Uterine Fibroid Embolization: Providing Hope for Women with Large Fibroids
By Alicia Armeli

Hope

In the past, uterine fibroid embolization (UFE) was believed to only be safe and effective in treating small to medium fibroids. Yet, new research has shown that this non-invasive treatment option could provide hope for women with large fibroids as well.

“Previous thinking was that bigger fibroids often times resulted in internal necrosis (cell and tissue death), which implies that these fibroids have outgrown their blood supply,” explained Dr. Linda Anne Hughes, an interventional radiologist at North Broward Radiologists in Fort Lauderdale, Florida. “Therefore doing an embolization, which cuts off blood supply to the fibroids, wouldn’t be as effective.”

But current data is now disputing such theories. A study published earlier this year in Cardiovascular and Interventional Radiology1 compared the effectiveness of UFE in women with small fibroids less than 10 cm in diameter to women with large fibroids greater than 10 cm in diameter. The authors of the study found there were no significant differences in reported quality-of-life scores or in health complication rates following the procedure.

And these results aren’t unusual for UFE. “I’ve had fairly good experiences with treating larger fibroids,” Dr. Hughes told Ask4UFE. “On one extreme, the largest solitary fibroid I embolized was 20 cm. It only shrunk to 14 cm, which is still big, but clinically the patient was extremely satisfied and happy with the outcome.”

Embolizing large fibroids can dramatically improve symptoms, but every woman is different. “It depends on the individual and what the symptoms are,” Dr. Hughes continued. “Our definition of success is that we alleviate symptoms to the extent that patients don’t seek or desire further treatment.”

According to Dr. Hughes, fibroid relief by UFE belongs to a triad of components. Cutting off blood supply to the fibroid can ease abnormal bleeding; cause the fibroid to shrink—ideally preventing further growth; and soften it to relieve pressure symptoms. “The fibroid will still be there,” Dr. Hughes added. “But if it’s smaller and softer, a lot of women experience adequate relief.”

However, no matter the effectiveness of the UFE procedure itself, Dr. Hughes attributes patient success to another vital piece of the care management plan. What does she encourage?

Active collaboration amongst patients and healthcare providers.

“What’s important is a team approach in terms of the interventional radiologist, the patient, and the gynecologist being involved in the care,” Dr. Hughes stressed. “This is what allows us to push the envelope with regard to size, with regard to fertility, and in terms of reaching out and being able to treat more patients.”

 

ABOUT THE AUTHOR   Alicia Armeli is a Freelance Writer and Photographer, Registered Dietitian Nutritionist, and Certified Holistic Life Coach. She has master’s degrees in English Education and Nutrition. Through her writing, she empowers readers to live optimally by building awareness surrounding issues that impact health and wellbeing. In addition to writing, she enjoys singing, traveling abroad and volunteering with her local animal shelter.

ABOUT THE DOCTOR  Linda Anne Hughes is an interventional radiologist at North Broward Radiologists in Fort Lauderdale, FL. American Board Certified in Radiology, Dr. Hughes specializes in applying cutting-edge Vascular and Interventional Radiology technologies, thereby offering the highest standard of care in a number of areas including UFE. By coauthoring several publications in Cardiovascular and Interventional Radiology, Dr. Hughes strives to educate physicians and patients about the latest minimally invasive procedures.

REFERENCES

  1. Bérczi V, Valcseva E, Kozics D, Kalina I, Kaposi P, Sziller P, Várbíró S, Botos EM. Safety and effectiveness of UFE in fibroids larger than 10 cm. Cardiovasc Intervent Radiol. 2015 Oct; 38(5): 1152-1156.
Surgical Adhesions: A Hidden Complication of Uterine Surgery
By Alicia Armeli

UFE_ConnectiveScaring

You can’t see them but they could be the cause of infertility, bowel obstructions, and persistent pain. Despite the gravity of these conditions, it has been noted that specialists may be unaware of the severity of this hidden post-surgical problem.1 What’s also alarming is that due to this lack of awareness in the medical community, insurance companies may be reluctant to cover the costs.

Surgical adhesions—or scar tissue that forms between tissues and organs during the healing process—are a common complication of abdominal and pelvic surgery that affects a staggering 93 percent of patients.1

Normally, tissues and organs have smooth, slick surfaces that allow them to slide against each other with ease inside the body. When adhesions form, tissues and organs stick together, which can potentially lead to the aforementioned conditions. And if you’re a woman who has sought out surgery to treat fibroids—this could include you.

