Uterine Fibroids and Embolisation
What are uterine fibroids?
Uterine fibroids (leiomyomas or myomas) are the most common pelvic tumours and the most common benign tumours in women that arise from the uterine smooth-muscle tissue (myometrium). 1,2,3
Fibroids can be single or multiple and can vary in size and location. They are commonly classified into three subgroups based on their location: subserosal (projecting outside the uterus, intramural (within the myometrium), and or submucosal (projecting into the cavity of the uterus)4.
Ultrasonography (transabdominal and transvaginal) is the most widely used modality for investigation because of its availability, ease of use, and cost-effectiveness2.
Who is at risk?
Women at increased risk for developing fibroids include patients: of African descent, over the age of 40, have high blood pressure, are overweight, have had no children or have immediate family members with fibroids1.
What are the symptoms?
Many women may be asymptomatic and are diagnosed incidentally on clinical examination or imaging. However common symptoms associated with uterine fibroids include5,6,7:
- Menstrual abnormalities (e.g. heavy, irregular, and prolonged uterine bleeding)
- Iron deficiency anaemia
- Bulk symptoms (e.g. pelvic pressure/pain, obstructive symptoms)
- Abdominal protrusion
These symptoms can have a considerable impact on a women’s quality of life as well as their productivity.
Current and emerging medical treatment options
Treatment is individualized, based on symptoms, the size and location of fibroids, age and the needs and desires of the patient for preservation of fertility or the uterus. Symptomatic uterine fibroids may be treated medically, surgically or with a combination of both5,6,7,8:
- Serial monitoring
- Medications (e.g. oral contraceptives)
- Uterine fibroid embolization (UFE)
- Potential treatments (including magnetic resonance-guided focused ultrasound ablation (MRgFUS), laparoscopic ultrasound-guided radiofrequency ablation, and transcervical ultrasound). Short- and long-term efficacy and safety of these procedures still need to be determined by further studies.
Uterine Fibroid Embolisation (UFE)
This is a minimally invasive treatment option that has gained widespread popularity amongst the medical professionals and patients with great success and positive long-term outcomes. The procedure is carried out by a highly qualified Interventional Radiologist. The procedure consisting of injecting an occluding agent via a catheter that is inserted from the common femoral artery(groin region) or radial artery (wrist area) into one or both uterine arteries to block the blood flow that supplies the fibroid tumours, causing them to shrink and later disappear8.
Benefits of this procedure include8,9:
- Symptom relief with low rates of complications
- Minimally invasive and less painful
- Faster recovery times
- Shorter hospital stays
- Faster return to routine activities.
- No scarring/evidence of surgery
Many women are not aware of the treatment options available when diagnosed with uterine fibroids despite the high prevalence of the disorder. Providing imported information and the factors women should consider will help in making an informed decision in choosing the best treatment option for them8.
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- Baird DD, Dunson DB, Hill MC, Cousins D, Schectman JM. High cumulative incidence of uterine leiomyomas in black and white women: ultrasound evidence. Am J Obstet Gynecol 2003; 188:100-7.
- Linder D, Gartler SM. Glucose-6-phosphate dehydrogenase mosaicism: utilization as a cell maker in the study of leiomyomas. Science 1965;150:67-9.
- Holdsworth-Carson SJ, Zaitseva M, Vollenhoven BJ, Rogers PA. Clonality of smooth muscle and fibroblast cell populations isolated from human fibroid and myometrial tissues. Mol Hum Reprod 2014;20:250-9.
- Munro MG, Critchley Ho, Broder MS, Fraser IS. The FIGO Classification System (“Palm-COEIN”) for causes of abnormal uterine bleeding in non-gravid women in the reproductive years, including guidelines for clinical investigation. Int J Gynaecol Obbstet 2011;113:3-13.
- Silberzweig JE, Powell DK, Matsumoto AH, Spies JB. Management of uterine fibroids: a focus on uterine-sparing interventional techniques. Radiology 2016;280 (03):675-692.
- Zimmermann A, Bernuit D, Gerlinger C, Schaefers M, Geppert K. Prevalence, symptoms and management of uterine fibroids: an international internet-based survey of 21746 women. BMC Womens Health 2012;12:6 (26 March 2012). Available at: http://www.biomedcentral.com/1472-6874/12/6. Accessed on May 11, 2020.
- Dowes E, Sikirica V, Gilabert-Estelles J, Bolge SC, Dodd SL, Maroulis C, et al. The burden of uterine fibroids in five European countries. Eur J Obstert Gynecol Reprod Biol 2010;152:96-102.
- Society of Interventional Radiology. The fibroid fix: What women need to know. Society of Interventional Radiology;2017.
- Rischbieter P, Sinclair C, Lawson A, Ahmad S. Uterine artery embolization as an effective choice for symptomatic fibroids: five year outcome. SA Journal of Radiology 2017;21(1)a1265.https://doi.org/10.4102/sajr.