January 2005

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Treatment for fibroids provides relief, preserves uterus

By Meg Bolton

Amy Young, MD

Women who suffer from uncomfortable fibroid tumors can gain relief without losing their uterus thanks to a procedure called uterine fibroid embolization, a minimally invasive procedure performed by Baylor College of Medicine physicians.

Fibroid tumors, or myomas, are masses of muscle tissue that form along the uterine wall. Although benign, fibroids can cause many problems including pelvic pain, pressure on the bladder or bowel, and abnormal, heavy bleeding.

"Fibroids are prevalent in 80 percent of women, but are clinically evident in only 20-40 percent," said Amy Young, MD, assistant professor of obstetrics and gynecology at BCM.

While the exact source of fibroids is unknown, there is evidence that the condition is hereditary.

Ruth L. Bush, MD

"While some women develop tumors sporadically, there is evidence that a genetic component exists," said Ruth L. Bush, MD, assistant professor of vascular surgery, in the Michael E. DeBakey Department of Surgery at BCM. "For example, if a woman's mother has fibroids, there is a high likelihood she will develop fibroids as well."

Once formed, fibroids thrive on blood delivered from blood vessels in the uterus. The purpose of UFE is to block blood supply that nourishes the fibroids.

Traditionally, fibroids have been treated by surgically removing the tumors from the uterus (myomectomy) or removing the entire uterus (hysterectomy). Because these surgeries are highly invasive and require weeks of recovery, many patients avoid them, even though their fibroids are unpleasant and uncomfortable. With UFE, women stay in the hospital only overnight and can usually return to normal activities within a week of the procedure.

UFE initially began as a procedure to control bleeding before and after uterine surgery. When performed before surgery for fibroids, UFE had alleviated symptoms in many patients, making the more extensive operation unnecessary. Because of that, physicians decided to use the procedure on its own.

Guided by X-ray imaging, a vascular surgeon or an interventional radiologist inserts a catheter, or flexible tube, into a woman's femoral artery in the upper thigh. The catheter then passes along that arterial pathway until it reaches the artery in the woman's uterus. When the catheter is positioned correctly, small polyvinyl alcohol (PVA) particles are injected into the fibroid's blood vessels until blood flow to the fibroids is obstructed. The procedure is performed on both sides of the uterus to ensure that all fibroids are treated.

"With decreased blood supply, the tumors will shrink over time and symptoms will be alleviated," said Bush.

Bush and Young coordinate care of patients undergoing UFE. Young participates in the initial evaluation of the patient and her after-surgery care. Bush or an interventional radiologist performs the actual procedure.

"It is important that ob-gyns work with vascular surgeons," said Bush. "Working together, we can decide if a patient is an appropriate candidate for the procedure and ensure that they understand all of their treatment options."

Although open surgery presents more risks than UFE, it is recommended for women with fibroids that are very large and thus make the uterus large.

"We measure fibroids in the same way we measure women who are pregnant," said Bush. "If the uterus is smaller than it would be at 20 weeks, then the procedure is possible. If the size of the uterus is more than 20 weeks, surgical intervention is a better option."

Additional conditions that exclude women from the procedure include:

• Lack of symptoms.
• Possible cancer.
• Inflamed or infected pelvis.
• Pregnancy or plans to become pregnant.
• Malfunctioning or failing kidneys.
• Allergy to dyes used in looking at the uterus by X-ray.

Although studies show UFE has few complications, risks do exist, as they do with all surgical procedures. Potential problems include cramping, infection, allergic reactions, and menstruation or reproductive complications. However, Bush says the main risk associated with UFE is that it won't work.

"The success rate has been excellent and the procedure gives women an ideal option for treating their fibroids," said Bush.

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