Vascular Surgery and Endovascular Therapy

Uterine Fibroids

Uterine fibroids

Uterine fibroids are the most common tumors of the female reproductive system. Fibroids – also called uterine myomas, leiomyomas or fibromas – are benign growths that develop from smooth muscle cells and fibrous connective tissue either just beneath the outer surface of the uterus, or within the uterine wall. Fibroid growth is linked to the presence of estrogen and progesterone, but the mechanism involved is not understood. Fibroids range from the size of a pea to the size of a grapefruit. As many as 50 percent of women develop uterine fibroids at some point in their lives, but because fibroids may not produce symptoms, many women are unaware that they have them.

Risk Factors and Symptoms

Women in the 30s and 40s are at highest risk of developing fibroids. Women of African-American, Hispanic and Asian heritage also seem to be at an increased risk, for reasons not understood.

Some women with fibroids have mild or no symptoms, while for others symptoms are severe and disruptive. Some women experience iron-deficiency anemia from heavy or prolonged menstrual periods or abnormal bleeding between periods. Common symptoms include:

  • Heavy or prolonged menstrual periods
  • Abnormal bleeding between menstrual periods
  • Pelvic pain (caused as the tumor presses on pelvic organs)
  • Frequent urination
  • Low back pain
  • Pain during intercourse
  • An enlarged abdomen, which causes a constant feeling of fullness or pressure

Treatments

Hysterectomy. Many women with fibroids are informed by their doctors that they need a hysterectomy, which is a surgical procedure to remove the uterus. Approximately a third to a half of the 600,000 hysterectomies performed each year in the US are for fibroids. For many patients, though, a less invasive uterine sparing alternative called uterine fibroid embolization (UFE) is an option.

Uterine fibroid embolization. During uterine fibroid embolization (UFE), a medical specialist called an interventional radiologist cuts off the blood supply to fibroids, so that they gradually shrink. Doctors begin the procedure by inserting a tiny tube called a catheter into an artery at the top of the leg. They guide the catheter into the uterine artery, map the arteries feeding the fibroids with an arteriogram (an x-ray in which a dye is injected into the arteries), then inject microspheres the size of grains of sand through the catheter and into the fibroids to block their blood supply. The fibroids begin to shrink, and many women experience rapid relief from their symptoms. The procedure takes about an hour and the recovery time is significantly less than traditional surgery. Unlike in hysterectomy, the uterus and ovaries are spared. Studies show that most women who undergo UFE experience either significant or complete resolution of their symptoms over time, and fibroids rarely return.