Fibroids & You

By Dr. Pankit Parikh, MD

WHAT ARE FIBROIDS?

Fibroids are benign (non-cancerous) tumors that are found in the muscular wall of the uterus.  They affect the majority of women, up to 80%, by the age of 50 years, however are more common in African American, Middle Eastern, and South Asian women.

WHAT ARE SYMPTOMS OF FIBROIDS?

Heavy, irregular vaginal bleeding (Menometorrhagia)
Increased abdominal girth/bloating
Debilitating cramping
Pelvic pressure and pain
Urinary frequency
Constipation
Pain during sex

HOW ARE FIBROIDS DIAGNOSED?

The most accurate test for fibroids is a pelvic MRI, however most fibroids are diagnosed by ultrasound. 

HOW ARE FIBROIDS TREATED?

Endovascular and minimally invasive surgical options are available. Options include hysterectomy (removal of the entire uterus) and myomectomy (removal of a 1 or more fibroids), performed by a gynecologist. The risks of hysterectomy include injury to the bowel, ureters (tubes that carry urine to the bladder), incision site complications (infection, hernia, etc.) and injury to nearby blood vessels. Though these complications are relatively rare, they should be considered prior to choosing a surgical therapy. More importantly, with myomectomy, the recurrence rate is nearly 50% at 3 years and more than 60% at 5 years.  That means most women will have more fibroids pop up after myomectomy.  As for hysterectomy, if you have large fibroids, you may require a large incision or a process called morcellation which involves grinding up large fibroids while still in your body to get them out through small incisions made for laparoscopic or robotic surgery. 

This process could result in the unintentional spread of an undetected cancer cells in the fibroids throughout your body.  In fact, the FDA banned morcellation in 2014 due, in part, to a higher than expected rate of spreading cancer.  While morcellation has been reinstated, the American College of Gynecology recommends that all patients be made aware of this small risk.

A minimally invasive and effective treatment for fibroids is Uterine Fibroid Embolization (UFE).  The advantages of UFE are greater than 90% effectiveness, outpatient procedure (does not require admission to the hospital), and a short recovery time of 1-2 weeks.  As opposed to a myomectomy, UFE treats the whole uterus and the rate of recurrence is at most 17.2% at 30 months.  In my practice, this number is essentially 0%. Complications of UFE are rare (major complications are less than 3%) but include injury to the blood vessel that is accessed and infection. Though rare, early onset menopause can occur in women in their mid to late forties.

HOW IS A FIBROID EMBOLIZATION PERFORMED?

Fibroid embolization is a non-surgical treatment for fibroids. A small needle is inserted in the artery in the wrist or groin and then a series of small wires and catheters are directed into the arteries that supply the uterus. Small beads are then injected to stop blood flow to the fibroids. The artery is then sealed with brief compression or a closure device. The procedure usually lasts 45 to 90 minutes.

WHAT SHOULD I EXPECT AFTER THE PROCEDURE?

Most women will experience 1-5 days of cramping after the procedure. A small percentage of women may experience fevers, chills and body aches, though this usually only lasts for 1-3 days and is usually not dangerous. Many women will also experience passage of fibroid material, similar to a normal menstrual cycle. Most women are able to resume light activity in 3-5 days and full activity in 1-2 weeks.

CAN UFE TREAT ADENOMYOSIS?

Fibroid embolization is an effective treatment for adenomyosis as well as a combination of adenomyosis and fibroids. For patients with only adenomyosis, the largest study to date demonstrates a short term improvement in 90% and a long-term durable improvement in 74% of women.

CAN I GET PREGNANT AFTER A UFE?

Yes, rates of fertility after myomectomy and UFE are similar, around 50-60%.  One study followed 359 women with fibroids who could not get pregnant.  After UFE, 41.5% of those women became pregnant one or more times and a total of 131 women gave birth to 150 children.

BOTTOM LINE

Most, if not all, women with symptomatic fibroids and/or adenomyosis should be offered UFE.

REFERENCES

Spies JB. Current evidence on uterine embolization for fibroids. Semin Intervent Radiol. 2013;30(4):340-346. doi:10.1055/s-0033-1359727

Nezhat FR, Roemisch M, Nezhat CH, Seidman DS, Nezhat CR. Recurrence rate after laparoscopic myomectomy. J Am Assoc Gynecol Laparosc. 1998 Aug;5(3):237-40. doi: 10.1016/s1074-3804(98)80025-x. PMID: 9668143.

Marret H, Cottier JP, Alonso AM, Giraudeau B, Body G, Herbreteau D. Predictive factors for fibroids recurrence after uterine artery embolisation. BJOG. 2005 Apr;112(4):461-5. doi: 10.1111/j.1471-0528.2004.00487.x. PMID: 15777445.

Toor SS, Jaberi A, Macdonald DB, McInnes MD, Schweitzer ME, Rasuli P. Complication rates and effectiveness of uterine artery embolization in the treatment of symptomatic leiomyomas: a systematic review and meta-analysis. AJR Am J Roentgenol. 2012;199(5):1153-1163. doi:10.2214/AJR.11.8362

Pisco JM, Duarte M, Bilhim T, et al. Spontaneous Pregnancy with a Live Birth after Conventional and Partial Uterine Fibroid Embolization. Radiology. 2017;285(1):302-310. doi:10.1148/radiol.2017161495

de Bruijn AM, Smink M, Lohle PNM et al (2017) Uterine artery embolization for the treatment of adenomyosis: a systematic review and meta-analysis. J Vasc Interv Radiol 28:1629-1642.