Two-thirds of Women Have Fibroids: Are You One of Them?
August 2021 Issue - Pink Prescriptions
by Kirsten J. Nelson, M.D.
Fibroids can be a debilitating complication in your life, and if you suffer from them, it’s easy to understand how true this can be. However, there is a way for women with symptomatic uterine fibroids to reclaim their health and return to a full life. The minimally invasive, non-surgical, and highly effective procedure is called Uterine Fibroid Embolization, and it can be performed outpatient in a specialized physician’s office-based procedure room by an Interventional Radiologist. Before learning more about the procedure, it’s important to understand fibroids and how they can affect a woman’s health:
What are Fibroids?
Fibroids are benign, non-cancerous growths in, or on the walls of, the uterus. Another medical term for fibroids is leiomyoma, or myoma. Fibroids can grow as a single tumor, or there can be multiple fibroids in the uterus. They can range from less than an inch in diameter to more than six inches.
How common are uterine fibroids and what causes them?
Uterine fibroids are the most common tumors within the female reproductive system affecting nearly two-thirds of women by the age of 50. Fibroids become more common as women age with the majority diagnosed between the ages of 30-54. After menopause, fibroids usually shrink. It is unclear why fibroids develop, but several factors may influence their formation. Research indicates that fibroids are controlled by the hormones estrogen and progesterone, and there is a hereditary component, as well. Having a family member with fibroids can increase your risk. However, you should not discount symptoms simply because you do not have a family member with fibroids.
Who is most at risk for developing uterine fibroids, and what are additional fibroid risk factors?
Although all women are susceptible to developing uterine fibroids, several studies suggest African American women have a higher prevalence for fibroids, with 80-90% being diagnosed with the condition. African American women are also diagnosed with fibroids at a younger age, with more than 25% already developing fibroids between the ages of 21–30. By age 35, that number increases to 60%. African American women are also two to three times more likely to have recurring fibroids, or suffer from complications.
Additional factors that contribute to a higher risk for fibroids include higher estrogen levels, excess body weight, a higher consumption of sugary foods, red meat and alcohol, especially beer.
What are the symptoms of Fibroids?
Heavy menstrual periods are one of the most common symptoms of uterine fibroids, with about 30% of women experiencing excessive bleeding during their periods. These women may also pass clots, have longer cycles of bleeding and become anemic due to a heavy flow.
Pelvic Pain: Although not all women with fibroids have pain, it is very common for fibroids to cause moderate to severe cramping pain during or between periods. Some women are forced to lose one to two days of work each month because of pelvic pain.
Frequent Urination: Fibroids that press on the bladder can sometimes make you feel like you have an urgent need to urinate, or to get up several times each night to use the bathroom. In severe cases, pressure from a fibroid can make you lose control of your bladder (urinary incontinence).
Painful Intercourse: Pain during sex is common with fibroids. Some women avoid certain positions, or intercourse altogether. Fibroids may also trigger bleeding after sex.
Back Pain: When fibroids press against the back muscles and nerves that come from the spine, you may feel back pain, or pain that radiates down your legs.
Constipation: Fibroids that press on the colon or rectum can cause significant bloating or constipation.
Infertility: Fibroids can make it difficult to get pregnant. Although most women with fibroids can have a normal pregnancy, women with large or numerous fibroids sometimes have a harder time getting pregnant, or a higher chance of miscarriage.
How are fibroids diagnosed?
Your doctor or gynecologist may discover one or more fibroids during a routine physical exam. Fibroids often cause the uterus to become larger, which means the doctor who does a pelvic exam may notice if your uterus is enlarged and might even feel the fibroids. The simplest and quickest way to look for fibroids with imaging is through a pelvic ultrasound. An ultrasound can show if you have fibroids in your uterus and can give an idea of the size of each one. Other diagnostic tests may include CT Scans and MRIs. These will clearly show fibroids that are not visible on ultrasound and provides the most detail when it comes to the size and position of the fibroids. They may also provide other potential sources of your symptoms.
What are my treatment choices?
