Uterine Fibroids

Uterine fibroids (also known as leiomyomas) are benign tumours of the muscular layer of the uterus (the myometrium). They can be a nuisance for many women, causing issues such as heavy periods, pelvic pain and complicating pregnancies. There are a range of treatments available for uterine fibroids, however Uterine Artery Embolisation offers a minimally invasive, safe option that preserves the uterus.

Uterine fibroids are one of the most common tumours in women. Seventy to eighty percent of women will have had a uterine fibroid by the age of fifty. Most commonly, uterine fibroids tend to affect middle-aged women, although most are too small to cause symptoms.

Symptoms

Although most fibroids do not cause symptoms, it can be quite debilitating when they do. The symptoms of uterine fibroids include:

  • Bleeding. Heavy periods that may be irregular or last longer than usual
  • Pelvic pain or pressure occurs as the fibroids get larger, degenerate or bleed.
  • Pregnancy issues. Large fibroids may prevent pregnancy or cause recurrent miscarriage.
  • Urinary or bowel issues. Fibroids may put pressure on other organs in the pelvis such as the bladder and rectum, causing urinary symptoms (e.g. frequency or urgency) and intestinal symptoms (e.g. constipation) respectively.

Diagnosing Uterine Fibroids

Occasionally, fibroids may be felt on examination of the pelvis, but usually require imaging to confirm the diagnosis.

The diagnosis is made by a combination of history, examination, and imaging. Transvaginal ultrasound is a cost effective method of looking at the layers of the uterus. MRI is the most accurate imaging test, however is more expensive and time consuming.

Treatment Options

There are many treatments for fibroids, including a wide range of medications and surgical options. Fibroids that do not cause symptoms do not require any treatment.

The range of medications used to treat fibroids includes:

  • Analgesics (pain relief). Non-steroidal anti-inflammatory drugs can reduce the pain associated with fibroids, but have no action against the fibroids.
  • Hormones or hormone analogues. Progestins are drugs similar to the naturally occurring hormone progesterone. They can suppress fibroid growth and fibroid symptoms. They need to be taken daily and have a contraceptive effect. GnRH agonists mimic a naturally-occurring hormone called GnRH (Gonadotropin releasing hormone). This can reduce the size of fibroids and improve symptoms. They are usually given for 3-4 months prior to surgery to reduce the size of the fibroids and make surgical removal easier.

Uterine Artery Embolisation Q and A;

Q. Can the particles used in uterine artery embolisation leak or cause any damage to other parts of the body?

A. Bio absorbable particles are injected into the artery supplying the fibroids. Non-target embolisation, a condition when some particles inadvertently flow into other parts of the body, may occur in extremely rare cases.

Q. How fast does uterine artery embolisation work?

A. Fibroids begin to shrink immediately. Improvement in bleeding is immediate, and shrinkage is reached 90% of total by six months after the procedure. Heavy bleeding from fibroids reduces significantly from the next menstrual period.

Q. Are there side effects from the Uterine Artery Embolisation?

A. Most patients experience cramping pain for one or two days after embolisation. Patients go home on the  next day. Some patients, especially those with larger fibroids experience a low-grade fever for a few days after embolisation.This is referred to as post embolisation syndrome.

Q. Is general anesthetic administered?

A. For embolisation, no. This procedure is done under local anaesthetic and sedation in most instances. General anaesthetic is rarely used. A nerve block (hypogastric nerve) may also be performed before, during or after the procedure.

Q. Will uterine artery embolisation keep new fibroids from forming?

A. Recurrence after embolisation may occur. This can also happen after myomectomy. Uterine artery embolisation can be repeated if required and does not prevent or preclude further surgery including myomectomy or hysterectomy from being performed in the future.

Q. What are some of the reasons I wouldn’t be a candidate for uterine artery embolisation?

A. Embolisation is not a cure for cancer. Certain other diseases might be present causing symptoms similar to those caused by fibroids. We will screen you for these conditions.  Allergy to iodinated contrast (dye given during the procedure) and pregnancy are contra indications.

Q. Is embolisation experimental?

A. Embolisation has been used to control hemorrhage (heavy bleeding) in many parts of the body, including the uterus for more than twenty years. Nothing is experimental about the procedure. Embolisation has been approved by Medicare, and is covered by all private health insurance plans. The procedure has been endorsed by the National Institute of Clinical Excellence (NICE) and the other major Interventional Radiology societies around the world including CIRSE(Cardiovascular and Interventional Radiology society of Europe) and SIR(Society of Interventional Radiology of North America)

Q. What about fertility?

A. Women have conceived after embolisation. Women have successfully carried babies to term after embolisation. Early menopause less than 4% in women under 45 and unto 20%  over that age. Ask your doctor about the risks to fertility associated with major surgery such as myomectomy.

 Q. I have several fibroids, one that is said to be pedunculated, outside of my uterus. Can these type of fibroids be treated with Uterine Artery Embolisation?

A. Yes. Many types of fibroids can be treated with UAE, because the procedure involves blocking the blood supply to the fibroid. Certain narrow necked pedunculate fibroids with long stalks may be easier to access  with laparoscopic surgery.

Success Rate of Embolisation

Uterine Fibroid Embolisation has an overall success rate of 94%. This means 94% of all patients who had the procedure experienced relief from their symptoms and significant fibroid shrinkage.

  • 99% of patients had immediate relief from heavy bleeding
  • 94% of patients experienced 50-60 percent shrinkage
  • 48% of patients who attempted to conceive were successful
  • 99% of patients returned to work in less than a week

Potential Complications

Embolisation is a minimally invasive and very safe procedure, but some side effects and risks are associated. Post procedure cramping is the most common, but usually controlled by pain-killers. Other side effects include:

  • Nausea and fever in 1% of patients
  • Infection leading to hysterectomy less than 0.1% of patients
  • Artery injury less than 0.1%
  • Early menopause less than 4%
  • Possible passage of fibroid vaginally 2%
  • Non-target embolisation, extremely rare

We are here to help

If you have any further questions regarding Uterine Fibroids and treatment through Uterine Artery Embolisation in Perth, please do not hesitate to contact our Subiaco rooms on (08) 9284 2900. 

Links:

The Society of Interventional Radiology recently released a campaign #fibroidfix to educate women around the world of the non-surgical, minimally invasive treatments available for fibroids. A hysterectomy may not be your only answer.

You can read more on this campaign below;

UFE – Patient Info Sheet

https://www.sirweb.org/patients/fibroid_fix2/ufe-resources/

UFE – Procedure Checklist

https://www.sirweb.org/patients/fibroid_fix2/ufe-checklist/

http://www.sirweb.org/patients/uterine-fibroids/

http://www.insideradiology.com.au/pages/view.php?T_id=50#.V6LYXcf82Cx