Uterine Fibroids - Feature 0410
Uterine fibroids, or leiomyomata are benign tumors of smooth muscle
that occur in the uterus. This is the most common pelvic mass in
women in the United States. This amounts to millions of women, but
fortunately three-fourths remain asymptomatic.
Common Symptoms
Approximately one quarter of women with fibroids seek medical
attention. The common symptoms are:
1) extremely heavy menses, which often leads to anemia.
2) bleeding in between periods.
3) pelvic pain
4) Pressure on the bladder and other organs.
Common Treatments
Traditionally, treatment of symptomatic fibroids has been
hysterectomy. Although surgery takes care of the problem
definitively, the result is irreversible lost of fertility
potential. Patients may also suffer a profound impact on their
gender identity. The number of hysterectomies fortunately is in
decline due to the advent of newer treatments, most notably
myomectomy, although these other methods may miss the culprit
fibroid and all report a recurrence rate between 15 and 25%.
While uterine-sparing treatments do maintain fertility potential,
the surgery takes longer and often results in much greater blood
loss and perioperative morbidity. The use of hormones, typically
estrogen-containing compounds or GnRH antagonists, while effective,
is not a good long term strategy. Moreover, when therapy is
discontinued, the fibroids typically regrow.
Fibriod embolization has been developed as a new less invasive
treatment for fibroids. The benefits are lower risks and a shorter
recovery time compared to a surgical procedure. The effectiveness of
the treatment is supported in multiple research studies.
For Physicians
All patients should be seen and evaluated by an experienced
clinician. Fibroids should be documented with an MRI or ultrasound
exam. The use of MR, while expensive, may provide anatomic detail
and functional information that can not be gained from ultrasound
alone. There are other causes for uterine bleeding which should be
evaluated. Preprocedure testing should include obtaining an
endometrial biopsy.
There are few contraindications, mainly which relate to healing and
recovery. Patients who have received pelvic irradiation or have
chronic endometritis may be at risk for infection. Patients with
chronic renal insufficiency should not be subjected to this
procedure, which requires iodinated contrast material. Malignancy
should also be excluded.
For Patients
The uterine artery embolization procedure typically takes between
one and two hours. It starts with an angiogram to delineate the
anatomy. Both uterine arteries need to be selectively catheterized
and embolized for successful treatment. Embolization is performed
with particles which are sized in the submillimeter range. These
occlude the arterioles and preferentially devitalize the fibroids,
while sparing the uterus. The procedure requires only conscious
sedation, with routine agents. General anesthesia is not necessary.
Immediately following embolization, most patients experience
significant pelvic pain, which may be accompanied by nausea. Pelvic
pain typically is the worst within the first few days, and tapers
off by the third to fifth day. Most patients are back to work within
a week.
Author
David Moody M.D.
References
Fertil Steril 2003;79:112-127
Ravina et al. Conception, Fertilité, Sexualité 1995; 23: 45-49
Ravina et al. Lancet 1995; 356: 671-672
Goodwin et al. JVIR 1997; 8: 517-526.
Stancato-Pasik et al. Radiology 1996; 201 (P):179
Dickey et al. JVIR 1997; 8 (Supplement): 241
Worthington-Kirsch et al. Radiology 1998; 208: 625-629
Goodwin et al. JVIR 1998; 9(Supplement): 53-58
Downie et al. CVIR 1998; 21: S142
Useful Links
www.fibroidoptions.com
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