Uterine Fibroid Embolization, an Effective Alternative to Major Surgery
Robert A. Hieb, MD
Medical College of Wisconsin Vascular and Interventional Radiologist
It is estimated that uterine fibroid tumors occur in 20 to 40 percent of all American women of childbearing age. Although these tumors are benign, they can cause painful and uncomfortable symptoms. In the past, many women had major surgery to alleviate symptoms, but a minimally invasive procedure called uterine fibroid embolization is now available. Robert A. Hieb, MD, talks about uterine fibroids and this new and effective treatment option.
Q. What are uterine fibroids? Who gets them and what symptoms do they cause? And how are they diagnosed?
Fibroid tumors are masses of smooth muscle tissue cells that occur in the uterus. We don't know what causes them, but we know they are very common. They tend to occur more often in African-American women than in Caucasian women and there also tends to be a familial relationship. In other words, if your mother and her sisters had fibroids, chances are you will too. While fibroids may appear in women in their 20s, most women do not have symptoms until their late 30s or 40s. About 75 percent of women who have fibroids show no symptoms. Only about 25 percent of women with fibroids have symptoms that may require treatment.
Symptoms typically fall into two categories. The main symptom is what we call menorrhagia, which simply means heavy menstrual bleeding. Sometimes the bleeding can be both heavy and prolonged, lasting up to seven or eight days or longer.The other main symptom is bulk related, where the fibroids exert pressure on surrounding organs such as the bladder or bowel. This can cause frequent urination or urgency, constipation, pain during intercourse or just pelvic pain. Fibroids may also be a factor in infertility, but generally they do not affect a woman's ability to have children.
Fibroids can be found through a pelvic exam because the uterus may become enlarged. A more definitive diagnosis would then be achieved through ultrasound or MRI.
Q. How are uterine fibroids treated? Treatment depends on the severity of symptoms, the woman's age, her overall health and her desire for possible future pregnancies. Younger women with mild symptoms can find relief through over-the counter pain medications. But when symptoms are severe, surgery is usually required.
Myomectomy is a surgical procedure that removes just the fibroids but leaves the uterus intact. This is an option for younger women who may want to bear children because it can usually preserve their fertility. Older women may choose to have a hysterectomy, which is complete removal of the uterus. But this is major surgery with a four to six week recovery period. For that reason, many women are now opting for a newer, minimally invasive procedure called uterine fibroid embolization that blocks the arteries that supply blood to the fibroids.
Q. How is uterine fibroid embolization performed? Is it safe and effective?In fibroid embolization, a catheter is placed in each of the two uterine arteries and small particles are injected to block blood flow to the fibroids. As a result, the fibroids shrink and scar down, alleviating symptoms. The procedure is performed in an interventional radiology suite and is done under fluoroscopy — basically live X-ray that's similar to the technology used in heart catheterization. Imaging guides the placement of the catheters and monitors the flow of the injection to the arteries. Patients require only local anesthesia and light sedation. The procedure is permanent and about 90 percent effective in alleviating symptoms. Side effects are very rare, however, the results are not immediate with the majority of the shrinkage of the fibroids occurring in the first three to six months after treatment. Embolization using similar agents has been performed for more than 30 years to treat bleeding associated with surgery and trauma. In fact, fibroid embolization evolved from its use weeks or months before a myomectomy to limit blood loss during the actual surgery. Women who had embolization often found that their symptoms disappeared and they no longer needed the operation. Fibroid embolization became a routine procedure in this country in the late 1990s and has been performed on thousands of women.
Q. Can a woman still have children after undergoing uterine fibroid embolization? Although there are reports of women having babies after embolization, it is not the treatment's goal to preserve or restore a woman's fertility. The ideal candidate for fibroid embolization is a woman in her 40s who has completed her family and wants relief from symptoms of uterine fibroids, but doesn't want to have major surgery.