adhesions can lead to infertility

What is the history of uterine fibroid embolization?

Embolization of uterine arteries for severe post-partum or post-traumatic hemorrhage performed for nearly 20 years. Jacques Ravina, French Gynecologist, in 1990 used embolization prior to hysterectomy to decrease surgical blood loss. Serendipitous discovery: women noticed bleeding, pain, and bulk symptoms improved after Uterine Fibroid Embolization.These women started to cancel their surgeries. This discovery has lead to a promising new alternative treatment-uterine fibroid embolization!

How does uterine fibroid embolization work?

Polyvinyl particles alcohol particles injected to block blood flow to fibroid. Aimed at starving fibroids, by depriving them of blood supply. Fibroids die (caseous necrosis) then scar down (hyaline sclerosis) and shrink. POST-PROCEDURE CARE: Overnight in hospital for pain management and observation. Transient pelvic cramping 8-12 hrs after procedure relieved with epidural anesthesia. Nausea may occur and is treated with antinausea medications. Discharge following morning with oral pain medication, NSAID’s, and antinausea medications. POST UFE AT HOME – mild to moderate cramping typically several days to a week. Most women return to work in 3-4 days and report full recovery in 1-2 weeks, 20% may develop temporary fever known as Post-Embolization Syndrome, can last up to one week. Treated with NSAID’S. Follow up appointment in 2 weeks. Follow up MRI in 3-6 months

What are the current uterine fibroid embolization statistics?

85-90% of women have reported a partial improvement or complete resolution of symptoms, especially decreased bleeding. 85-90% of women demonstrate on average 40-70% shrinkage in uterine and fibroid volume in 3-12 month follow-up. More than 90% of women reported satisfaction with the procedure.

What are the advantages of uterine fibroid embolization?

It treats all fibroids simultaneously. Minimally invasive. Complications infrequent. No observed recurrence of treated fibroids in follow-up to nearly 10 years. Shorter recovery period. No adhesion (scar) formation. Minimal blood loss. No need for transfusion. Epidural and conscious sedation vs. general anesthesia. Emotionally, physically, and sexually – UFE can have advantage over other treatments

Are there any potential disdvantages of uterine fibroid embolization?

10-15% do not respond despite technical success. Up to 2% of procedures technically unsuccessful. Pelvic pain or cramping after procedure can remain moderate to severe for several days. 1% to 2% chance of serious complication i.e. hysterectomy. No tissue obtained for pathologic diagnosis. Long term (more than) 10 year follow-up not known. Difficult to obtain. Operator experience often lacking.

What are the risks of UFE?

Hysterectomy: 1% incidence due to uterine infection or infarction. Premature ovarian failure: 1% of patients experience amenorrhea. Most in late 40’s. Radiation not considered dangerous. Serious dye allergy is extremely rare. Catheter related complications are rare in experienced hands.

Will UFE decrease fertility?

Conclusive studies with large numbers are lacking. Dozens of reported healthy pregnancies, with no reports of any adverse outcome due to UAE. If infertility due to fibroids, fertility may improve in select patients after UFE. Research ongoing. Women with symptomatic fibroids desiring fertility probably should consider myomectomy first, especially if relatively uncomplicated.

Who should not have UFE?

Women with asymptomatic fibroids. Suspicion of malignancy. Infection or pelvic inflammatory disease. Pregnant women. Peri-menopausal and Post-menopausal women

Who is a potential candidate for UFE?

Women with symptomatic fibroids: heavy bleeding, pelvic pain, bulk related symptoms. Myomectomy or hysterectomy has been recommended. Women who have a desire to preserve their uterus. Women with aversion or desire to avoid surgery. Women who have a desire to maintain fertility, if hysterectomy is only option.

Studies, interviews and follow up exams based upon the several thousand UAE procedures make one thing quite clear: Fibroid Embolization is a highly successful, minimally invasive alternative to hysterectomy.