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Uterine fibroids are benign tumors, which can cause symptoms such as excessive bleeding, pelvic pain and pressure, painful sexual intercourse, urinary bladder pressure and urgency, and abdominal distention. If left untreated, the symptoms can persist until menopause, which severely impacts the patient’s quality of life.  Approximately 25 million women in the U.S. have uterine fibroids. Fibroids can grow within the muscle of the uterus, along the outside of the uterus, and into the cavity of the uterus.

Fortunately most fibroids do not cause symptoms; approximately 10 to 20% of women with fibroids require treatment.  Many of these women are treated with drugs that are not curative and often have severe side effects such as osteoporosis, menopausal symptoms, and amenorrhea in premenopausal women. Despite evidence that indicates fibroid size shrinks with hormonal treatment, symptoms usually return to pretreatment levels within six months to a year after ceasing the hormonal therapy.  Some of these women undergo hysterectomy or myomectomy for treatment
of fibroids. A hysterectomy requires at least a hospital stay of three to five days, with a recuperation time of six to eight weeks. Furthermore, this treatment does not accommodate those patients who want to retain their fertility. A myomectomy is the surgical removal of the fibroids, and although the patient’s fertility usually remains intact, it is generally performed only on those patients with a few small fibroids. Multiple myomectomies have been associated with increased blood loss, operating time, pain and postoperative morbidity, as well as longer hospital stays as compared to hysterectomy.

However, women suffering from symptomatic uterine fibroids may also benefit from a minimally invasive catheter-based vascular procedure as an alternative to traditional surgical hysterectomy or myomectomy.  The procedure, uterine artery embolization (UAE), is performed by an interventional radiologist.  A catheter is inserted into the femoral artery (at the groin), and is guided into the arteries supplying the uterus.  Blood flow to the uterus is evaluated as contrast is injected through the catheter.  Small particles are then slowly injected through the catheter, and are carried by the blood to the fibroid tumors.  The small particles accumulate within the tumors and within the arteries supplying the tumors, and therefore block the blood supply.  The fibroids then die, and ultimately shrink in size.  The procedure treats the entire uterus, including fibroids that are small and not detectable with imaging studies.

Uterine artery embolization is performed with conscious sedation in the Radiology Department.  The procedure typically lasts an hour and a half.  There are no incisions, as the entire procedure is performed through the vascular access in the groin.  Upon completion of the procedure, patients spend 2 hours in a recovery area and are then admitted to the hospital usually for a one-night stay.  Patients are discharged the following day, and can usually resume normal activities in seven to ten days.

Many studies have shown that in comparison to hysterectomy, UAE offers a shorter hospital stay, shorter recovery time, and fewer complications after 30 days.  Approximately 85 to 90% of all women were satisfied or very satisfied, and experience significant or total relief of heavy bleeding, pain, and/or bulk-related symptoms. In August 2008, practice recommendations from the American College of Obstetricians and Gynecologists stated that UAE is “safe and effective” based on scientific evidence.  Potential benefits of fibroid treatment with UAE include:  preservation of the uterus, decrease in heavy menstrual bleeding from symptomatic fibroids, decrease in urinary dysfunction, decrease in pelvic pain and/or pressure, minimal blood loss, short-stay admission, and safe procedure with minimal risk.  Recurrence of treated fibroids is very rare according to short and mid-term data.  In one study in which patients were followed for six years, there were no recurrences among fibroids that had been completely embolized.

UAE is covered by most major insurance companies and is widely available in the United States.  Most women with symptomatic fibroids are candidates for UAE and should obtain a consultation with an interventional radiologist to determine if UAE is an option for them.  An MRI will aid in the determination of the appropriateness of UAE for treatment of fibroid-related symptoms. Virtua Memorial Hospital of Burlington County has been performing UAE since 2001.  Fellowship-trained Interventional Radiologists are available to meet individually with each patient during a pre-procedure consultation. At the time of the consultation, the radiologist will review the patient’s history and discuss with her the appropriateness of UAE for treatment of her symptoms.

For more information or to schedule a consultation, please contact Interventional Radiology at Virtua Memorial Hospital at 609-267-0700, x43717.