What are other names for fibroids?
You might hear fibroids referred to by other names, including myoma, leiomyoma, leiomyomata and fibromyoma. They all refer to the same thing, fibroids.
What are typical symptoms of uterine fibroids?
Symptoms related to uterine fibroids vary depending on location, size and number of the fibroids present. Symptoms may include:
How are uterine fibroids diagnosed?
Fibroids may be diagnosed during a gynecologic examination. The presence of fibroids is confirmed by an abdominal ultrasound (US).
Fibroids also can be confirmed using magnetic resonance imaging (MRI). Ultrasound & MRI are painless diagnostic tests. Appropriate management may vary depending on the size and location of the fibroids, as well as the severity of symptoms.
How are uterine fibroids treated?
Most fibroids do not cause symptoms. Asymptomatic fibroids do not require treatment, only when they cause symptoms are they treated.
When fibroids are symptomatic, then treatment is warranted.
There are many methods to managing/treating fibroids, but each different with pros and cons.
Myomectomy: Myomectomy is a surgical procedure that removes visible fibroids from the uterine wall. Myomectomy, like UFE, leaves the uterus in place and may, therefore, preserve the woman’s ability to have children. There are several ways to perform myomectomy, including hysteroscopic myomectomy, laparoscopic myomectomy and abdominal myomectomy.
Hysterectomy (Surgical): This involves complete surgical excision (removal) of the uterus as the solution for the fibroids. It is major surgery and requires extended hospital stay and recovery period, usually for several weeks. This used to be the only treatment for fibroids, however decades ago. There are higher risks and complication rates related to this type of treatment, when compared to UFE.
Myomectomy and hysterectomy carry risks, including infection and bleeding leading to transfusion. Patients who undergo myomectomy may develop adhesions causing tissue and organs in the abdomen to fuse together, which can lead to infertility.
Imaging-Guided Focused Ultrasound Ablation: MRI or Ultrasound Guided Focused Ultrasound is a relatively new treatment (available since 2004) choice for the treatment of fibroids. MR Guided Focused Ultrasound (MRgFUS) or High Intensity Focused Ultrasound (HiFU) is a revolutionary, completely non-invasive treatment option for some women with fibroids and shows great promise in the treatment of smaller and medium sized fibroids. This procedure is performed as an outpatient procedure and patients remain conscious but, sedated and feeling no pain. It does not require general anesthesia and recovery time is also significantly reduced compared with surgical alternatives. MRgFUS is a completely non-invasive treatment option that has shown great promise in the treatment women with smaller and medium sized fibroids and gives them fast recovery with limited side effects. The system is not widely available.
Alternative Therapy: Many aspects of our lives interrelate with others including but not limited to: Stress, Sleep, Diet, Nutrition and Exercise. By modifying many of these factors with any combination of nutrition and lifestyle counseling, vitamin and herbal supplements, homeopathy and bodywork therapies, symptoms may be decreased or even eliminated. For example, nutritional modifications such as a decrease in the intake of inflammatory foods (caffeine, alcohol, processed junk foods) and environmental hormones (red meats and dairy products with estrogens) with an increase in the intake of anti-inflammatory foods, whole fiber and organic foods may improve symptoms.
Uterine Fibroid Embolization (UFE):This is the most common method of treatment and much less invasive when compared to the surgical alternatives.
o Procedure Description:
o Before the Procedure:
§ Blood tests
§ MRI of the pelvis/uterus to evaluate the fibroids prior to the procedure (if not already done)
§ Clinic visit to discuss the details of the procedure and answer any questions
o After the Procedure:
§ Women usually stay in the hospital overnight after UFE.
§ Some women are able to go home a few hours after treatment, but this is less common.
§ Pain medications are given.
§ Should lie flat for 4 to 6 hours after the procedure, minimizing mobilization.
§ Pelvic cramps are common for the first 24 hours after the procedure. They may last for 2 weeks. Cramps may be severe and may last more than 6 hours at a time.
§ The changes of symptoms after UFE are variable amongst women. The symptoms of pain and bleeding may decrease, increase, or change in frequency after the initial week or two.
§ Fibroid shrinkage, with reduction of abdominal fullness and distention, may not be noticed except after several weeks or months after the UFE.
§ The treated fibroid tissue may pass through your vagina, if it is in a submucosal location.
While embolization to treat uterine fibroids has been performed since 1995, embolization of the uterus is not new. Interventional radiologists have used it successfully for over 20 years to treat heavy bleeding after childbirth (postpartum hemorrhage – PPH).
The procedure is now available at hospitals and medical centers across the world. Hundreds of thousands of women have been treated by UFE all over the world. UFE is considered the “Gold-Standard” for the treatment of women symptomatic fibroids.
How successful is the fibroid embolization (UFE) procedure?
Studies show that 85-95 percent of women who have the procedure experience significant or total relief of heavy bleeding, pain and other symptoms.
Bulk related symptoms such as pelvic pain, pelvic pressure, frequent urination, constipation, back pain and painful intercourse are controlled in 80 to 95 percent of patients undergoing UFE.
Careful pre-procedure planning and evaluation are vital to increasing the chance of a successful outcome.
The procedure also is particularly effective for multiple fibroids.
Recurrence of treated fibroids is very rare.
