Gynecological Treatment

Uterine Fibroid Embolization for the Treatment of Uterine Fibroids

Uterine Fibroids

Have you been diagnosed with uterine fibroids? Don’t worry, they are extremely common and treatable.

Uterine fibroids are benign tumors that develop within the muscular wall of the uterus. Twenty to 40 percent of women over the age of 35 have uterine fibroids and over 50 percent of African American women have them.

Uterine fibroids are the most frequent indication for hysterectomy in pre-menopausal women. Of the 600,000 hysterectomies performed annually within the United States, one third are due to symptomatic fibroids. Now there is a proven, non-surgical alternative to hysterectomy for the treatment of symptomatic uterine fibroids, called uterine fibroid embolization (UFE). You can learn more about UFE farther down on this page.

Fibroid Types

Uterine fibroids are categorized by their location within the muscular wall of the uterus.

Intramural fibroids are the most common type of uterine fibroids. They develop within the muscular wall of the uterus and tend to grow inward.

Subserosal fibroids develop under the outside lining of the uterus. They typically don’t cause changes of menstrual flow, however they may cause symptoms of pelvic or back pain, pressure, and/or bloating.

Subserosal fibroids can have stalk or stem. These are called pedunculated subserosal fibroids.

Submucosal fibroids develop under the uterine cavity lining. Although they are the least common type, they cause the greatest symptoms. Even small subserosal fibroids can cause heavy menstrual bleeding with clots and gushing as well as prolonged cycles.

Symptoms

Most fibroids don’t cause symptoms. Only 10 to 20 percent of women with fibroids have symptoms that require treatment. Symptoms may include:

Heavy menstrual bleeding that tends to be prolonged
Intermittent, unusual monthly bleeding
Anemia (low blood count)
Pelvic pain and pressure
Painful menstrual cramping
Frequency in urination secondary to bladder pressure
Constipation
Bloating
Pain during sexual intercourse
Increase in waist size

Diagnosis

Typically an ultrasound can determine if you have uterine fibroids. However, it is limited. An MRI (magnetic resonance imaging) is far superior in determining the presence, location, and type of fibroids. It is also a better test to diagnose other uterine and pelvic pathology that may be the cause of the symptoms you’ve been experiencing. Diagnosis is necessary before to uterine fibroid embolization (UFE) treatments can begin.

Uterine Fibroid Embolization (UFE) Treatments

If you are scheduled to receive UFE treatments, they will be performed safely in an outpatient setting. Following the procedure, non-steroidal medication (Motrin) and painkillers will be prescribed for several days. This helps to control any pain and cramping you may experience. In addition, medication for nausea may be prescribed as needed. Most women resume light activities in a few days and are able to return to normal activities within ten days. In comparison, recovery time after a hysterectomy is approximately six weeks.

UFE Facts

UFE is effective on most size and types of fibroids.
Eighty-five to ninety percent of women have significant relief of their symptoms.
Recurrence of treated fibroids is rare.
Approximately 14,000 UFE procedures are performed annually in the U.S.
Embolization of the uterine arteries has been performed by interventional radiologists for over 20 years. It was, and still is, used to treat life-threatening bleeding after childbirth.
The embolic particles are FDA approved and have been in use in people for over 20 years.
UFE is covered by most major insurance companies.
It is an organ sparing procedure.
UFE preserves fertility with numerous reports of successful pregnancy after UFE.

Non-surgical Uterine Fibroid Embolization – A Major Advance in Women’s Health

Uterine fibroid embolization (UFE), also known as uterine artery embolization, is performed by an interventional radiologist, a physician who is trained to perform this and other types of embolization and minimally invasive procedures. It is performed while the patient is conscious, but sedated and feeling no pain. It does not require general anesthesia.

The interventional radiologist makes a tiny nick in the skin in the groin and inserts a catheter into the femoral artery. Using real-time imaging, the physician guides the catheter through the artery and then releases tiny particles, the size of grains of sand, into the uterine arteries that supply blood to the fibroid tumor. This blocks the blood flow to the fibroid tumor and causes it to shrink and die.

Risks

UFE is a very safe method and, like other minimally invasive procedures, has significant advantages over conventional open surgery. However, as with any medical procedure, there are some associated risks. A small number of patients have experienced infection, which usually can be controlled by antibiotics. There also is a less than one percent chance of injury to the uterus, potentially leading to a hysterectomy. These complication rates are lower than those of hysterectomy and myomectomy.

For the procedure, an interventional radiologist will make a tiny nick in your skin at the groin through which a thin catheter (much like a piece of spaghetti) is passed into the femoral vein, directly to the testicular vein. The physician then injects contrast dye to provide direct visualization of the veins so he/she can map out exactly where the problem is and where to embolize or block the vein.

Ovarian Vein Embolization for the Treatment of Pelvic Congestion Syndrome

Pelvic Congestion Syndrome – Chronic Pelvic Pain in Women

It is estimated that one-third of all women will experience chronic pelvic pain in their lifetime. Many of these women are told the problem is “all in their head,” but recent advancements now show the pain may be due to hard to detect varicose veins in the pelvis, known as pelvic congestion syndrome.