If you do not have symptoms, treatment is probably unnecessary. Your physician may want to continue to monitor your condition. If you do have symptoms, several options are available:
Medications for uterine fibroids usually focus on hormones that regulate your menstrual cycle, including birth control pills, hormone injections and medicated intrauterine devices (IUD). These medications can help some symptoms, such as heavy periods and pelvic pressure, but will not get rid of fibroids. All these medications prevent pregnancy, and some can cause unpleasant side effects.
Endometrial Ablation: Several techniques exist to remove the inside lining of the uterus, which is the part that causes heavy bleeding. All the techniques involve a gynecologist placing a thin instrument into the uterus through the cervix and using heat, laser, electricity, microwaves or freezing to remove the lining. This treatment is not used if you still want to get pregnant. It will not shrink fibroids, which means you will still have some fibroid symptoms.
Myomectomy: A myomectomy is a surgical procedure to remove the fibroids without taking out the uterus. The size and location of the fibroids determines how this surgery is performed.
Hysterectomy: A hysterectomy is a surgical procedure to remove the uterus, which also removes all the fibroids. If the ovaries are left in place, it is called a partial hysterectomy. If the ovaries are also removed, the procedure is called a total hysterectomy. Like a myomectomy, a hysterectomy can be performed several ways depending on the size of your uterus and the size and location of fibroids.
Uterine Fibroid Embolization: Uterine Fibroid Embolization (UFE) is a minimally invasive procedure that blocks the blood flow to the fibroid(s), causing the fibroid to shrink and alleviating symptoms. UFE is a low risk procedure that is an alternative to traditional surgery. With an added special pain management protocol, pain and discomfort are minimal, and recovery time is reduced to days instead of weeks or months.
How is Uterine Fibroid Embolization performed?
UFE is performed by an interventional radiologist, a board certified physician specializing in minimally invasive, targeted treatments performed using X-rays and other imaging techniques to see inside the body and treat conditions without surgery. During the UFE procedure, the patient receives local anesthesia and remains awake. The interventional radiologist inserts a catheter into the patient’s upper thigh or wrist to access her arteries and uses X-ray imaging to guide the catheter to the patient’s uterine artery. An embolic agent (tiny plastic or gel particles) is injected into the catheter and into the fibroid-feeding vessels. The embolic agent blocks the blood flow to the fibroids, causing the fibroids to shrink, scar and retract into the wall of the uterus. The process is repeated in the patient’s other uterine artery, if needed, to address all fibroids in the uterus.
Does Uterine Fibroid Embolization work and is it safe?
UFE is a safe and proven fibroid treatment, having been performed on hundreds of thousands of women over the past 20 years. UFE helps alleviate symptoms, such as heavy menstrual bleeding, and bulk symptoms, including pelvic pain and pressure, urinary frequency and constipation. Ninety percent of women show significant improvement in symptoms and quality of life after UFE.
Can I have uterine fibroid embolization (UFE) if I still want to get pregnant?
UFE is not recommended if you are planning to get pregnant. There is a small amount of evidence that suggests a slightly higher miscarriage rate if you have UFE. It is certainly possible to have a normal pregnancy, normal delivery and normal baby after having the procedure, but if you have the option to have another treatment for your fibroids, that would be safest until further data is available about pregnancy after UFE.
What are the benefits of UFE?
• Performed as a minimally invasive outpatient procedure
• Much shorter recovery time compared to surgery—
often less than two weeks versus 8 weeks
• Performed through small incision
• Preserves uterus
• Does not require the use of hormone therapy
• Covered by most insurance
Every women is unique, and before making decisions on what course of treatment to pursue for fibroids, should discuss the variety of surgical and non-surgical fibroid treatment options in detail with her physician and healthcare team
Dr. Kirstin Nelson, a Board-Certified Interventional Radiologist with Savannah Vascular Institute, has been performing uterine fibroid embolization (UFE) at Savannah Vascular’s main office in Savannah and now, the new office in Bluffton, which is equipped with a state-of-the-art procedure room, for more than 15 years. She has a passion for helping women reclaim their life from fibroids and return to a full and healthy life. For more information call 912-352-8346.