WHAT ARE FIBROIDS?
Uterine fibroids are the most common benign (non-cancerous) tumors within the female reproductive system. While the majority of uterine fibroids are diagnosed and treated in women between the ages of 35 and 54, fibroids can occur in women under the age of 35, even as young as the early 20s.
A fibroid starts as a normal muscle cell in the uterus. For unknown reasons, this single cell grows and multiplies into a cluster of cells that form the fibroid. Fibroids are stimulated to grow by estrogen (a hormone produce by the ovaries) and blood flow. During menopause, as the estrogen level naturally declines, the fibroid tumor often shrinks on its own.
CAN FIBROIDS CAUSE CANCER?
In most women, fibroids do not lead to cancer. Rarely, fibroids have been reported to turn into a cancer of the uterus called leiomyosarcoma. This happens to an estimated 1 in 1000 women who have fibroids. The average age of women with leiomyosarcoma is 55. There are some medical researchers who recommend treating fibroids early, before they have a chance to turn into this rare cancer.
Recently, the FDA advised against another treatment for fibroids called ‘Power Morcellation,’ which may be performed with a hysterectomy, because of the possibility that it may spread un-diagnosed cancer to other areas. UFE does not use power morcellation, and therefore UFE is not known to cause spread of undiagnosed cancer. For more information, please read this FDA notice.
RISK FACTORS FOR DEVELOPING FIBROIDS
The following risk factors may contribute to development of fibroids:
- Family history
- Ethnicity. African American women are 2-3 times more likely than other women to develop fibroids.
- Increased estrogen levels
- Hypertension and obesity
- Red meat consumption. Available evidence suggests that women who eat more than one serving per day of red meat have a 70% greater risk for uterine myoma, compared with women who eat the least.
- Alcohol consumption. Women who had one or more drinks of alcohol per day, specifically beer, had more than a 50% increased risk for leiomyomata
Usually, fibroids are asymptomatic. However, fibroids may cause symptoms such as:
- Heavy, prolonged, monthly periods
- Irregular episodes of bleeding occurring separately from monthly periods
- Pelvic pain or pressure
- Pain during intercourse
- Frequent need to urinate
- Constipation or bloating
- An enlarged belly
DIAGNOSIS OF FIBROIDS
Depending on the size and location, fibroids may be detected through a routine pelvic exam and pelvic ultrasound. Often, an additional imaging test such as a contrast enhanced pelvic MRI may be utilized to more accurately identify the size, number, and location of all of the fibroids.
SURGICAL TREATMENT OF FIBROIDS
Traditionally, treatment for women with problematic uterine fibroids has been surgical: hysterectomy or myomectomy. These procedures are done by a gynecologist.
A myomectomy is a procedure in which a fibroid is removed laparoscopically through a small incision in the pelvis. A myomectomy will not prevent future fibroids from developing.
During a hysterectomy, a larger surgical incision is made in the pelvis, and the entire uterus is removed, including the fibroids. A hysterectomy may require a recovery time of up to 8 weeks, and there may be complications during the surgery such as heavy blood loss and formation of scar tissue (adhesions) in the abdomen which can wrap around bowel and cause a bowel obstruction.
More than 600,000 women undergo hysterectomies in the United States each year, but some doctors believe that many don’t need this drastic operation. In fact, according to several prominent medical studies, nearly 90 percent of hysterectomies may not be necessary.
UTERINE FIBROID EMBOLIZATION TREATMENT
Uterine fibroid embolization (UFE) is a nonsurgical permanent treatment for fibroids. Compared to the surgical options, UFE results in fewer complications, a shorter hospital stay and a far quicker recovery time. Long term data show that 90 to 95% of women who have the UFE procedure report ongoing satisfaction and significant or total symptomatic relief for many years following the procedure.
UFE is performed through a tiny puncture either in the femoral artery in the groin, or in the radial artery at the wrist. The radial artery puncture is a newer technique, and allows the patient to get off the procedure table quicker and also to position themselves more comfortably on the recovery bed.
Under fluoroscopic (xray) guidance, the interventional radiologist guides a wire and catheter into the uterine arteries on both sides (which supply the fibroids), and injects small particle, the size of grains of sand, that block the blood supply to the fibroids, causing the fibroid to shrink and die. The outpatient procedure is performed in about an hour in our on-site vascular suite, and the patient is awake but sedated and comfortable. Heavy periods usually take a few cycles to lessen. Patients can usually resume normal activity after a week (as opposed to a hysterectomy which usually requires a much longer recovery time).
After the procedure, the patient is prescribed medications to help control the cramping and pain that may develop. Light activities can be resumed in a few days, and most women return to normal activities in 7 to 10 days.
The American College of Obstetricians and Gynecologists (ACOG) has designated and approved UFE as a first-line treatment option for uterine fibroids.
At CFIM, our physicians are among the most experienced in the entire region at performing the UFE procedure. Call us today to schedule a free screening for this and other conditions at a CFIM office in northern Virginia (convenient to Springfield, Fairfax, Alexandria, Arlington, Woodbridge) or Maryland (convenient to Waldorf, La Plata, Clinton).