Uterine Fibroid Embolization

Uterine fibroids are very common and, for many women, cause symptoms that affect the quality of their life. The uterus is part of the female reproductive system located in the pelvis. The uterus, or womb, is a muscular organ that receives the fertilized egg and provides the environment needed for growth of a fetus.

Uterine Fibroid Embolization (UFE) blocks the blood supply to fibroids, causing them to shrink. It is clinically proven to reduce the major symptoms of fibroids, including pain, excessive and prolonged bleeding, and frequent urination. UFE is minimally invasive, requiring only a small nick in the skin. The procedure lasts less than an hour, and patients return to work in an average of 11 days.

What are uterine fibroids?

Uterine fibroids are benign (non-cancerous) tumors of the uterus. It is estimated that 20% to 40% of women 35 years of age and older have fibroids. Although most do not cause symptoms, uterine fibroids can cause severe problems for some women who have the condition.

Uterine fibroids can grow in various parts of the uterus:

• Those that grow in the muscular wall of the uterus are called intramural fibroids.
• Those that grow on the outer surface of the uterus are called subserosal fibroids.
• Those that grow on the inner surface of the uterus are called submucosal fibroids.

Intramural fibroids are the most common type of fibroid. Because these fibroids grow in the muscular wall of the uterus, they make it fell larger than normal. These fibroids can cause an increase in menstrual bleeding, pelvic pain, back pain or pressure.

Subserosal fibroids are the second most common type of fibroid. Because they are located on the outer wall of the uterus, these fibroids usually do not affect menstrual flow. However, they can cause pelvic pain, back pain or pressure.

Submucosal fibroids can cause heavy or prolonged periods, even if the fibroids are very small.

Typically, women who have uterine fibroids have more than one fibroid and they can range widely in size. Some are no bigger than a pea, while others can grow to the size of a melon or larger. When fibroids are diagnosed, the extent of the disease is determined by comparing the size of the uterus to a typical size during pregnancy. For example, a large fibroid or multiple fibroids may enlarge the uterus to the same size as a six- or seven-month pregnancy.

What causes uterine fibroids?

The exact reason why uterine fibroids develop is unknown. However, medical researchers have associated the condition with two factors - genetics and hormones.
Genetics
African-American women are at higher risk for uterine fibroids. Fibroids occur in as many as 50% of these women - a rate that is about twice that of other racial groups. Also those with a family history of fibroids are more likely to develop them.
Hormones
Uterine fibroids can dramatically increase in size during pregnancy. It is thought that this effect is due to the increase in the amount of estrogen - the female hormone - that naturally occurs during pregnancy. After delivery, the fibroids usually shrink to the size they were before the pregnancy.
During menopause, estrogen levels dramatically decrease. This causes uterine fibroids to shrink, relieving symptoms. However, if a women takes hormone replacement therapy (HRT) during menopause, estrogen levels do not decrease, the fibroids may not shrink and the symptoms may remain.

What are typical symptoms?

A uterine fibroid may begin to grow when a woman is in her 20s. However, most women do not begin to have symptoms until they are in their late 30s or early 40s. Depending on the location, size and number of fibroids, a woman with uterine fibroids may experience the following symptoms:

• Heavy, prolonged menstrual periods and unusual monthly bleeding - sometimes with clots - which can cause anemia
• Increased menstrual cramping
• Pain, pressure or discomfort in the pelvis
• Pain in the back, sides or legs
• Pain during sexual intercourse
• Blockage of urine flow from the kidney to the bladder
• Urinary frequency due to pressure on the bladder
• Constipation and/or bloating due to pressure on the bowel
• Abnormally enlarged abdomen

How do I know if I have uterine fibroids?

Usually, uterine fibroids are first diagnosed during a gynecologic internal examination. This pelvic exam allows the physician to check the size of your uterus. If it feels enlarged, your physician may send you for an ultrasound examination. This exam can detect if fibroids are present, as well as determine their precise location and size.

The presence of fibroids can also be diagnosed using magnetic resonance imaging (MRI) or computer tomography (CT). In cases of submucosal fibroids, your gynecologist may use a small scope placed through your vagina to examine the inside wall of your uterus.

How are uterine fibroids treated?

The treatment for uterine fibroids depends on the size and location of the fibroids and the severity of your symptoms. If you do not have symptoms, your doctor may decide that there is no need to treat the fibroids. However, your physician will likely recommend yearly visits to have them checked.

If you develop symptoms, there are a number of treatment options available including:

• Medical therapy
• Surgical therapy
• Non-surgical therapy (uterine fibroid embolization)

Medical Therapy
Medical therapy for uterine fibroids may include the use of drugs to provide control of symptoms. These drugs include non-steroidal anti-inflammatory drugs (NSAIDs), birth control pills and hormone therapy. Some drugs cause menopause-like side effects such as hot flashes and bone loss.
Surgical Therapy
There are two surgical options for uterine fibroids - myomectomy and hysterectomy. A myomectomy is a surgical technique which removes the fibroids from the wall of the uterus. Many women are not candidates for this procedure because of the size, number or location of their fibroids. A hysterectomy is a surgical procedure which removes the entire uterus. While these options are generally effective, they require anesthesia and lengthy recovery times and carry a risk of surgical complications.
Non-Surgical Therapy
Uterine fibroid embolization (UFE) is a less invasive approach that is designed to preserve your uterus. UFE is performed by an interventional radiologist (IR), a doctor who uses X-rays and other imaging techniques to see inside the body and treat conditions without surgery. During UFE, you are given sedation medication but remain awake. The IR inserts a thin tube into an artery at the top of your thigh, then uses X-ray imaging to guide the tube to the uterine artery. Tiny round particles are injected into the blood vessels that lead to the fibroids. They block blood flow, causing the fibroids to shrink. The particles remain permanently at the fibroid site. The process is repeated in your other uterine artery for complete blockage of blood to the fibroid. Over time, your fibroids shrink, relieving your symptoms.

Benefits of UFE

Shorter hospital stay

UFE:< one day

Hysterectomy:2.3 days

Return to work faster

UFE:10.7 days

Hysterectomy:32.5 days

Fewer complications (after 30 days)

UFE:12.7%

Hysterectomy:32%

Health insurance coverage for UFE

Most insurance companies cover UFE as a treatment for symptomatic fibroids. Discuss your coverage with your doctor or insurance provider before the procedure.

How do I decide which treatment is best for me?

It is important that you understand all the treatments that are available to you. Therefore, you should have a detailed discussion with your physician about your options, including benefits and potential risks. Only you and your physician can decide which choice is best for you.

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Uterine Fibroid Embolization, A Patient's Guide to a Minimally Invasive Fibroid Treatment, Biosphere Medical, Inc., 2005.

Uterine Fibroids, A Patient's Guide, Boston Scientific, 2004.

For more information, or for an appointment for Uterine Fibroid Embolization, please contact Hutcheson Medical Center.