Learn more about Uterine Fibroids at the Society of Interventional Radiology (SIR) consumer information center web site

What Are Uterine Fibroids?

Fibroids are solid, non-cancerous tumors that occur in and around the uterus. They are also called leiomyomas or myomas. Uterine fibroids are the most common tumor of the female genital tract. 1 out of every 4 women are diagnosed with these benign growths.

Scientists do not really know what causes fibroids, although there seems to be a relationship to certain hormones, although the specifics are not yet understood.

Risks and Symptoms

All women are at risk of getting fibroids, but African-Americans are up to 3.2 times more likely to develop fibroids than Caucasians. While fibroids can appear in women in their twenties and early thirties, most patients do not have any symptoms until their late thirties or forties.

Many women with uterine fibroids have no symptoms at all, and are unaware that they have a uterine fibroid. Others can have a variety of symptoms, including:

• Heavy or irregular periods
  
• Painful cramps
  
• Frequent urination
  
• Pain during intercourse
  
• Pressure or pain in the abdomen and lower back pain
  
• Fertility problems

Diagnosing Uterine Fibroids

Many times, a fibroid is detected during a doctor's bi-manual gynecological examination. The growth initially is felt as an "enlarged uterus," and in fact, many doctors describe the size of a fibroid as they would a pregnant woman's gestation. (For example, "4 weeks size.") After a doctor has detected an enlarged uterus, an ultrasound and/or magnetic resonance imaging (MRI) study is ordered, to confirm the diagnosis of uterine fibroid. Both of these diagnostic tests are painless.

Treatment Options

Historically, the primary treatment option recommended was hysterectomy (removal of the uterus). But today, there are a number of other options:

Don't Do Anything
Many women who do not have symptoms choose to do nothing. This option is often chosen by women approaching menopause, since fibroids tend to shrink considerably afterward.

Uterine Fibroid Embolization (UFE)

This new technique is performed by an interventional radiologist and is much less invasive than surgery. A small tube or catheter is inserted into a large artery, and polyvinyl or gelatin pellets are "shot" at the fibroid. The pellets cut off the blood supply to the fibroid, killing it, and causing it to shrink. Recovery time can be as short as one week. Many women are choosing this option because it is less invasive, offers a quick recovery, and allows them to keep their uterus. Learn more about how UFE is performed [anchor to paragraphs below].
 

Myomectomy
This surgical procedure is often chosen by women who still want to have children. In the procedure, only the fibroid is removed; the uterus is left intact. Myomectomy typically carries with it a higher risk of hemorrhaging than a hysterectomy, but the recovery time is similar to hysterectomy.

Hormone Therapy
The use of GnRH agonists has been shown to effectively block estrogen production in some patients, which cuts off the fibroid's supply of estrogen and causes it to shrink. Lupron is the drug most commonly used, although this drug has been shown to cause menopause-like symptoms such as hot flashes, mood swings, insomnia, sexual dysfunction, and premature bone mineral loss.

Endometrial Ablation and Resection (OPERA)
OPERA is an outpatient procedure performed by a gynecologist. During the procedure, the doctor inserts a scope through the cervix and burns and/or scrapes the uterine lining and cuts or burns out the fibroids. Fibroids on the outside of the uterus cannot be removed using OPERA, and like hysterectomy, the procedure causes permanent infertility.

How UFE is Performed
UFE is performed while you are under "twilight sedation." An interventional radiologist inserts a thin plastic tube called a catheter into your femoral artery (a main artery in the groin) and guides it toward the uterus while watching on an x-ray or fluoroscope. Tiny polyvinyl particles are then directed through the catheter toward the artery supplying the fibroid(s). This technique blocks the blood flow to the fibroid and essentially kills it. The result is that the fibroid shrinks and is ultimately absorbed by your body over the course of six to eight months.

What to Expect After the Procedure
After the sedation wears off, most women experience moderate to severe pain and cramping during the first 10-15 hours after the procedure. Appropriate intravenous narcotics and other pain medications are used to manage the post procedure pain. You will spend one night in the hospital and go home the following day.

Learn more about Uterine Fibroids at the Society of Interventional Radiology (SIR)  consumer information center web site