fibroids

Which Patients are suitable for Uterine Fibroid Embolisation?

Despite the vast amount of data on UFE many patients are told they are unsuitable for the procedure because:

• They have multiple fibroids
• They have only one
• Their fibroids are too big
• Their fibroid is pedunculated inside the womb

All these statements are wrong

Most women with problematic fibroids are suitable despite number, size or position.

References

Watson GM, Walker WJ. Uterine artery embolisation for the treatment of symptomatic fibroids in 114 women; reduction in size of the fibroids and women’s views of the success of the treatment. BJOG 2002 Feb; 109(2):129-35

Smeets AJ, Nijenhuis RJ van Rooij WJ, Weimar EA, Boekkooi PF, Lampmann EL, Vervest HA, Lohl PN. Uterine artery embolisation in patients with a large fibroid burden: long term clinical and MR follow-up. Cardiovasc Intervent Radiol. 2010 Oct;33(5);943-8. Epub 2010 Jan 12

Parthipun AA, Taylor J, Manyonda I, Belli AM. Does size really matter? Analysis of the effect of large fibroids and uterine volumes on complication rates of uterine artery embolisation. Cardiovasc Intervent Radiol. 2010 Oct;33(5):955-9. Epub 2010 May 5

Delayed Treatment

We see many patients who have had failed myomectomy followed by recurrence or continual growth of remaining fibroids, who are either advised conservative treatment by their doctor or who do not wish to face the prospect of further treatment, especially surgery. Patients need to realise that fibroids often continue to grow and the bigger they become the more difficult they are to treat and the more a patient's quality of life is impaired. It is especially important that if fibroids grow following myomectomy, prompt treatment should be strongly considered before the fibroids become too large and therefore very difficult to treat except by radical surgery.

Myths About Fibroids & Uterine Fibroid Embolisation

Many women in their forties with fibroids causing significant often debilitating symptoms will delay treatment having been told that fibroids shrink after the menopause. This is inaccurate and misleading. After the menopause, assuming that the patient does not have hormone replacement therapy, oestrogen stimulation is removed. Thus fibroids can no longer grow. Occasionally some fibroids die owing to defective blood supply but this is not common and in most cases fibroid masses will remain relatively unchanged after the menopause. Patients with fibroid masses should therefore be wary of delaying treatment in the hope that fibroid masses may shrink after the menopause.

HRT in the post menopausal woman can cause fibroids to grow or bleed. Post embolisation fibroids are killed and therefore cannot grow or be affected by oestrogen and patients can have HRT after the menopause. With regard to fertility, statements have been made suggesting that fibroid embolisation causes damage to the normal uterine tissue. Whereas a few cases have been described in the world literature this complication is extremely rare and may relate to over embolisation or use of the wrong size particles due to inexperience. Particle size is important in embolisation as the diameter of vessels in fibroids is different from that of vessels supplying normal uterine tissue.

Fibroids and Hormone Replacement Therapy

Oestrogen is the main stimulus of fibroid growth. After the menopause oestrogen drops to a minimal level. HRT can stimulate fibroid growth and therefore fibroid-related symptoms. After embolisation fibroids are killed and can no longer be affected by oestrogen or other hormones. HRT is therefore not contraindicated after fibroid embolisation.

Sex After Uterine Fibroid Embolisation

Women who have UFE or hysterectomy are often concerned if there will be any deterioration in their ability to enjoy sex. Data shows that after UFE women’s’ sex lives remain intact or improve.

References
Sexuality and body image after uterine artery embolisation and hysterectomy in the treatment of uterine fibroids: a randomised comparison. Harenkamp WJ, Wolkers NA, Bartholomeus W, de Blok S, Birnie E, Reekers JA, Ankum WM. Cariovasc Intervent Radiol 2007 Sep-Oct;30(5):866-75

Fibroid embolisation. Walker WJ, Pelage JP, Sutton C. Clin Radiol 2002 May;57(5):325-31

Sexual functioning and psychological well-being after uterine artery embolisation in women with symptomatic uterine fibroids. Voogt MJ, De Vries J, Fonteijn W,Lohle PN, Boekkooi PF. Fertil Steril 2009 Aug;92(2):756-61. Epub 2008 Aug 9

Which Radiologists should Perform Uterine Fibroid Embolisation?

Uterine fibroid embolisation is a complex procedure with a significant learning curve requiring not only a skilled Interventional Radiologist but one who has performed many UFE procedures. You should ask your interventional radiologist how many fibroid embolisations (as opposed to other types of embolisation) he has performed.