What are uterine fibroids?

Uterine fibroids, also called leiomyoma, are abnormal but benign tumors of muscle tissue that arise from the muscular wall of the uterus. These tumors are usually asymptomatic but can cause symptoms including pain, abnormal bleeding, frequent urination, constipation, a feeling of abdominal bloating and pain during intercourse. Fibroids may also result in infertility.

A physical exam will frequently detect some enlargement of the uterus. When this enlargement is felt to be significant then a pelvic ultrasound exam is usually performed. This exam is very sensitive for the detection of fibroids. Sometimes an MRI is performed because it gives the best fine detail in evaluating fibroids.

Once the diagnosis has been established there are a variety of treatments. Fibroids usually recede during and after menopause because the hormone stimulation for growth is removed. Hormone therapy may suppress the fibroids growth and even cause them to shrink but growth will resume once discontinued. In patients who wish to become pregnant a procedure known as laprascopic or open myomectomy can be performed to remove individual fibroids surgically. In patients who do not wish to become pregnant the traditional treatment has been hysterectomy. Uterine fibroid embolization (UFE) has been performed since the early 1990’s and provides an alternative, non-surgical treatment that is effective and does not require removal of the uterus or major surgery.

What can I expect during this procedure?

The procedure is performed by an interventional radiologist. Intravenous sedation is provided to keep the patient comfortable during the procedure. A small catheter is introduced through the artery in the groin (sometimes on both sides) and positioned into the arteries that feed the uterus. Tiny particles are injected into the arteries to stop blood flow. The muscular wall of the uterus tolerates this well with no ill effects, but the fibroid deprived of its blood supply dies. Over time it will shrink as much as 70% allowing for improvement or complete resolution of symptoms. The procedure takes about an hour to perform. Most patients will stay in the hospital overnight as some post-embolization pain is expected.

What should I expect after this procedure?

Discharge the following day is usual and patients resume their pre-procedure activity levels in 7-10 days. UFE is not major surgery and the recovery time is considerably shorter than for hysterectomy. Complete recovery time for hysterectomy can be many weeks to as long as 3 months. With UFE the uterus itself is not removed, there are no surgical incisions and the possibility of post-operative scarring does not exist.

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