Surgically removing fibroids, as seen with myomectomy, may come with a catch—especially for women who are seeking procedures to preserve fertility. This is because the risk of adhesions may increase with each cut. And consequently, adhesions are reported to be the cause of 20-40 percent of secondary infertility cases.1

A recent European Journal of Obstetrics & Gynecology and Reproductive Biology study reported that, “the risk of adhesions increased with increasing number of fibroids removed.” 2

If adhesions form in or around the fallopian tubes, there’s an increased risk of ectopic pregnancy. If adhesions grow inside the uterus, they can block a fertilized egg from even reaching the uterine lining for implantation. Or if implantation does in fact occur, adhesions inside the uterus could disrupt pregnancy and result in repeat miscarriages.3

Overall, the reported risk of adhesions after myomectomy is considered low but still needs to be taken into consideration.4

Another major complication of adhesions is bowel obstructions—or a block in the intestines. Because adhesions cause tissues to stick together, intestines can become disorganized and pushed out of place. When this occurs, blood can no longer reach the intestines, which results in food and waste not being able to move through the intestines as normal. Bowel obstructions are painful and a very serious condition that needs immediate medical attention.5

An estimated 74 percent of bowel obstructions found in post-surgical patients are because of adhesions—especially in surgeries of the lower abdomen and pelvis, as seen in gynecological surgeries like hysterectomy.1,5

But the statistics can vary. A study published in the Journal of Minimally Invasive Gynecology looked at the incidences of small bowel obstructions in 3,229 women who had a hysterectomy for benign reasons over the course of nine years. Results of the study showed that only 17 women had small bowl obstructions.6

“The incidence of small bowel obstruction after hysterectomy performed because of benign indications is low,” the authors concluded. What’s more, in this study, the type of hysterectomy performed (abdominal, vaginal, or laparoscopic) didn’t seem to make a difference in terms of risk. Other studies support and dispute these findings. 7

Varying statistics like these suggest that the exact reason for adhesion growth isn’t entirely clear.2,4,6,7  Adhesions have been seen to form even after non-surgical procedures like uterine fibroid embolization (UFE). Although a small percentage, one study showed 14 percent of women to develop adhesions after UFE.2

This indicates that adhesion growth may depend on various factors such as age, prior history of abdominal surgery, a predisposition for the condition, and undergoing procedures that impede blood flow to the tissue.2,7

For this reason, it’s important that women speak openly to their gynecologists before and after surgery. Medical prevention guidelines advocate for creating a care plan that reduces the risk of adhesions—especially for high-risk surgeries.1

Preoperatively, this can include discussing your own personal risk factors, all surgical options available to you, and the use of anti-adhesion products during surgery.1 After your surgery, an early detection plan to monitor adhesion growth is advised.4

Patient care doesn’t start and end in the operating room but is ongoing and crucial in order to reduce the risk of painful post-surgical complications like adhesions.

 

REFERENCES

  1. De Wilde, R. L., Brolmann, H., Koninckx, P. R., Lundorff, P., Lower, A. M., Wattiez, A., Mara, M., Wallwiener, M., & the Anti-Adhesions in Gynecology Expert Panel (ANGEL). (2012). Prevention of adhesions in gynaecological surgery: the 2012 European field guideline. Gynecological Surgery, 9(4): 365-368. doi: 10.1007/s10397-012-0764-2
  2. Conforti, A., Krishnamurthy, G. B., Dragamestianos, C., Kouvelas, S., Micallef, F. A., Tsimpanakos, I., & Magos, A. (2014). Intrauterine adhesions after open myomectomy: an audit. European Journal of Obstetrics & Gynecology and Reproductive Biology, 179: 42-45. doi: 10.1016/j.ejogrb.2014.04.034
  3. National Institute of Diabetes and Digestive and Kidney Diseases. (2013). Abdominal Adhesions. Retrieved October 5, 2015, from http://www.niddk.nih.gov/health-information/health-topics/digestive-diseases/abdominal-adhesions/Pages/facts.aspx
  4. Gambadauro, P., Gudmundsson, J., & Torrejon, R. (2012). Intrauterine adhesions following conservative treatment of uterine fibroids. Obstetrics and Gynecology International, 853269. doi: 10.1155/2012/853269
  5. University of California San Francisco Department of Surgery. (2015). Abdominal Adhesions and Bowel Obstruction. Retrieved October 5, 2015, from http://www.surgery.ucsf.edu/conditions–procedures/bowel-obstruction.aspx
  6. Muffly, T. M., Ridgeway, B., Abbott, S., Chmielewski, L., & Falcone, T. (2012). Small bowel obstruction after hysterectomy to treat benign disease. Journal of Minimally Invasive Gynecology, 19(5): 615-619. doi: 10.1016/j.jmig.2012.05.011.
  7. Angenete, E., Jacobsson, A., Gellerstedt, M., Haglind, E. (2012). Effect of laparoscopy on the risk of small-bowel obstruction: a population-based register study. Archives of Surgery, 147(4): 359-365.
With fibroids, sometimes the best thing to do is watch and wait.
By Alicia Armeli

FibroidsWait

Painful periods, abnormal uterine bleeding, and pelvic pressure. These are only a handful of classic symptoms associated with having uterine fibroids—common benign tumors found in 20 to 80 percent of women by age 50.1

But even though a substantial percentage of women may have fibroids, a mere 10-20 percent experience symptoms serious enough to require treatment.2 For women who don’t have symptoms, is medical intervention even necessary?

