Ending the Monthly Cycle of Fear:
Treating Uterine Fibroids with Uterine Fibroid Embolization
For many women, uterine fibroids can have a significant impact on quality of life. They find it difficult to go to work or leave their homes on certain days of their menstrual periods for fear of excessive and uncontrollable bleeding. While there are numerous treatment options, most require major surgery that isn’t ideal for most women.
What are Uterine Fibroids?
According to the National Institute of Environmental Health Sciences, 70 percent (or more) of women have uterine fibroids by age 50. Uterine fibroids are noncancerous tumors or growths that appear in a woman’s uterus during her reproductive years. They can cause heavy menstrual bleeding, severe cramping pain, periods that last longer than normal, breakthrough bleeding between periods, and even abdominal pain and pressure, bloating, constipation, frequent urination and pain during intercourse.
Surgical Methods to Treat Uterine Fibroids
The only way to resolve uterine fibroids with 100 percent efficacy is via a hysterectomy, or the surgical removal of the uterus. A hysterectomy will end a woman’s menstrual periods – meaning pregnancy is no longer an option. This procedure requires a complex, invasive surgery with a long recovery time.
Another surgical option is the myomectomy, where the surgeon makes an incision in the lower abdomen and goes through the uterus to cut out portions of or remove entire fibroids. However, because women can have many fibroids at once and they can grow on multiple areas of the uterine muscle, this procedure cannot guarantee the complete removal of all fibroids. Recovery for this procedure typically takes 2-4 weeks.
Uterine Fibroid Embolization as an Alternative Treatment Option
Uterine fibroid embolization (UFE) is a minimally invasive, non-surgical option available for treating uterine fibroids. According to Dr. Jamie Doster, chair of Interventional and Vascular Radiology at Raleigh Radiology, this common, alternative treatment option is successful for about 90 percent of patients, helps patients avoid major surgery, and allows for a much shorter recovery time. Dr. Doster was specifically trained to perform UFE during her interventional radiology fellowship.
“UFE works because we take away the blood supply to the fibroids, which then causes them to shrink and die off (necrosis),” explained Dr. Doster. “When they shrink, they are no longer hormonally active, which helps eliminate the heavy and breakthrough bleeding. Meanwhile, the shrinkage helps resolve the bulk of the patient’s other symptoms. After this procedure, patients can go back to work much sooner and the procedure is often more affordable than surgery as well.”
How Does UFE Work?
Interventional radiologists perform UFEs in the hospital, including at both WakeMed Raleigh Campus and Cary Hospital. As part of the treatment process, the patient will first receive an MRI to ensure she is a candidate for UFE – to check the anatomy of the fibroids, determine where they are located and ensure no other complications (i.e., malignancy) are at play. After this MRI and a pre-planning consult, where the MRI results and details of the procedure are discussed, the patient is scheduled for her UFE.
During this very technical and precise procedure, the radiologist uses a catheter inserted through the uterine artery to inject tiny beads into the blood vessels that feed the fibroids. Hence, the blood flow to the fibroids is blocked, and they will all begin to shrink. For 90 percent of patients, UFE can be performed trans-radially, or through a tiny incision in the wrist. For the other 10 percent, the procedure is performed through the groin, also just a tiny incision. This is based on the patient’s height (the size of catheter will not allow trans-radial on taller patients) and blood flow. With the wrist incision, a patient can get up and walk very soon after her procedure. In total, UFE takes about one to two hours. When the procedure is finished, patients either stay overnight or in some cases, may be able to leave the hospital on the same day.
What is Recovery Like?
According to Dr. Doster, the first 24 to 48 hours after UFE are the most difficult. A patient will typically remain in bed for that time and may experience pain, abdominal cramping, fatigue or vomiting. These symptoms usually resolve within a week, and patients are then able to return to work or their normal daily activities. Patients do not experience the total loss of their menstrual periods (amenorrhea) after UFE; however, a smaller and less impactful period remains. Some patients may continue to have slight discomfort and spotting for two to three menstrual cycles before they report a complete improvement.
“The complete resolution of symptoms is our ultimate goal, and most patients come back to tell us their symptoms are gone or significantly improved,” said Dr. Doster. “It’s remarkable and very rewarding when we can help these women take back their quality of life.”
Each patient should have a follow-up appointment with her radiologist one to three months after the procedure. Meanwhile, Dr. Doster’s office will call the patient one week later to check on her during recovery. Based on age, a small subset of women may have a recurrence of symptoms within five years, possibly due to the growth of new fibroids. However, these patients are typically younger women (around age 30) who are years away from menopause, and having a second UFE will help. For all women, the symptoms of uterine fibroids will typically resolve with menopause.
“At Raleigh Radiology, we are proud to offer UFE for women who suffer from uterine fibroids. We can help them stop living in fear of their menstrual periods and give them more freedom to enjoy their lives again,” added Dr. Doster. “We are also proud to offer same-day discharge as well as the trans-radial (wrist) option for a minimally invasive and safer treatment experience.”
To learn more about Dr. Doster and Raleigh Radiology, visit www.raleighrad.com.
National Institute of Environmental Health Sciences: www.niehs.nih.gov
Office on Women’s Health: www.womenshealth.gov
Mayo Clinic: www.mayoclinic.org