Are there risks associated with the UFE?
Fibroid embolization is considered to be very safe, however, there are some associated risks, as there are with almost any medical procedure.
A risk for any anesthesia is having a bad reaction to the anesthetic that is used, although rare.
The risks for any invasive procedure include: bleeding, infection and bruising.
The risks of uterine artery embolization are:
o Injury to an artery
o Injury to the uterus (less than 1%), and in some rare cases may require a hysterectomy.
o Complications with a future pregnancy.
o Early menopause
Most women experience moderate to severe pain and cramping in the first several hours following the procedure, which may last for a day or two. Some experience nausea and fever. These symptoms are usually well controlled with oral medications.
A very small number of patients have experienced infection, which usually can be controlled and prevented with antibiotics before and after the procedure.
These complication rates are much lower than those of hysterectomy and myomectomy.
You should talk with your doctor about possible risks of any procedure you may choose.
What happens to the fibroids after embolization?
After cutting of the blood supply to the fibroids, they shrink an approximately 40-60% in size and also change in consistency, changing from very firm muscular tissue to a soft, fluid-like or spongy consistency. Small fibroids are very rarely completely re-absorbed or disappear. However, this does is not clinically significant. What matters ids the improvement and disappearance of the symptoms related to the fibroids.
What happens to the tiny particles used for the embolization in the UFE?
The tiny particles (or microspheres) used to block the blood supply in the uterine arteries are trapped within the small branches of the uterine arteries within the fibroid tissue. They are too large to travel forward through the small capillary bed and they cannot move backwards in the uterine artery against the remaining incoming blood flow. These particles have not been shown to cause any long-term effects.
Will fertility be affected?
There have been numerous reports of pregnancies following uterine fibroid embolization, however prospective studies are needed to determine the effects of UFE on the ability of a woman to have children.
There may be complications with a future pregnancy. Some of these are intrauterine growth restriction (a condition that causes the baby to grow more slowly than usual in the uterus), preterm delivery (the baby is born early), bleeding after delivery, problems with the placenta, and miscarriage.
Pregnancy is not generally recommended after this procedure, however still possible, and may be attempted, but should be discussed with your gynecologist and should be attempted only after at least one year after the UFE procedure.
Will insurance pay for the fibroid embolization procedure?
Most insurance companies pay for fibroid embolization. You will want to talk with your interventional radiologist about this before your procedure.
Why doesn't my gynaecologist offer UFE procedure?
Interventional Radiologists are specially trained in performing UFE procedures and this training is certified by the Board of Medical Specialties. While gynecologists are specially trained
to performed hysterectomies, myomectomies and other less invasive laparoscopic and hysteroscopic surgical procedures, most of them have not been formally trained and therefore do not possess the
skills necessary to perform uterine fibroid embolization.
How do I know if I am a candidate for uterine fibroid embolization (UFE)?
Whether or not a patient is a candidate for UFE depends on the exact size, number and location of the fibroids as well as the patient's symptoms.
A detailed medical history and pelvic MRI are necessary prior to making a final determination.
The ideal candidate is a patient who no longer desires fertility, has multiple small to medium size fibroids and whose primary clinical symptom is heavy menstrual bleeding (menorrhagia).
However, this does not exclude the possibility of becoming pregnant after UFE.
Large fibroids may also be treated by UFE, however the decrease in size is only partial.
If I would like to maintain fertility, could I still be a candidate for UFE?
The ideal candidate for uterine fibroid embolization has no desire for future fertility.
While there have been multiple anecdotal reports of normal pregnancies following uterine fibroid embolization in the medical literature, it is currently unknown whether there is any increase risk of infertility or pregnancy following this procedure.
Therefore, UFE is generally not recommended in patients who still desire fertility unless: The patient has failed other treatment options such as myomectomy and the only other option is hysterectomy;
Due to the size, number, and/or location of the fibroids, there is a relatively high risk of a myomectomy resulting in a hysterectomy or causing significant scarring within the uterus, thus eliminating or significantly decreasing the patient's fertility.
Can UFE be used to treat other conditions such as adenomyosis?
Currently, UFE is only indicated for the symptoms caused by uterine fibroids. Patients with pain or abnormal bleeding caused by adenomyosis may be treated by UFE. However, clinical results are less impressive when compared to the clinical results in treating uterine fibroids with UFE.
Is UFE a safe procedure?
Uterine fibroid embolization has been performed safely in thousands and thousands women worldwide. While no procedure is without risk, fibroid embolization has been shown to have a lower major complication rate than traditional surgical treatment options such as myomectomy. The two most serious potential complications are infection and ovarian failure leading to premature menopause. Infections are extremely uncommon and can usually be treated with oral or IV antibiotics. Rarely (much less than 1 percent), a severe infection can develop and may require the patient to undergo a hysterectomy. Ovarian failure leading to premature menopause is also relatively uncommon occurring in 1 to 2 percent of most patients and 2 to 4 percent of women nearing menopause.
Do fibroids grow back after UFE?
There is no evidence at this time that adequately treated fibroids grow back after uterine fibroid embolization. If, however, a fibroid's blood supply is not completely eliminated, it could continue to grow and cause symptoms. By comparison, approximately 30 percent of patients have a recurrence of fibroids after myomectomy.