“The most important thing to know is that fibroids are exceedingly common and many women don’t know they have them,” explained Dr. Christopher Tarnay, Clinical Professor of Obstetrics & Gynecology and Urology at UCLA School of Medicine, Chief of the Division of Female Pelvic Medicine and Reconstructive Surgery, and Co-Director of the Comprehensive Fibroid Treatment Program at UCLA. “Just because a woman is diagnosed with a fibroid based on an imaging test doesn’t mean any treatment needs to be done. Fibroids are not dangerous and many are often asymptomatic.”

And the research agrees. Instead of seeking out treatment for asymptomatic fibroids, for some women the best thing to do may be to watch and wait.

“First we need to separate patients who are diagnosed with fibroids and have symptoms from those without symptoms,” Dr. Tarnay clarified. “Watchful waiting”—an approach that postpones treatment while still keeping an eye on the progress of a disease—“is a common treatment plan for a patient with fibroids but without symptoms.” And for these patients, watchful waiting could prove more beneficial than medical therapy or surgery.3

The purpose of this method is to see if fibroids progress and if symptoms develop. In this way, patients and physicians can make informed decisions concerning which kinds of treatments, if any, are needed.3 What’s more, according to an article published earlier this year by Current Medical Research and Opinion4, watchful waiting could also be useful for women close to menopause. After menopause, fibroids tend to shrink and symptoms may improve.

And with the right candidate, watchful waiting is considered safe. “For women without symptoms, the risks of watchful waiting are often very minimal,” Dr. Tarnay told Ask4UFE. “One of the only risks would be if there was any concern that symptoms were caused by something other than a fibroid. The other risk of watchful waiting is when patients have symptoms, such as heavy bleeding caused by fibroids, and continue to wait and not treat the fibroid. This could cause severe persistent bleeding and subsequent anemia.”

Anemia,5 a serious health condition where there aren’t enough red blood cells, could lead to complications like weakness, dizziness, fatigue, and in some cases, heart failure.

If you’ve been diagnosed with fibroids and are considering watchful waiting, it’s necessary to first discuss this with your physician to see if it’s the right course of treatment for you. According to Dr. Tarnay, screening for symptoms is a significant part of this process. If a woman doesn’t have symptoms, to watch and wait may be fitting. Once this is established, a fibroid care management plan can then be put into place.

“I educate patients about symptoms,” Dr. Tarnay emphasized. “That way, if they develop symptoms later on or if symptoms get worse, it would be time to stop watchful waiting and revisit other therapy options. However, if symptoms don’t develop, then simply following up with an ultrasound in 6-12 months to look for whether the fibroid grows or not would be appropriate.”

Before rushing into medical therapy or unnecessary procedures, women should learn of all their options. Many may find that responsibly monitoring fibroids could be the only therapy ever needed.

 

ABOUT THE AUTHOR   Alicia Armeli is a Freelance Writer and Photographer, Registered Dietitian Nutritionist, and Certified Holistic Life Coach. She has master’s degrees in English Education and Nutrition. Through her writing, she empowers readers to live optimally by building awareness surrounding issues that impact health and wellbeing. In addition to writing, she enjoys singing, traveling abroad and volunteering with her local animal shelter.

ABOUT THE DOCTOR  Christopher Tarnay is a Clinical Professor of Obstetrics & Gynecology and Urology at UCLA School of Medicine, Chief of the Division of Female Pelvic Medicine and Reconstructive Surgery, and Co-Director of the Comprehensive Fibroid Treatment Program at UCLA. Dr. Tarnay incorporates the latest advances in minimally invasive surgery emphasizing the importance of uterine and fertility preservation. Named a Super Doctor of Southern California Los Angeles, Dr. Tarnay is American Board Certified in Obstetrics & Gynecology and Female Pelvic Medicine and Reconstructive Surgery.

REFERENCES

  1. Office of Women’s Health, U.S. Department of Health & Human Services. (2015). Uterine Fibroids Fact Sheet. Retrieved October 14, 2015, from http://www.womenshealth.gov/publications/our-publications/fact-sheet/uterine-fibroids.html
  2. Society of Interventional Radiology. (2015). Uterine Fibroid Symptoms, Diagnosis, and Treatment. Retrieved October 14, 2015, from http://www.sirweb.org/patients/uterine-fibroids/
  3. Center for Advancing Health. (2013). What Is Watchful Waiting? Retrieved October 14, 2015, from http://www.cfah.org/prepared-patient/make-good-treatment-decisions/what-is-watchful-waiting
  4. Singh, S. S., & Belland, L. (2015). Contemporary management of uterine fibroids: focus on emerging medical treatments. Current Medical Research and Opinion, 31(1): 1-12. doi: 10.1185/03007995.2014.982246
  5. National Heart, Lung, and Blood Institute, US Department of Health & Human Services. (2012). What Are the Signs and Symptoms of Anemia? Retrieved October 14, 2015, from http://www.nhlbi.nih.gov/health/health-topics/topics/anemia/signs