Uterine Fibroid Embolization

1. What are Uterine Fibroids?

Fibroids are growths arising from the wall (muscle layer) of the uterus. Medically fibroids are termed ‘Leiomyoma’ and they are non-cancerous.

2. What are the problems caused by Uterine Fibroids?

Uterine fibroids are very common. It has been estimated that 40-80% of women have uterine fibroids. But the good news is that most patients with fibroids do not have any symptoms. Those having symptoms usually suffer from,

  • Heavy bleeding during periods
  • Pain during periods
  • Bleeding between periods
  • Cramping
  • Feeling of fullness or belly in the lower belly 
  • Low back pain
  • Frequent passage of urine.
Abdominal pain due to uterine fibroids

3. Who is at risk of developing Uterine Fibroids?

The precise reason why some patients develop uterine fibroids is not clearly known. Some of the risk factors are 

  • Obesity
  • Early age of onset of menstruation
  • Family history of fibroids

4. How are Fibroids diagnosed?

Uterine fibroids are diagnosed during a routine pelvic exam by a gynaecologist. The gynaecologist will suspect fibroids when an irregularity is noted when examining the uterus. 

Ultrasound is usually the first test done to detect a fibroid. 

Ultrasonography – Ultrasound is a quick, cheap and painless test to detect uterine fibroids. The study can detect the size, number and type of uterine fibroid. In certain patients, a scan through the vagina (Transvaginal scan) may have to be performed to better show the fibroids. 

Magnetic resonance imaging (MRI) – This test is done to better show the fibroids and to differentiate from other types of tumours. For patients considering Uterine fibroid embolization, MRI is performed to know the exact location of the fibroid, the number and size. This information can be crucial in determining the outcome of treatment. 

Hysterosonography, Hysterosalpingography and Hysteroscopy are other tests that may be done in selected patients to diagnose fibroids.

5. What are the treatment options for Uterine Fibroids?

Medications:

Medicines targeting the hormones regulating the menstrual cycle are useful for treating uterine fibroids

GnRH agonists (like Leuprolide), Progestin-releasing IUD are some of the treatment options. 

Surgical:

Hysterectomy – The term refers to surgical removal of the uterus. 

Myomectomy – The term refers to selective removal of the fibroid. [Myoma- + -ectomy]

Non-Surgical:

Uterine fibroid embolization (also termed Uterine artery embolization)

6. What is Uterine Fibroid Embolization (UFE) ? How is it performed?

Catheter advanced into the Uterine artery by accessing the femoral artery
Magnified illustration - showing the UFE procedure

UFE is a non-surgical treatment option done through a pin-hole in the groin (or the wrist). The interventional procedure blocks the blood supply and thereby causes the fibroid to shrink in size. 

This angiography-based procedure is done by advancing a small catheter into the Uterine artery (Artery supplying the Uterus) and injecting small particles under the guidance of specialized x-rays (fluoroscopy)

7. What are the advantages of Uterine Fibroid Embolization?

The procedure is done under local anesthesia. Hysterectomy or Myomectomy will require a General anesthesia.

Procedure is done through a pinhole (less than 2mm) without any surgical incision. 

Women undergoing UFE can resume their routine activities earlier compared to after a surgical procedure.

Symptom relief is comparable to that of surgery. 

8. Which patients are not eligible for Uterine Fibroid Embolization?

Patients with

  • Active pelvic infection
  • Uncorrectable bleeding problems
  • Extremely large fibroids
  • Some specific fibroid subtypes (detected on MRI) 
  • Women who desire a future pregnancy