Non-Surgical Treatment of Fibroid Tumors

Background

Uterine Fibroids are benign (non-cancerous) growths which develop in the muscular wall of the uterus. Fibroids go by many names including leiomyoma, leiomyomata, myoma, and fibroma. Fibroids may be single or multiple, ranging in size from very small (less than a quarter inch) up to the size of a cantaloupe (10 inches or more).

Although most women are not symptomatic and may never even know they have a fibroid, many women do experience discomfort as the size and number of fibroids increase.

Common symptoms related to fibroids are:

• Heavy, prolonged menstrual bleeding with clots even leading to anemia (low blood counts)
• Increasing menstrual cramps
• Pelvic pain or feeling of "bulkiness" or "weight"
• Pain in the back or legs because of pressure on nearby nerves
• Pain during sexual intercourse
• Pressure on the bladder resulting in frequent urination
• Pressure on the bowel leading to bloating or constipation

 
Illustration shows the location and types of fibroids in the uterus.

Embolization is a technical term for blocking arteries with small particles. Using an Xray machine called a fluoroscope for guidance, a small catheter is placed in the blood vessels leading to the fibroid and the particles are slowly injected until the blood flow slows down or stops.

 This procedure has been performed for more than 20 years in cases of uncontrolled bleeding after childbirth or pelvic surgery. Coincidentally, it was found that women who underwent embolization for these reasons had a decrease in the size of their fibroids!

The first UAE performed in the U.S. for specific treatment of fibroids was performed at UCLA. Since that time, the procedure has gained wide acceptance as an alternative to surgery in selected patients.

Current Treatment Options For Symptomatic Fibroids Include:

• Lupron, a medication to block estrogen production resulting in shrinkage of fibroids. Fibroids return to original size when medicine stopped.
• Hysterectomy or surgical removal of the uterus and fibroids.
• Myomectomy or removal of only a portion of the uterus containing the fibroid(s).
• Uterine Artery Embolization to reduce blood supply to the fibroids and cause permanent shrinkage.

How does Uterine Artery Embolization Work?

Fibroids have a very rich blood supply which they depend on to maintain their size and grow. By reducing the blood supply, the fibroids will shrink in size. Reduced size means less weight in the uterus and less pressure on surrounding structures such as bowel and bladder. This results in alleviation of the patient’s symptoms.

Who is a candidate for UAE?

• Women with symptomatic fibroids, heavy bleeding and/or pelvic pain.
• Myomectomy or hysterectomy has been recommended.
• Women with a desire to preserve their uterus.
• Women wanting to avoid surgery.

Who is NOT a candidate for UAE?

• Women with asymptomatic fibroids.
• If malignancy is suspected.
• Active infection or pelvic inflammatory disease present.
• Pregnant women.
• Women close to or in menopause.

Advantages of UAE:

• All fibroids treated simultaneously.
• Minimally invasive compared with surgery.
• No observed re-growth of fibroids after treatment.
• General anesthesia is not needed.
• Uterus is preserved. No scarring in the pelvis as with surgery.

Disadvantages of UAE:

• 10-15% do not respond despite good "angiographic" appearance.
• Pelvic pain or cramping can be moderate or severe for several days.
• 2% of cases technically unsuccessful & 2% major complication rate.
• Does not exclude possibility of future endometrial cancer as does surgery.
• Long term follow up beyond 10 years not known.

Risks of UAE:

• 1% will need hysterectomy because of tissue damage or infection.
• 1% of patients experience premature ovarian failure.
• Catheter related complications/vessel injury is extremely rare.
• Serious dye allergy is extremely rare.
• Amount of radiation used during this exam is not dangerous.

UAE and Future Fertility:

• No large studies performed to give definite numbers.
• Dozens of reported healthy pregnancies after UAE.
• If infertility is due to compression of the endometrium by the fibroid, the procedure may actually improve fertility.
• Myomectomy (surgical removal of fibroid) is still preferred if fertility is desired.

For more on this go to WWW.SCVIR.ORG

Uterine Fibroid Embolization Procedure

What is the actual procedure and recovery like?

UAE is performed in the radiology department under sterile conditions using a special Xray unit called a fluoroscope. Patient's vital signs including heart rate, blood pressure, and respirations are measured. Intravenous sedation is given to reduce anxiety and relieve any sensation of pain.

A small needle puncture is made into the artery over the hip joint, and a small catheter no larger than a coffee stirrer is placed in the blood vessel feeding the uterus. Pictures are made with Xray dye injection defining the uterus and blood supply to the fibroids. Then, small particles are slowly injected into the arteries supplying the fibroids until blood flow stops. This is performed on both sides of the uterus, although normally only one needle stick is needed over the right hip.

After the exam, the small tube is removed and pressure is applied to stop any bleeding. Patients are returned to their room where they are monitored by registered nurses and given pain medicine if needed. Most women are discharged from the hospital the same day, but some need an overnight stay because of pelvic cramping and pain. Patients may receive a prescription for pain and/or nausea when discharged.

What to expect at home after UAE:

• Mild to moderate cramping from several days to a week.
• Most women return to work in 3-4 days (exam is frequently scheduled for a Friday to accommodate this).
• 20% of women experience temporary fever known as the Post-Embolization Syndrome which is treated with NSAID'S (Non-Steroidal Anti-Inflammatory Drugs).

Results of UAE:

• 85-90% of women report partial or complete relief of symptoms.
• 85-90% of women demonstrate shrinkage of fibroids by 40-70%.
• 90% of women report satisfaction with the procedure scheduled at SMH or an outpatient facility.