Uterine fibroids are a benign growth within the uterus (womb). They are common – occurring in about 25% of women. Symptoms include:
- Heavy periods and prolonged bleeding
- Severe period pain
- Pressure – urinary or bowel problems
Fibroids cause heavy abnormal bleeding by distorting the lining of the womb. The heavy bleeding caused by fibroids can lead to tiredness, fatigue and low energy due to iron deficiency anaemia.
Pressure (or bulk) symptoms are caused by fibroids pressing on adjacent organs, typically the bladder. When very large they can also cause bloating.
Do I need treatment?
Only patients who are symptomatic need treatment. Approximately 60% of women with fibroids will not be symptomatic. Many women will have one or more small (1-2 cm) fibroids which do not cause any problems. If you are concerned by any of the following then you may wish to consider treatment:
- Heavy bleeding with frequent changes of pads
- Having to wear double pads
- Passing large clots
- Tiredness due to anaemia
- Concerns over periods limit your work, social life or normal activities
- Having to pass urine frequently
- Incontinence when laughing or sneezing
What causes fibroids?
We don’t know for sure. We do know they are more common in women over 40 and those with a family history. The risk may also be increased by diet, obesity and blood pressure.
Are fibroids cancer?
No. Fibroids are non-cancerous, benign tumours, known medically as leiomyomas. They do not spread to other parts of the body in the way cancers do. It possible however for a fibroid to develop into a malignant growth (a leiomyosarcoma). Sometimes this can be picked up on MRI scan performed prior to fibroid embolisation. Additionally, if a patient does not respond as expected to fibroid embolisation this may alert us to the possibility of an underlying cancerous component.
How is disease managed?
Fibroids can be managed in the following ways:
- Medically – for example using contraceptive medication to control bleeding symptoms. This does not treat the fibroids themselves
- Surgically – either by myomectomy or hysterectomy. Myomectomy involves surgical removal of individual fibroids. Hysterectomy, removal of the entire uterus is a definitive treatment for symptoms from fibroids but comes with the risks of anaesthesia and surgery. These risks may be reduced by modern surgical approaches.
- Fibroid Embolisation (UFE) – this minimally invasive approach uses tiny particles to block the blood supply to the fibroids, causing them to reduce in size.
The first line treatment option is medical management. Should this fail then consideration is given to the number, location and size of fibroids as well as your symptoms, age and menopausal status in deciding with you what is the most appropriate treatment.
Undoubtedly symptoms are best managed by an individual patient-centred approach and some women would be best served by surgery and others by UFE. When you are seen in rooms by the IR specialist you can trust that you will be offered treatment only if it is thought to be the best option for you as an individual.
FAQ
How do I know if I am a candidate?
What investigations or scans are needed?
How long is the procedure?
Do I need an anaesthetic?
How is the procedure performed?
How long will I be in hospital?
What is the recovery period?
Why should I choose UFE?
What is the evidence UFE works?
Is UFE experimental?
Why might I not be suitable for UFE?
What are the downsides?
What about fertility?
Is this treatment for everyone?
In a nutshell:
How do I know if I am a candidate?
Initial patient enquiries are welcome. Send us an email or call and we will email a patient information form for you to complete.
Ask your GP to refer you for a consult. Note that consultations without a referral cannot be claimed from medicare.
After listening to your symptoms and taking a medical history we will discuss further investigations or scans needed to establish whether you are a candidate.
What investigations or scans are needed?
This will be discussed at time of consult but may include:
MRI – we know that ultrasound is poor as distinguishing fibroids from adenomyosis (another benign condition which can also be treated by UFE). MRI is superior in establishing the full picture regards your fibroids. This allows us to suggest whether they are best managed by UFE or surgically.
Pap smear – an up to date is required.
How long is the procedure?
UFE typically takes about 90 mins.
Do I need an anaesthetic?
Unlike some other treatment options UFE is performed under sedation and local anaesthetic. The procedure itself is not painful. Pain in the hours after the UFE is managed by a strong painkillers.
How is the procedure performed?
The procedure is performed by a specialist interventional radiologist – expert in this area. A small plastic tube (<3mm) is placed in an artery in the wrist or groin. X-ray guidance is used to approach the artery supplying the uterus and fibroids. Tiny particles, like sand, are injected into these blood vessels, this causes the fibroids to shrink. There is no abdominal incision or scar.
How long will I be in hospital?
You will stay overnight, if pain is controlled and you can eat and drink you will go home the next morning.
What is the recovery period?
You will have to avoid exercise, heavy lifting etc for 5-7 days. To reduce risk of infection you will have to avoid bathing, tampons and intercourse for one week. It is common to feel tired and have a low fever for the first few days. By the end of the first week you should be feeling almost normal. 99% of women return to work at this point.
Why should I choose UFE?
UFE is an excellent option if your symptoms are poorly controlled on medication but you do not want surgery.
It preserves the uterus should you potentially wish to have children (see UFE and fertility)
It avoids a scar. The recovery period is much shorter than for surgical treatments.
Evidence shows the risk of major complications is lower for UFE compared to surgery.
UFE provides relief in 90-95% of women. For those who remain symptomatic, surgical options remain possible after UFE.
What is the evidence UFE works?
UFE is supported by the UK NICE, the UK and US Colleges of Obstetricians and Gynecologists and also by the Australian RANZCOG who state that the UFE is effective but less invasive, with fewer complications and quicker recovery.
UFE is also supported by the Cochrane Review, the international body who publish guidance for physicians based on all available evidence.
Is UFE experimental?
No, it has been used for over 20 years and has been studies in many gold-standard research papers. It is approved by Medicare.
Why might I not be suitable for UFE?
This can be established based upon your MRI.
If you have a single fibroid next to the lining of the womb then this is best removed surgically. If your fibroids do not have a good blood supply you will not benefit as much from UFE.
What are the downsides?
Although they will shrink, the fibroids will remain. Some women wish to have them removed completely.
Depending on the location, there is a small risk that a fibroid can be passed after the procedure (usually 2-3 months later) similar to a period. This is not a complication and usually passes with no issue.
There is a risk of infection which in the worst cases can result in a hysterectomy being required – this is very rare.
What about fertility?
Fertility problems can be because of fibroids. Treatment of fibroids can therefore improve chances of becoming pregnant.
Available evidence shows no clear difference in ability to get pregnant after treatment between UFE and myomectomy. Whether myomectomy of UFE is best for you if you wish to become pregnant will be discussed at your consult.
Almost 50% of women can become pregnant after UFE, as UFE can make the womb more favourable
It is advised not to attempt to become pregnant for 6 months after UFE to allow the lining of the womb time to recover.
Is this treatment for everyone?
No. It is best for those who wish to avoid surgery and try a minimally invasive option first.
In a nutshell:
UFE is a minimally invasive and effective treatment with a quicker recovery and fewer complications than surgical options.