Uterine fibroids afflict 20 to 40 percent of women age 35 and older. Uterine fibroids are common benign growths that develop in the muscular wall of the uterus. Sizes range from a quarter of an inch to larger than a cantaloupe, and typically there is more than one fibroid present. African American women are at a higher risk of fibroids with almost 50 percent having fibroids of significant size. In the past, the standard for treating women with painful fibroids was myomectomy, an open surgery that involves cutting out the biggest fibroid or collection of fibroids then stitching the uterus back together. In extreme cases a hysterectomy is performed.
Since most fibroids don’t cause symptoms, only 10 to 20 percent of women who have fibroids require treatment. For those who have pain, heavy bleeding and bladder pressure, these symptoms can be too much to ignore, and there is a minimally invasive procedure called uterine fibroid embolization (UFE). Although not a new procedure, it really has only increased in use in the past few years with greater media attention, including the fact that Secretary of State Condoleezza Rice received the procedure.
Uterine fibroid embolization is performed by an interventional radiologist while the patient is conscious. A catheter is inserted into the femoral artery while the physician uses image guidance to navigate the catheter. Tiny particles the size of grains of sand are released into the uterine arteries that supply blood to the fibroid tumor. This devascularizes the tumor, causing it to shrink. Patients typically don’t have to stay overnight; however, it can be a painful procedure, especially for patients with larger fibroids.
“I try to tell women the advantages of this are a shorter recovery time, less complications and morbidity,” explains Dr. Jon Roberts, interventional radiologist with Memphis Radiological PC. “I present it to patients as an informed option. Some women may rather go ahead and have surgery.” Side effects include pain, nausea and fever, but Roberts says they clear up in a few days. He says he usually sends patients home after four hours, not requiring them to stay overnight.
According to the Society of Interventional Radiology, an estimated 13,000 to 14,000 UFE procedures are performed annually in the United States. On average, 85 to 90 percent of women who have had the procedure experience significant or total relief of heavy bleeding, pain and bulk-related symptoms. The procedure has shown effective for multiple and large fibroids. Recurrence of treated fibroids is very rare. Short and mid-term data show UFE to be very effective with a very low rate of recurrence.
The embolization of fibroids was first used to decrease blood loss during myomectomy.
After women underwent the devascularization procedure from a radiologist, much to the surprise of the initial users of the procedure, these patients began to feel better and opted out of the surgery. “Anybody that doesn’t have to have abdominal surgery, that’s a benefit,” says Roberts. “You can have a totally uncomplicated abdominal surgery and five years from now you start to develop adhesions. It’s very rare for us [using this procedure] to have complications of any kind.”
Interventional radiologists have a working relationship with gynecologists who refer their patients to be evaluated for the procedure. Most women with symptomatic fibroids are candidates for UFE and can obtain a consult with an interventional radiologist.
Memphis Medical News, June 2006
BY HOLLI W. HAYNIE