What are Uterine Fibroids? Benign growths of uterine muscle Also called leiomyomas Classified according to location: Submucosal- adjacent to the lining of the uterine cavity Intramural- within the wall of the uterus (most common type) Subserosal- beneath the exterior lining of the uterus Fibroids are frequently multiple and vary in size What are the Symptoms? Heavy menstrual bleeding (menorrhagia) This may lead to anemia Size related symptoms Abdominal distension Bladder pressure (constant urge to urinate) Constipation Pelvic pain or pressure Pain during intercourse How Common are Fibroids? Most common pelvic tumor in females Found in 25-50% of all women Symptoms produced in one-fourth of women with fibroids Women are usually symptomatic in their 30's and 40's Growth of fibroids fueled by estrogen, therefore, they enlarge before menopause and may continue to grow with hormone replacement therapy after menopause How are Fibroids Diagnosed? Your doctor will obtain a history of your symptoms and perform a gynecologic exam An ultrasound or magnetic resonance image (MRI) performed to document the size, number, and location of the fibroids How are Fibroids Treated? Hysterectomy is the most common form of treatment for symptomatic fibroids. Approximately 200,000 hysterectomies are performed each year in the U.S. for fibroids. Advantages: Well established procedure 100% effective in controlling symptoms Disadvantages: Major surgery with risks of anesthesia, hemorrhage, infection, adhesions, and injury to adjacent organs. Relatively long recovery period (4-6 weeks). Possible emotional effects due to the loss of uterus. Question of potential sexual dysfunction in some women. Myomectomy is surgical resection of individual fibroids. Advantages: Preserves fertility in most cases Preserves the uterus Disadvantages: Risks of surgery and anesthesia, like a hysterectomy. Relatively long recovery period, like a hysterectomy. Recurrent symptoms in 20% require additional therapy. Not all fibroids are amenable to myomectomy. Hormonal therapy (Lupron) blocks estrogen production which usually shrinks fibroids and improves symptoms. Advantages: Non-invasive and less expensive. Disadvantages: Produces symptoms of menopause. Used on short-term basis prior to surgical treatment or prior to menopause. Fibroids usually grow back to original size when hormone therapy is stopped. Embolization is the intentional blockade of the blood supply to the uterus. This leads to shrinkage of the fibroids and resolution of symptoms. Advantages: Less invasive than surgery. Shorter recovery period (6 days compared with 6 weeks). Uterus is preserved. All fibroids treated simultaneously (compared with myomectomy which frequently cannot remove all at once) 90% more effective in treating heavy menstrual bleeding. 90% more effective in shrinking fibroids. Possibility of less effect on sexual function (this is very difficult to study scientifically and the true effect of hysterectomy or embolization on sexual function is unknown at this time). Disadvantages: Post-embolization side effects for the first 3-4 days after the procedure (pelvic cramps, low-grade fever, nausea). These symptoms are quite variable and are generally controlled with medications. Who Performs Uterine Fibroid Embolization? Only a board certified vascular and interventional radiologist should perform the procedure. Interventional radiologists are specially trained to perform angiograms and embolizations. Embolization has been a part of practice of interventional radiology for 20 years. It is not experimental. The method of blocking the blood flow to an organ with angiographic techniques has been used by interventional radiologists to treat tumors, stop hemorrhage from trauma, and even stop bleeding from the uterus after delivery. Questions to ask your interventional radiologist: How many years experience do you have? Is your practice dedicated to interventional procedures? Do you have a certificate of added qualification? Help explain all my options for treatment of fibroids. Which is the best for me? How is the Procedure Performed? You check into the hospital early in the morning. You are taken to an angiography suite in the Radiology department. An angiogram will be performed to map the uterine arteries. A micro-catheter, about the size of a spaghetti noodle, is passed into the uterine arteries through a nick in the skin. Small inert particles that look like tiny grains of sugar are infused into the arteries to block the blood flow to the fibroids. The catheter is removed from the artery and you are admitted to the hospital for observation. After the Embolization Procedure Recovery in the hospital overnight, discharge the next morning. Recuperate at home for the next 4-5 days. Medications given to counteract the effects of the embolization. Pelvic cramps, low-grade fever, and nausea occur in variable amounts for a few days after the procedure. These symptoms do not always happen, but are typically well tolerated with appropriate medication. Results 90% effective in relieving symptoms (i.e. decreased bleeding) 90% of women have 50-65% shrinkage in fibroid bulk. This relieves bladder compression, constipation, and abdominal distension associated with bulky fibroids. Patient satisfaction surveys show 95% of women who had the embolization procedure would strongly consider or definitely undergo the procedure again given the alternatives.