What can I do about Uterine Fibroids?
Peter Hanson, MD
Vascular & Interventional Radiology
Chippewa Valley Vein Center
Eau Claire
What are uterine fibroids?
Uterine fibroids, also known as myomas or leiomyomas, are benign masses of the uterus occurring in 25–50% of women. Fibroids are usually diagnosed in women 30–40 years of age. Their exact cause is unknown, but a genetic predisposition is suspected. Symptoms occur in 10–30% of women and include heavy menstrual periods sometimes leading to anemia, bleeding between periods, pelvic pain and pressure and frequent urination. Fibroids can cause infertility
or miscarriage.
How are uterine fibroids diagnosed?
Uterine fibroids are usually diagnosed by a physician during a gynecologic pelvic examination when enlargement of the uterus is noted. Frequently, an ultrasound of the pelvis is then ordered and shows the fibroids and an enlarged uterus. Fibroids can also be detected on CT scans and are best seen on magnetic resonance imaging (MRI) scans. Sometimes other conditions mimicking
fibroids, such as ovarian cysts, can be seen on the imaging studies. A gynecologist can also view fibroids directly using a special tool called a hysteroscope.
How are uterine fibroids treated?
Conservative Options
Since most fibroids do not cause symptoms, they do not require treatment. When there are symptoms, the first step in treatment is usually medication. Fibroids are sensitive to hormones, so medications used to treat fibroids include birth control pills or other hormonal therapy medications such as Lupron. Non-steroidal
anti-inflammatory drugs such as ibuprofen or naproxen sodium can also be given to control symptoms. Unfortunately, the fibroids often grow back and the symptoms return once the therapy is discontinued. The next step is to consider more invasive options such as myomectomy, endometrial ablation, MR-guided ultrasound, hysterectomy and uterine artery embolization.
Myomectomy
With myomectomy, individual fibroids are removed through an abdominal incision with a laparoscope or trans-vaginally with a hysteroscope. The advantage is that fertility can be preserved. The disadvantage is that fibroids may recur and some fibroids cannot be treated with myomectomy.
Endometrial Ablation
Endometrial ablation involves destroying the lining of the uterus to control heavy bleeding. It has the benefits of preserving the uterus and can be done on an outpatient basis. The fibroids themselves, however, are not treated and therefore symptoms related to fibroid bulk persist. Also, fertility is not preserved.
High-Intensity Focused Ultrasound
High-intensity focused ultrasound can be used with MR guidance to treat fibroids. This is non-invasive and has a quick recovery. The procedure can take several hours and can only treat certain fibroids. It is not indicated in woman desiring future pregnancy. It is being investigated at larger healthcare centers and may not be covered by insurance.
Hysterectomy
Hysterectomy is surgical removal of the uterus and is 100% curative of symptoms related to uterine fibroids. The procedure is common and well established. Since it is more invasive surgery and involves a surgical incision, there is a higher rate of complications and a longer recovery time compared to other treatment options. Hysterectomy has been associated with other long-term physical and psychological effects. A woman is no longer able to have children after having a hysterectomy.
Uterine Artery Embolization
Uterine artery embolization (UAE) also known as uterine fibroid embolization (UFE) is a procedure performed by an Interventional Radiologist. Interventional Radiologists are physicians specially trained in performing minimally invasive procedures using imaging guidance such as ultrasound or x-ray. UAE is performed via a small nick in the skin with local anesthetic and IV medications for sedation. A small tube or catheter is guided using x-rays into the right and left uterine arteries and small plastic particles the size ofgrains of sand are injected into the arteries cutting off blood flow to the fibroids. The fibroids shrink over time. The procedure takes approximately one hour and most women stay one night in
the hospital after the procedure. Complications are low
(1–2%,similar to myomectomy) and recovery time is quick with most women returning to their normal activities by one week. The procedure has been shown to be 78–94% successful in controlling the symptoms fromuterine fibroids. The procedure can be performed in women with one or multiple fibroids. Fertility is typically preserved and women have gotten pregnant after UAE, but usually medical management or myomectomy is recommended over UAE in women wishing future pregnancy. Most insurance companies cover UFE.
More Information
For more information regarding uterine artery embolization or interventional radiology please feel free to visit the Society for Interventional Radiology website at www.sirweb.org and www.ask4ufe.com.
Dr. Peter Hanson – Medical X-Ray Consultants
For information or to schedule an appointment:
715-832-2200 | www.cvveincenter.com
Dr. Hanson sees patients in Eau Claire.
