Uterine Fibroids
Uterine Artery Embolisation (UAE)
UAE is now a well established minimally invasive treatment option for women with uterine fibroids. It is a well researched technique and has a clear place in the treatment of women symptomatic fibroids along with a number of other options explained below. Some women with fibroids can be severely affected by their symptoms such as heavy periods, period pain and pressure symptoms, all of which can interfere with their daily lives.
We have over 10 years experience doing UAE for both NHS and private patients and can help advise you to decide whether this is the right treatment option for you on an individual basis.
What are fibroids?
Fibroids are non-cancerous growths that develop in or around the womb (uterus). These growths are made up of muscle and fibrous tissue and vary in size. They are known medically as uterine myomas or leiomyomas. Uterine fibroids are very common, found in up to 40% of women in their 40s. Many women are unaware they have fibroids because they don’t have any symptoms but around a third of those with fibroids can be adversely affected. These patients may experience various symptoms such as:
• heavy periods or painful periods
• abdominal or lower back pain
• a frequent need to urinate
• constipation
• pain or discomfort during sex
These symptoms can be of varying levels of severity but for some patients, dramatically affects and restricts their lives. In rare cases, further complications caused by fibroids can affect pregnancy or cause infertility.
The exact cause of fibroids is unknown but they have been linked to the hormone oestrogen, the female reproductive hormone produced by the ovaries. Fibroids usually develop during a woman’s reproductive years (roughly between the ages of 16 to 50) when oestrogen levels are at their highest. Fibroids tend to shrink when oestrogen levels are low such as after the menopause when women’s periods stop.
Fibroids can occur in a number of locations in the uterus, most commonly developing within the uterine wall (intramural fibroids) but may protrude outside the uterus from beneath the external layer (subserosal fibroids) or into the internal cavity of the uterus from beneath the inner lining (submucosal fibroids).
Are fibroids common?
Fibroids are very common; around 1 in 3 women will develop them at some point in their life. They most frequently occur in women aged 30 to 50.
Fibroids are thought to be more prevalent in women of African-Caribbean origin.
It is also thought they occur more often in overweight women because being overweight increases the level of oestrogen in the body.
Women who have had children have a lower risk of developing fibroids and the risk decreases further the more children you have.
Can fibroids be treated?
Fibroids do not need to be treated if they are not causing symptoms or affecting your everyday activities. Over time, they will often shrink and disappear without treatment, particularly after the menopause.
If you do have symptoms caused by fibroids, medication to help relieve the symptoms will usually be suggested first. There are also medications available to help shrink fibroids. If both of these prove ineffective, referral to a Gynaecologist to consider specialist medication, surgery or other minimally invasive procedures may be recommended.
Non-drug treatment options:
Surgery
Removing your fibroids may be considered if your symptoms are particularly severe and medication has been ineffective. Several different surgical procedures can be used to treat fibroids. A specialist Gynaecologist should discuss all the available options with you, including benefits and any associated risks. The main surgical procedures used to treat fibroids are:
1. Hysterectomy; this is a surgical procedure to remove the uterus. It is the most effective way of preventing fibroids coming back since there is no uterus left for them to form in. A hysterectomy may be recommended if you have large fibroids or severe bleeding, your family is complete and you wish the problem to be dealt with definitively. However, some women find this unacceptable in terms of the amount of time spent in hospital, recover period requiring significant period off work/daily responsibilities and the complication rate from open surgery is generally higher and more significant in nature than from more minimally invasive options.
There are a number of different ways a hysterectomy can be carried out including via the abdomen or through the vagina. You will usually need to stay in hospital for several days and it takes about 6 – 8 weeks to fully recover, during which time you should rest as much as possible. Side effects can include early menopause and a loss of libido (sex drive). This usually only occurs if the ovaries have also been removed.
2. Myomectomy; this is surgery to remove the fibroids from the wall of the uterus. It may be considered as an alternative to hysterectomy if you would still like to maintain fertility; however, myomectomy is not suitable for all types of fibroid. Your Gynaecologist can tell you whether the procedure is suitable for you based on the size, number and position of your fibroids. Myomectomies are carried out under general anaesthetic and you usually need to stay in hospital for a few days afterwards. You will need to rest for several weeks to recover. Myomectomy is usually an effective treatment for fibroids although fibroids can grow back and necessitate further surgery.
3. Hysteroscopic resection of fibroids; this is a procedure where a thin telescope (hysteroscope) and small surgical instruments are used to remove fibroids from inside the womb (only for submucosal fibroids). It is suitable for women who want to have children in the future. No incisions are needed because the hysteroscope is inserted through the vagina and into the womb through the entrance to the womb (cervix) usually under general anaesthetic. You can usually go home on the same day.
Non-surgical procedures
4. Uterine artery embolisation (UAE); this is an alternative procedure to a hysterectomy or myomectomy for treating fibroids. It may be recommended for women with all sizes of fibroids but also very large fibroids. UAE is performed by an Interventional Radiologist, a specialist doctor expert in imaging and pin-hole surgery. It involves blocking the blood vessels that supply the fibroids, causing them to shrink. X-ray dye is injected through a small tube (catheter) through a blood vessel in your groin which is then manipulated under X-ray control precisely into the arteries supplying the fibroids. It is carried out under local anaesthetic giving a shorter hospital stay (usually a single night) and quicker recovery period of rest than surgery, usually around a week or so.
Although it is possible to have a successful pregnancy after having UAE, the overall effects of the procedure on fertility and pregnancy are uncertain. It should only be carried out after you have discussed the potential risks and benefits in your own situation with your doctor.
5. Endometrial ablation; this is a relatively minor procedure that involves removing the lining of the womb. It is mainly used to reduce heavy bleeding in women without fibroids but it can be used to treat small submucosal fibroids in the womb lining by using laser energy, a heated wire loop or hot fluid in a balloon. The procedure can be carried out either under local or general anaesthetic and is relatively quick (around 20 minutes). You can usually go home the same day.
Some women have reported experiencing more severe or prolonged pain after having endometrial ablation. It may still be possible to get pregnant afterwards but the procedure is not recommended for women who want to have more children because the risk of serious problems, such as miscarriage, is high.
6. MRI-guided procedures; two relatively new techniques for treating fibroids use MRI; MRI-guided percutaneous laser ablation & MRI-guided transcutaneous focused ultrasound. These techniques use MRI to guide small needles into the centre of the fibroid being targeted. Laser energy or ultrasound energy is passed through the needles to destroy the fibroid. These treatment methods cannot be used to treat all types of fibroids and the long-term benefits and risks are not yet known. These new techniques are not yet widely available in the UK. Research is still being carried out but there is some evidence to suggest that these procedures have short- to medium-term benefits when performed by an experienced clinician. The effects on fertility are not fully known which needs to be taken into account.
