Many Australian women are troubled by fibroids symptoms such as heavy menstrual bleeding, period pain, bladder and pressure symptoms.
Often, they have been told to put up with it, wait for menopause, or have a hysterectomy.
Have you ever wondered if we can shrink fibroid without cutting out the uterus?
Thankfully we are in the 21st Century, there is now a much less invasive alternative to a hysterectomy. It is called UFE or Uterine Fibroid Embolisation.
Local anaesthetic, no surgical incisions, one night in hospital, one-week recovery-too good to believe? Read on to find out more.
What is a uterine fibroid embolization (UFE)?
UFE (Uterine Fibroid Embolisation), also known as UAE (Uterine Artery Embolisation), is a minimally invasive radiological procedure that will shrink fibroids and alleviate fibroid symptoms such as heavy menstrual bleeding (HMB), period pain, pelvic pressure and bladder symptoms. Studies has shown that UFE is as effective as hysterectomy, but much less invasive with quicker recovery.
Haven’t heard about this? Well, your gynaecologist might not have mentioned UFE, which is performed by an Interventional Radiologist, not gynaecologists.
UFE Uterine Fibroid Embolisation-a non-surgical treatment.
How is UFE done?
UFE is performed under local anaesthetic and sedation. A small tube called catheter is inserted into the femoral artery in the groin. Using modern X-ray equipment, the catheter is then navigated to the arteries to the uterus. Small plastic particles (usually PVA polyvinyl alcohol) the size of sands are mixed with X-ray dye and injected to shut down the blood supply so that the fibroids will shrink and die. Patients stay overnight in hospital and may resume normal activities in one week.
During UFE, small particles are injected to block the arteries to the uterus.
Watch this video: How does UFE work?
How does UFE shrink fibroids without harming the normal uterus?
The uterus is a very special organ in human body. It is only about 60 to 80 ml when a woman is not pregnant. During pregnancy, we know that the uterus enlarges tremendously, carrying with it 40 times increase in blood flow. The uterus has an immense capacity to re-open and recruit dormant blood vessels when needed, like during pregnancy. Once the baby is born, the uterus shrivels down and most of the blood vessels also shut down. Abnormal growths like fibroids do not have the ability to reopen or recruit blood vessels. Particles blocking the blood vessels supplying fibroid will lead to shrinkage. Some particles may enter normal myometrial tissue, causing transient lack of oxygen, but dormant vessels are then recruited to keep normal uterus alive. As a result, the fibroids die, and normal uterus remains alive.
Case Study 1: 43 year old teacher with a bulging abdomen
She also suffers from bloating and pressure symptom, as well as frequency of urination day and night. She is well and healthy otherwise, and she is not keen in major surgery. Note the marked reduction of fibroid volume from 533ml to 211ml at 6 month progress MRI; the fibroid is dead, no longer viable, seen as dark signal without contrast enhancement; the normal looking viable enhancing myometrium is labelled “M”. All her bladder symptoms have resolved. She is glad that she can fit her jeans again.
Does size and number matter for UFE?
No. UFE treats all fibroids, large or small, one or multiple are by the same procedure-blocking of the left and right uterine arteries by flowing in small particles. Therefore, the number of fibroids does not matter.
Size does not matter in general. On average, fibroid will shrink 60% of its volume. This amount of shrinkage is sufficient for symptom control in more than 90% of patients.
Fibroid shrinkage is related to the composition of the fibroid. Active fibroids that are rich in cells and blood suppl tend to shrink more, than “fibrous” or less active fibroids.
Case Study 2: 48 year old wife of a doctor failing conservative treatments
She suffers from severe heavy menstrual bleeding (HMB) and failed conservative treatments including removal of some of the fibroids and Mirena. She continued to suffer from HMB but declined hysterectomy. Pre-UFE MRI showed multiple fibroids denoted as “F”. After UFE, fibroids are shrunken, scarred and no longer viable, seen as dark nodules. The uterine volume reduced from 781ml to 349ml. Her periods become very light and she is very happy –”UFE changed my life”.
How effective is UFE?
UFE was first reported in 1995. Since then many research studies have document the effectiveness. There are now 7 randomised control trials (RCTs) comparing UFE with surgery (myomectomy or hysterectomy). The results were summarised by Cochrane review in 2014. Cochrane is the highest level of medical evidence when it comes to comparing treatment options. Cochrane stated that UFE has similar outcome compare with surgery, in terms of symptom relief, patient satisfaction and quality of life improvement. In other words, UFE is as effective as hysterectomy, but less invasive and with quicker recovery.
Watch Video: UFE on Channel 7 News
How soon do we see the effect of UFE?
For heavy periods, quite often the menstrual loss is noticeably reduced at the first menstrual period after UFE. Pressure and bladder symptoms might take 2-3 months to be noticeably relieved.
Is pregnancy possible after UFE?
Many research studies suggest pregnancy is possible after UFE. There seems to be no foetal growth retardation. However, when compared with a general obstetric population, the rate of miscarriage, pre-term delivery and post-partum haemorrhage is higher in women who have undergone UFE. This is probably related to the fibroid disease itself rather than the UFE procedure.
Summary
UFE is a minimally invasive angiographic procedure that has been proven to be safe and effective to treat fibroid related symptoms. It is performed under local anaesthetic, requires 1-night stay in hospital and 1-week recovery. It is most suitable for women who wish to avoid a hysterectomy.
Dr Eisen Liang is an Interventional Radiologist who founded Sydney Fibroid Clinic. He has worked collaboratively with gynaecologists for more than 10 years in helping women to resolve fibroid related symptoms. His research papers on fibroid disease have been presented internationally and published in ANZJOG.
For further information, please visit www.sydneyfibroidclinic.com.au