Fibroids Treatment: Uterine Artery Embolization

What is Uterine Fibroid?

Uterine Fibroids are benign (non-cancerous) growths that appear in the muscular wall of the uterus. It is a very commonly found and most women experience growth of uterine fibroids. In India, approximately more than 10million (more than 1 crore) cases of fibroids are reported while the actual number is estimated to be lot higher as fibroid checkups are not commonly undertaken in India.

Fibroids are dense fibrous tissue which grow on/in the walls of uterus and are usually  fed from the blood supply of the uterus. The size of a fibroid can be as small as a seed to as large as melons that can fill the abdominal cavity. To understand, imagine them something like overgrown body moles but inside uterus.

It is to be noted that while fibroids are referred to as tumors in uterus, they are not cancer and they don’t develop into cancer either.

What are the symptoms of Uterine Fibroids?

While most women have uterine fibroids, they may not notice as they do not experience any symptomatic issues and hence never get evaluated. Below are certain symptoms associated with uterine fibroids. Women may not experience all issues as listed below and hence you should get medical consultation even if any single symptom applies to you.

  • Heavy mensural discharge
  • Bleeding during mensural cycle or prolonged extended periods
  • Heavy gradual bloating of stomach (look like a pregnancy bloating but mostly very slow in growth)
  • Pelvic pain or lower back pain
  • Pain or discomfort during sex
  • Frequent urination
  • Regular constipation
  • Cramps in abdomen / stomach
  • Anemia
  • In a few cases, fibroids are considered a reason for female infertility.

Is Uterine Fibroid a serious health problem?

Yes, and no.

Unless fibroids are causing any of the above referred symptoms, they are considered mostly harmless and do not need treatment. However, in case any of the symptoms as discussed above are experienced, medical guidance is highly advised as fibroids may lead to some serious medical complications.

It is to be noted that fibroids are the main reason for removal of the uterus in women, thus depriving them of motherhood. Fibroids are also considered as one of the major reasons for miscarriages.

In some fibroids when left untreated, there are chances that the symptoms worsen severely enough, restricting normal daily functioning of the patient. Fibroids may also sometimes grow at a very rapid pace, and when left untreated, the treatment of larger fibroid poses more risk to the patient. In very few scenarios, uterine fibroids have been observed to develop cancerous tissues.

What causes Uterine Fibroid?

Exact reason for growth of fibroids is not known.

Two hormones, Estrogen & Progesterone, stimulate development of fibroids in the uterus, hence sometimes fibroids grow during pregnancy and have been observed to shrink after menopause due to reduction in hormone production in body.

Other factors which are considered to contribute to fibroid growth are:

  • Heredity: If you have history of fibroids in your family, you have high probability to develop fibroids
  • Usage of birth control pills
  • Early onset of mensural cycle
  • Vitamin D deficiency

Apart from above certain food items like – Dairy products, Diet with higher proportion of red meat and alcohol consumption considered to contribute to fibroid development.

Diagnosis of Uterine Fibroids

As informed earlier, uterine fibroids may not show any symptoms and hence get detected only when they are discovered during checkups. The doctor may observe an abnormality in the size of the uterus on clinical examination and advise for further tests as listed below for confirmation of presence of fibroids. They may also be incidentally picked up on a routine ultrasound done for another cause.  If you have any symptoms as mentioned before, you should consult an expert and get the following tests done:

  • Ultrasound: In ultra sound waves are used to get a picture of your uterus to confirm presence of fibroids and measure them.
  • MRI: It is done to gauge the size and location of fibroids
  • Hysteroscopy: A small, lighted telescope called a hysteroscope is inserted through your cervix into your uterus. Then saline is injected, expanding the uterine cavity which allows examination of the walls of your uterus and the openings of your fallopian tubes.

Doctors to meet if you have Uterine Fibroids

Being a medical issue related to women and associated with uterus, the problem is generally referred to Gynecologists. Gynecologists are the primary doctors to be consulted with. However once uterine fibroids are diagnosed, you must meet another specialized doctor – an Interventional Radiologist for new advanced treatment options available.

Uterine Fibroid Treatment

Various treatment options are available to a patient and one should consult different set of doctors before finalizing the choice of treatment.

  • Medical management: Doctors may prescribe you medication for reducing the size of fibroids. However, the medication normally works on hormone management and hence may have long term side effects. Also, medication may not be a long-term solution of fibroids.
  • Surgical Options: Traditionally, Fibroids have been treated by performing surgeries as mentioned below. While today more advanced and less invasive options are available, surgeries continue to remain most opted option due to lack of knowledge among patients about new techniques available. If you have been guided for surgery, you are highly advised to evaluate non-surgical treatment options. We can help you with free online medical guidance for the same.
    • Hysterectomy: Essentially, in hysterectomy, the uterus is removed from the body to avoid growth of fibroids. Hysterectomy many a times also involves removal of fallopian tubes and ovaries.
      Hysterectomy thus completely restricts possibility of mother hood for the women. If ovaries are also removed, having a child with other means like surrogacy is also not available as egg production is stopped. It takes a long time for patient to recover as it is a major surgery and is expensive. Also as a side effect of surgery, sometimes patient do not get into menopause later thus initiating other hormone related problems. (to verify)
    • Myomectomy: Under surgical options, myomectomy is the preferred option for patient as it involves only removal of problematic fibroids and keeps the uterus intact. It is open surgery and requires relatively longer recovery period for the patient.
  • Non-Surgical Treatment Option: With the advancement in technology, new safer treatment options are available for treatment of Uterine Fibroids.
    • Uterine Fibroid Embolization (UFE): Performed by an Interventional Radiologist, UFE is a non surgical & minimally invasive treatment option. Under this procedure, an ultrathin tube /catheter is guided under X ray equipment, through to the uterine artery supplying blood to the fibroid. The blood supply is then blocked by application of small particles of a medicine within the artery. With restricted supply of blood, the fibroid shrinks substantially and thus removing its associated causative complications. Benefits of UFE are:

      • Non-surgical
      • Once the procedure is over, most women go home shortly afterwards. Painkillers and anti-inflammatory medications may be prescribed to reduce swelling and cramping, and patients can expect to return to normal activities within a week or so.
      • Recurrence of fibroids is extremely rare.
      • Women can go on to become pregnant following uterine artery embolization. General anesthesia and an abdominal (belly) incision are not required.
      • There is no blood loss.
      • All fibroids may be treated at the same time.
      • Success rate of UFE is equivalent to surgical options

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