A New Treatment Option for Uterine Fibroids
For immediate release: August 11, 2009
Treatment options for women with fibroids include medical regimens, surgery and uterine artery embolization (UAE). Medical options include non-steroidal medication such as ibuprofen, birth control pills and hormone treatments such as gonadotropin releasing hormone (GnRH) agonists.
Surgical options include:
- Myomectomy -- a surgical procedure that removes visible fibroids from the uterine wall. Myomectomy, like UAE, leaves the uterus in place. There are several ways to perform myomectomy, including hysteroscopic myomectomy, laparoscopic myomectomy and abdominal myomectomy.
- Hysterectomy -- surgical removal of the uterus.
- Endometrial Ablation -- The endometrial lining of the uterus is destroyed. Used to control excessive bleeding, but generally, women can't have children after this procedure.
- Myelosis -- A laparoscopic procedure that involves using an electrical needle to destroy the blood vessels feeding the fibroids.
At first, Sandra Picot didn't know what was causing her low blood count and shortness of breath. During her menstrual cycle, she experienced heavy bleeding and blood loss, which caused her to become anemic. After some diagnostic tests, she was diagnosed with uterine fibroids. As time went on her symptoms did not improve, and eventually, the fibroids grew from the size of a golf ball to the size of a grapefruit.
Her doctor offered her several options, including drugs and surgery. But Picot didn't want to take hormones or birth control pills. Eventually, her doctor brought up the subject of a hysterectomy but Picot had serious reservations about undergoing an invasive surgical procedure.
"Surgery was definitely something I didn't want to do. My mother had a hysterectomy for uterine fibroids and I remember her recovery. It took some time and I didn't want to undergo that as an option," said Picot, Ph.D., R.N., an associate professor at the University of Maryland Department of Adult Health Nursing. Eventually, through her own research and determination, Picot found another option -- a more minimally invasive approach known as uterine artery embolization (UAE).
Uterine Artery Embolization
UAE is a new approach to treating fibroid tumors, which are benign growths that develop in the muscular wall of the uterus. The procedure is performed by an interventional radiologist trained in the use of X-rays to guide minimally invasive interventions within the arteries. During the procedure, the radiologist makes a small nick in the skin in the groin and inserts a catheter (a thin tube, the size of a strand of spaghetti, that can be seen with X-rays) into an artery. The catheter is guided to the arteries that bring blood to the uterus, and very small particles are injected through the catheter to block the blood supply to the fibroid tumor. This causes the tumors to shrink.
"This procedure causes the fibroids to degenerate and shrink while leaving the uterus intact," explains Howard Richard, M.D., an interventional radiologist at the University of Maryland Medical Center and an assistant professor of diagnostic radiology at the University of Maryland School of Medicine. "UAE strips the fibroids of their blood supply."
The UAE procedure is becoming more popular as more women are learning about it. "The success of the procedure has generated tremendous interest," said Richard, who treated Picot. "The awareness in the community is what's increasing. Word of mouth is a large part of it. Also, women are becoming more savvy on their own and finding us on our Web site."
Benefits, Good Candidates
Dr. Richard, an associate professor of radiology at the University of Maryland School of Medicine, say there are several advantages and benefits to the UAE procedure:
- The recovery time is shorter (most people are back to work in a week)
- There is virtually no risk of transfusion (as there would be in a surgical procedure)
- Many women can have the procedure done and go home the same day.
There is long-term patient satisfaction. With UAE, he says, recent studies show there's no reason to expect that the tumors will re-grow.
In contrast, the same doesn't necessarily hold true for a myomectomy (the surgical removal of the fibroid tumor but not the uterus). "Embolization treats the fibroids in the entire uterus, whereas with a myomectomy they only take out the ones they can see," Richard said. "With myomectomy there are other fibroids that are not necessarily as big that are still there and can continue to grow."
Dr. Richard says his patients usually recover quickly from the UAE procedure. "Most people are pleasantly surprised at the length of time it takes them to recover, particularly people who have undergone a myomectomy," he says. "Usually they are amazed at how quickly they are back to normal."
According to Dr. Richard, the best candidates for the procedure are those people who:
- Have tumors that are causing significant bleeding
- Have fibroid tumors that are causing pain or compression of the bladder or rectum
- Have already had children
- Don't want to have a hysterectomy
But not all women with fibroids need to be treated. "We wouldn't treat someone without symptoms," Richard said. "The only reason we would treat someone is if she had really bad menstrual bleeding or symptoms related to the size and position of the fibroid. Symptoms can vary based on location of the fibroid. Size alone is not a reason to treat."
Also, not all uterine fibroids can be treated with UAE. Therefore, all patients are evaluated with ultrasound and/or magnetic resonance imaging (MRI) to make sure the fibroid tumor is appropriate for the treatment.
According to the Society of Cardiovascular & Interventional Radiology (SCVIR), women who wish to have children in the future should be counseled to the small but definite risk of inducing premature menopause from the procedure. These women should consider myomectomy prior to embolization. The bottom line? Each woman's condition is unique and individual consultation with an interventional radiologist is encouraged to evaluated suitability for the embolization procedure.
According to various studies, nine out of 10 women who have the UAE procedure feel that their symptoms are significantly improved. On average, the tumors shrink by 75 percent and the uterus by 50 percent after six months.
Statistics cited by SCVIR show that 78 to 94 percent of women who have this procedure experience significant or total relief of heavy bleeding, pain and other symptoms. This is also effective for multiple fibroids. Recurrence of treated fibroids is very rare.
Uterine fibroid embolization, courtesy of the Society of Cardiovascular and Interventional Radiology.
"There's no reason to think they would re-grow," Richard said. "The statistics we quote are that 90 percent of women who had the procedure for bleeding are better and the average success rate is in the 85-95 percent range. The majority of women who had the procedure are very happy and don't have anything else done."
Side effects and complications are few, but include pain at the time of the procedure and complications related to the embolization of the fibroid tumors. Patients are usually able to go home the same day, although some may require an overnight stay in the hospital.
The majority of symptoms are controlled with medications and most women are able to return to work in three to five days. There is, however, a slight risk of infection in the embolized fibroid. This is usually managed with antibiotics. In addition, the embolization particles can travel to the ovaries, and in a few women, the ovaries stop functioning either temporarily or permanently.
Fibroids are the most common tumors of the female reproductive tract. "Fibroids are extraordinarily common," Richard said. "Roughly one third to half of all women will have them, but only 10 percent will have symptoms from them."
While fibroids do not always cause symptoms, their size and location can lead to problems for some women, including pain and heavy menstrual bleeding. They can also put pressure on the bladder, causing frequent urination that can even awaken women from sleep.
The number of women who have fibroids increases with age until menopause: Twenty to 40 percent of women ages 35 and older have uterine fibroids of a significant size. African-American women are at a higher risk -- as many as 50 percent have fibroids of a significant size. It is not known why, although genetic variability is thought to be a factor.
After Picot had the UAE procedure, she noticed a "dramatic difference. My menstrual cycles were lighter, not anywhere near as bad as pre-procedure experiences. It was just incredible."
Once she had her follow-up MRI she received even more good news. "My uterus had shrunk 40 percent from the size it was before the procedure to this point in time. One of the tumors had totally disappeared and the other one had shrunk 87 percent."
In the end, Picot felt she had made the right decision. "I was satisfied with this procedure because unlike some of my friends who had undergone abdominal hysterectomy, which was accompanied by a long period of recovery, I was able to come back to work in a week. The fact that I did not lose that amount of time from work was the most important factor for me. Uterine artery embolization was in my mind the least invasive way of managing this problem of uterine fibroids."