The causes of pelvic congestion syndrome are varied, but are often associated with the presence of ovarian and pelvic varicose veins. Pelvic congestion syndrome is similar to varicose veins in the legs. In both cases, the valves in the veins that help return blood to the heart are working against gravity, become weakened, and don’t close properly. This allows blood to flow backwards and pool in the vein causing pressure and bulging veins. In the pelvis, varicose veins can cause pain and affect the uterus, ovaries, and vulva. Up to 15 percent of women, generally between the ages of 20 and 50, have varicose veins in the pelvis, although not all experience symptoms.

The diagnosis is often missed because women lie down for a pelvic exam, relieving pressure from the ovarian veins, so that the veins no longer bulge with blood as they do while a woman is standing.

If you are one of the many women living with chronic pelvic pain, you’ve experienced the discomfort it causes on a daily basis. It affects not only you directly, but also can affect your interactions with your family, friends, and your general outlook on life. And if your cause of the pelvic pain is not diagnosed, no therapy is provided—even though there is therapy available.

To learn more about your treatments options, read through the information below or contact us directly at 919.677.9729 or email.

Prevalence

Women with pelvic congestion syndrome are typically less than 45 years old and in their childbearing years.
Ovarian veins increase in size related to previous pregnancies. Pelvic congestion syndrome is unusual in women who have not been pregnant.
Chronic pelvic pain accounts for 15 percent of outpatient gynecologic visits.
Studies show 30 percent of patients with chronic pelvic pain have pelvic congestion syndrome (PCS) as a sole cause of their pain and an additional 15 percent have PCS along with another pelvic pathology.

Risk Factors

Two or more pregnancies and hormonal increases
Fullness of leg veins
Polycystic ovaries
Hormonal dysfunction

Symptoms

The chronic pain that is associated with this disease is usually dull and aching. The pain is usually felt in the lower abdomen and lower back. The pain often increases during the following times:

Following intercourse
Menstrual periods
When tired or when standing (worse at end of day)
Pregnancy

Other symptoms include:

Irritable bladder
Abnormal menstrual bleeding
Vaginal discharge
Varicose veins on vulva, buttocks, or thigh

Diagnosis and Assessment

Once other abnormalities or inflammation has been ruled out by a thorough pelvic exam, pelvic congestion syndrome can be diagnosed through several minimally invasive methods. An interventional radiologist, a doctor specially trained in performing minimally invasive treatments using imaging for guidance, will use the following imaging techniques to confirm pelvic varicose veins that could be causing chronic pain.

Pelvic venography: A venogram is thought to be the most accurate method for diagnosis and is performed by injecting contract dye in the veins of the pelvic organs to make them visible during an X-ray. To help accuracy of diagnosis, an interventional radiologists will examine the patient on an incline, because the veins decrease in size when a woman is lying flat.

MRI: An MRI may be the best non-invasive way of diagnosing pelvic congestion syndrome. The exam needs to be done in a way that is specifically adapted for looking at the pelvic blood vessels. A standard MRI may not show the abnormality.

Pelvic ultrasound: A pelvic ultrasound is usually not very helpful in diagnosing pelvic congestion syndrome unless done in a very specific manner with the patient standing while the study is being done. Ultrasound may be used to exclude other problems that might be causing pelvic pain.

Transvaginal ultrasound: This technique is used to better see inside the pelvic cavity. As with a pelvic ultrasound, it is not very good at visualizing the pelvic veins unless the woman is standing. However, it may be used to exclude other problems.

Treatment Options

If you’ve been diagnosed with pelvic congestion syndrome and are symptomatic, an embolization should be done. Embolization is a minimally invasive procedure performed by interventional radiologists using imaging for guidance.

During the outpatient procedure, the interventional radiologist inserts a thin catheter, about the size of a strand of spaghetti, into the femoral vein in your groin and guides it to the affected vein using X-ray guidance. To seal the faulty, enlarged vein and relieve painful pressure, an interventional radiologist inserts tiny coils often with a sclerosing agent (the same type of material used to treat varicose veins) to close the vein. After treatment, you can return to normal activities immediately.

Additional treatments are available depending on the severity of your symptoms. Analgesics may be prescribed to reduce the pain. Hormones, such as birth control pills that decrease a woman’s hormone level causing menstruation to stop, may be helpful in controlling your symptoms. Surgical options include a hysterectomy with removal of ovaries, and tying off or removing the veins.

If you have pelvic pain that worsens throughout the day when standing, or any of the other symptoms mentioned above, there may be a treatment that’s right for you. Our physicians will work with your gynecologists to determine the best treatment option for your pain.

Efficacy

In addition to being less expensive to surgery and much less invasive, embolization offers a safe, effective, minimally invasive treatment option that restores your normal lifestyle. The procedure is very commonly successful in blocking the abnormal blood flow. It is successfully performed in 95 to 100 percent of cases. Although the majority of women are improved, the veins are never normal and in some cases other pelvic veins also become affected, which may require future treatment.