Capital Region Health Park
711 Troy-Schenectady Rd, Suite 113
Latham, New York 12110

(518) 262-5149

Gary Siskin, MD
Meridith Englander, MD
Kenneth Mandato, MD
Allen Herr, MD
Gail Sansivero, ANP
Nancy Mitchell, FNP
Christopher Doti, FNP
Sharon Ryan, LPN

UTERINE FIBROID EMBOLIZATION – Fibroids

WHAT ARE UTERINE FIBROIDS?

Uterine fibroid tumors are extremely common, benign growths of the muscular wall of the uterus (smooth muscle); they are also known as myomas, leiomyomas, or leiomyomata. Fibroids occur in approximately 20-25% of women of childbearing age and are more common in African-American women.  Fibroids are the most common reason for women to have a hysterectomy in the United States. 

• Cause of Fibroids:  While the cause of fibroid development is not known, studies have suggested that estrogen contributes to their growth and development since they tend to develop during adolescence and regress after menopause.  While it is not exactly known what initially causes a fibroid to develop, it is known that the growth of fibroids depends on hormones such as estrogen.  However, the rate that a fibroid grows is extremely variable among women.  Some fibroids remain small while others can grow much larger and reach the size of a 5-month pregnancy or more.
  
  In pregnancy, pre-existing fibroids can increase 3-5 times in size, due to high levels of estrogen present during pregnancy. After pregnancy, these same fibroids can shrink to their pre-pregnancy size.  Because fibroids are dependent upon estrogen for growth, they tend to gradually shrink on their own after menopause (when the ovaries stop producing estrogen).

• Symptoms of Fibroids:  Most fibroids do not cause symptoms and in fact, most women with fibroids do not know that they have fibroids until they are told about their diagnosis by their gynecologist.  However, 10-20% of patients with fibroids will develop significant symptoms:
  
  
  • Heavy Bleeding:  This is the most common complaint associated with fibroids and typically presents as heavy flow during the menstrual period (with or without the passage of clots).  In cases of severe bleeding, it is possible to develop an iron-deficiency anemia and to even require a transfusion.
    
    
  • Pelvic Pain/Pressure:  It is common for an enlarged uterus with fibroids to result in the sensation of pelvic heaviness, fullness, and bloating.  This pain is commonly associated with exercise and sexual intercourse.  Rectal pressure along with constipation may also be a consequence of uterine enlargement.  Continuing enlargement of fibroids can lead to back or leg pain due to compression of nerves located within the pelvis.  Back pain can particularly be associated with fibroids located in the back (posterior) of the uterus.
    
    
  • Frequent Urination:  Large fibroids can be responsible for urinary symptoms due to bladder compression.  This most commonly leads to increased frequency of urination or urinary incontinence (leakage of urine).  With extremely large fibroids, it is possible that the tube connecting the kidneys and the bladder, the ureters, can become compressed leading to blockage to the flow of urine from the kidneys.
    
    
    
• Classification of Fibroids:  There are three types of fibroids based on their location within the wall of the uterus.
  
  
  • Submucosal Fibroids:  These are located inside the lining of the uterine cavity and can grow into the uterine cavity.  If these fibroids grow into the uterine cavity on a stalk, they are known as pedunculated fibroids.  Submucosal fibroids are the least common type of fibroid and are often associated with heavy and prolonged menstrual periods.  Submucosal fibroids are also associated with miscarriages.
    
    
  • Intramural Fibroids:  These fibroids develop within the wall of the uterus.  As they grow, they increase the size of the uterus.  This can result in abdominal swelling and compression on the urinary bladder, which is located next to the uterus; bladder compression can result in frequent urination.  Heavy menstrual bleeding can also result from an intramural fibroid.
    
    
  • Subserosal Fibroids:  These fibroids develop in the outer portion of the uterus and can potentially grow into the abdomen.  If they grow on a stalk, these fibroids are also considered to be pedunculated.  Due to the large space available for these fibroids to grow into, they can potentially become quite large.  They are therefore associated with symptoms such as abdominal swelling and bladder compression.  They can even block the flow of urine from the kidneys into the bladder.  They do not typically change menstrual flow and are not associated with an increased miscarriage rate.
    
    
    
• Leiomyosarcoma:  It is common to be concerned about the presence of cancerous fibroids but the good news is that cancer in a fibroid, which is also known as leiomyosarcoma, is extremely rare, which is why treatment options such as UFE can be safety considered in these patients.  Malignant tumors do not usually arise from a fibroid that has been followed for several years by a gynecologist.  Instead, they often are rapidly growing lesions that arise separately from fibroids.  This type of cancer is a difficult one to diagnose since there are no imaging tests that can accurately diagnose this problem and reliably distinguish a cancer from a benign fibroid.  Surgery is the only reliable way to diagnose this type of uterine cancer and in fact, is the recommended treatment for rapidly growing fibroids.
  
  
  

• Treatment Options for Fibroids:
  
  
  • Observation:  Remember that most uterine fibroids do not cause symptoms and therefore do not necessarily require treatment.  In many patients, fibroids are diagnosed by physical examination and their growth can be monitored with periodic ultrasound examinations.
    
    
  • Hormonal Therapy:  Initially, the symptoms associated with fibroids can be managed with birth control pills and non-steroidal anti-inflammatory medication similar to ibuprofen.  Often times, patients may be put on medication known as a gonadotropin releasing hormone (GnRH) agonist such as Lupron.  These medications address symptoms by preventing the ovaries from producing estrogen.  Without estrogen, fibroids will shrink in size and the associated symptoms will lessen as well.  However, these medications will also cause symptoms which are similar to those experienced by women entering menopause (such as hot flashes).  In many patients, stopping this medication will cause the fibroids to regrow, typically within 12 weeks.  This medication is commonly used as a way to reduce the size of fibroids prior to surgery.
    
    
  • MRI-Guided Focused Ultrasound Surgery:  This is new therapy that uses ultrasound waves to destroy fibroid tissue.  By performing this procedure inside an MRI scanner, physicians are able to determine exactly where the fibroids are located.  This allows them to direct the ultrasound beam towards the fibroid and the energy of the ultrasound beam is able to heat the fibroid tissue enough to kill the cells of the fibroid.  At the present time, this is offered at limited centers throughout the world but has certainly shown promise as a non-invasive treatment option.
    
    
  • Myomectomy:  This procedure is designed to remove fibroids while leaving the uterus and ovaries intact.  This procedure can be performed through the use of open, traditional surgery or can be performed through scopes using a more minimally invasive approach.  A hysteroscope is a scope that is introduced through the vagina and into the uterus.  This can be used to remove submucosal fibroids.  A laparoscope is a scope that is introduced into the abdomen that can be used to remove subserosal fibroids on the outside of the uterus.  Myomectomy is most commonly offered to patients who wish to preserve their fertility since many reports have shown a 40-60% pregnancy rate after myomectomy.  Since the uterus is kept in place, it has been shown that almost 30% of patients will develop new fibroid-related symptoms within 5 years of the procedure.
    
    
  • Hysterectomy:  This is the most definitive treatment for uterine fibroids since it involves removal of the uterus and at the present time, is considered the standard among gynecologists for women with symptomatic fibroids who are beyond their childbearing years.  Fibroids continue to be the most common reason for a hysterectomy to be performed; an estimated 600,000 hysterectomies are performed in the United States annually and at least one-third are for fibroids.  Depending on the approach utilized, hysterectomy can be associated with a recovery period lasting from 4-6 weeks.  There is no disputing the fact that hysterectomy is extremely effective at addressing the symptoms associated with uterine fibroids and is associated with significant quality of life improvement in most patients.