Uterine fibroids are benign tumors of the uterus mostly made up of smooth muscle cells. They are the most common tumor of the female reproductive tract and are the reason behind nearly one-third of the hysterectomies done in the US.
Fibroids change the normal uterine structure, and this can cause excessive bleeding, as well as fullness and pressure on the bladder. Though they usually happen before menopause, they are more common with increasing age. This combined with a trend toward delayed childbearing means that fibroids and fertility problems often go together.
Typical first treatments include IUDs that contain progestin, or birth control pills. If this doesn’t work to relieve excessive bleeding, or if the main problem is pressure, then surgical removal of fibroids may be necessary for relief and to restore quality of life.
Surgical Removal of Uterine Fibroids
Hysterectomy is not generally the first treatment of choice for surgical removal of fibroids. A procedure called a myomectomyremoves the fibroid laparoscopically or through a standard abdominal incision, depending on the location and size of the fibroid. Myomectomy is considered a preferable surgical option for women who want to retain fertility. With a myomectomy, the surgeon’s goal is to remove fibroids that are causing problems, performing any necessary uterine repair, and leaving the uterus intact. Alternatives to myomectomy and hysterectomy are available, however.
Fibroid Ablation With Electrodes
Global fibroid ablation essentially destroys fibroids by first using medical imaging to verify the number and location of the growths. Guided by the medical imaging studies, electrodes are routed directly into each fibroid – several can be treated simultaneously. The electrodes create heat, and how hot and how long the electrodes activate depends on how big the fibroids are. After the procedure, the fibroids shrink steadily over a course of several months. Ablation can destroy fertility, however.
Uterine Fibroid Embolization
Uterine fibroid embolization (UFE) is a minimally invasive interventional radiology procedure performed by interventional radiology experts like Linda Hughes, MD. With UFE, real-time x-ray fluoroscopy guides what are known as “embolic agents” to the fibroids in the uterus. These agents block the arteries that supply blood to the fibroids. With their blood supply choked off, the fibroids shrink. Nearly 90% of women who have UFE experience significant or even complete resolution of their fibroid symptoms.
One of the biggest advantages of UFE, according to Hughes, is that it doesn’t have to be performed in a hospital, but can often be done in an interventional radiology facility, some of which are designed to feel less “clinical” and more luxurious and comfortable. With UFE, healing and recovery are faster, and the risks of hospitalization can generally be avoided.
Embolization and Pregnancy in Women Under 40
Another factor that favors UFE is that it can preserve fertility. Researchers in California conducted a small study in women under 40 who underwent UFE and were advised to wait at least six months before attempting to conceive. The fibroids themselves don’t necessarily cause infertility, but they can contribute to loss of pregnancies.
Twenty-eight pregnancies were documented, of which 86.3% proceeded without complications. This represented a 47.7% pregnancy rate in women younger than 40. For comparison, with laparoscopic myomectomy, subsequent pregnancy rates ranged from 16% to 33%, while abdominal myomectomy was followed by pregnancy rates of 10% to 46% and hysteroscopic myomectomy resulted in pregnancy rates of 8% to 35%.
Medical Imaging Guides Treatment, Not Just Diagnosis
Medical imaging is most closely associated with diagnostic procedures, such as using x-rays to diagnose a bone fracture. But medical imaging is increasingly used for what are known as interventional radiology procedures, where physicians use medical imagery to directly guide treatments, like the UFE procedures Dr. Hughes performs. The goal with interventional radiology is to provide effective treatments that are less invasive and result in shorter hospital stays and quicker recoveries. As common as uterine fibroids are, interventional radiology techniques like UFE show tremendous promise.
The radiologists who own and operate SteleRAD are all Board-certified and have decades of combined experience in all types and aspects of medical imaging. Hospitals, physician practices, and medical imaging centers throughout South Florida call upon the expertise of SteleRAD’s physicians regularly. If you would like to know more, we encourage you to call us at 954-358-5250, or contact us online.