“Uterine fibroid embolization – a boon for women with uterine fibroids,”
By Dr. Vikash CS, Director of Interventional radiology, Narayana Health (South India)
Nothing is as painful for a woman with fibroids as losing her uterus on account of hysterectomy, the usual treatment recommended by gynecologists. A major surgery like hysterectomy (removal of uterus) or myomectomy (removal of fibroids), associated hospital stay, pain and slow recovery is a traumatic experience. Uterine fibroid embolization (UFE) or uterine artery embolization (UAE) is a novel, minimally invasive procedure which avoids this by preserving the uterus and shrinking the fibroids without having to undergo surgery. The treatment is a daycare procedure that allows the patient to be discharged on the same day.
Uterine fibroids are non-cancerous growths/tumors in the uterus or womb, a common cause of morbidity in women. About 1 in 3 women aged between 30 to 50 years of age suffer from fibroids. Fibroids can be asymptomatic or cause one of the following symptoms
- Heavy, prolonged monthly periods,
- Irregular periods
- Anemia resulting in easy fatigability
- Excessive pain during periods
- Pain during sexual intercourse
- Frequent need to urinate
- Constipation or bloating
- Inability to conceive (Infertility)
- Enlarged belly, heaviness in the pelvis, backache, etc.
|UTERINE FIBROID/ARTERY EMBOLIZATION:
Non surgical treatment indicated for
- Uterine fibroids
- Failed myomectomy
- Recurrence of fibroids after myomectomy
- Adenomyosis of uterus
- Not a surgery, no surgical incision or scar
- Done under local anesthesia, No need of general anesthesia
- Daycare procedure – discharged on same day or next day
- Rapid recovery – within 2-6 days (1-2 months with hysterectomy & 3- 4 wks with myomectomy)
- Retains ability to have children after the procedure
- Retains uterus – signature of womanhood
- No risk of injury to adjacent organs which can happen during surgery
- No risk of adhesion formation, blood loss which can happen with surgery
- Can treat all fibroids at once (may not be possible with myomectomy)
Uterine Fibroid Embolization (UFE) is one of the recent advances in treating fibroids, performed by an interventional radiologist through a small needle hole. Flexible plastic tube called as catheter is inserted and guided to the blood vessels supplying the fibroid. Once the catheter is in the proper position, small particles are injected which block the blood vessels and deprive the fibroid of nutrients, resulting in shrinkage of the fibroid. Even though the fibroids shrink gradually over few months, patients see improvement in symptoms as early as few days to few months.
UFE is a procedure performed under local anesthesia and usually takes about 60min. As it is performed through a tiny needle hole, there are no sutures or scars. The patient is discharged the same day and can get back to normal pre-procedure routine within 2-5 days. This is in contrast to hysterectomy which needs hospitalization of around 7 days, about 1-2months to come back to presurgical state. Myomectomy (removal of fibroids alone preserving the uterus) also needs about 4-7 days hospitalization and 3-4wks to get back to presurgical state. UFE is thus a boon for working women who need to get back to their routine as early as possible.
During surgery, there is a chance of injury to the adjacent organs like intestines, urinary bladder, ureters, etc. Hysterectomy at an early age can lead to weakening of pelvic musculature which can result in complications like urinary incontinence, etc at a later age. These can be totally avoided with UFE. As this procedure is performed under local anesthesia, there are no risks associated with general anesthesia. Patients who are unfit for general anesthesia (and thus surgery) due to other co morbidities like heart, lung problems can undergo UFE safely.
Women do not only lose their uterus to hysterectomy, but they also lose the prospect of having a child. For young, unmarried or childless women with fibroids, hysterectomy is a mental scar that they are unable to heal throughout their lives. The agony attached with this is profound and lasting. Uterine fibroid embolization, on the other hand, retains the child bearing ability and also allows a woman to retain the signature of her womanhood – the uterus.
Other advantages of UFE are that there is virtually no blood loss as the blood vessels are blocked during the procedure. Thus blood loss during surgery and need of any blood transfusion does not arise with UFE.
Multiple comparative studies and trials have showed that UFE is as effective as surgery with advantages as mentioned above.
Another medical condition known as adenomyosis which also causes similar symptoms of bleeding can also be treated with uterine artery embolization, although with lower success rates.
Usually women look no farther than gynecologists for an advice, who more often than not, recommend either hysterectomy or myomectomy. Uterine fibroid embolization is a minimally invasive treatment which is equally effective with advantages of rapid recovery, less trauma and retention of uterus.
If you have uterine fibroids/adenomyosis with any of the above mentioned symptoms, do contact an interventional radiologist and ask for UFE/UAE.
Dr. Vikash CS, Director & head of Interventional radiology at Narayana Health city, Bommasandra is a graduate of All India Institute of Medical Sciences(AIIMS), New Delhi with Canadian fellowships and extensive experience in the field of interventional radiology and uterine fibroid/artery embolization.