Welcome To Our New Site

Hello! We are excited to post today on our new and improved Ask4UFE website.

We hope you like the look and feel of the revamped site. Some of the new features include:

QuarterlyNewsletter.IconQuarterly newsletter sign-up option

SeminarsEvents.IconInformation on health-related seminars and events
MobileFriendly.Icon Better compatibility with mobile devices

Ask4UFE.com was developed specifically to help raise awareness about uterine fibroids and their treatment options, including uterine fibroid embolization (UFE). Our relaunch should help make it easier for women to find an interventional radiologist in their area to schedule a UFE consultation.

Take a moment to explore our new site, perhaps share our post, and be sure to check back often. We’ll continue to update this blog on a regular basis to keep you informed.

If you have any questions about our new site, or anything else, please reach out to us at [email protected].

Common UFE Misconception: “I have too many fibroids.”
By Alicia Armeli

A misunderstanding women with fibroids often have is that uterine fibroid embolization (UFE) won’t work for them because they have “too many fibroids.” Yet, it’s because of UFE’s unique method of treatment that makes this technique a success—no matter how many fibroids a woman has.

“Currently the professional society practice guidelines do not have a limit to number or size of fibroids that UFE can treat,” clarified Dr. Meghal Antani, MD, Interventional Radiologist and Medical Director at the Center for Interventional Medicine in Springfield, Va. “Therefore, there is no such thing as ‘too many’ fibroids for UFE.”

To understand the reason for UFE’s success in treating multiple fibroids, it’s best to first learn how it works. UFE targets fibroids by zeroing in on what they need to survive—blood supplied to them by the uterine arteries.

A doctor called an interventional radiologist starts by making a small incision in the wrist or groin to access the peripheral arteries that lead to the uterine arteries. Using live magnetic resonance imaging (MRI) for precision, the doctor then guides a small tube called a catheter through the arteries. Once in the uterine arteries, tiny particles—smaller than grains of sand—are released to block off blood flow to all existing fibroid tissue, causing it to shrink and die.

Embolization has been shown to shrink fibroid tissue by 50 percent and lessen the severity of symptoms like pelvic pressure and heavy painful periods in a matter of months.1 “UFE is a good solution for multiple fibroids,” Dr. Antani said. “Blocking off both right and left uterine arteries can treat all of the fibroids, regardless of number.”

Overall, UFE’s success doesn’t depend on how many fibroids exist, but more so on targeting the right vessels. In some cases, Dr. Antani explained, fibroids are fed by other blood vessels, like branches of the ovarian arteries. If this is the case, treating these vessels with a second round of UFE may be necessary for the patient to experience full relief.

 

ABOUT THE AUTHOR   Alicia Armeli is a Health Freelance Writer, 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  Meghal Antani is an interventional radiologist and Medical Director at the Center for Interventional Medicine in Springfield, Va. With 20 years of combined patient care and research, Dr. Antani’s other specialties include, but aren’t limited to, vascular radiology, minimally invasive treatments for women’s health, and interventional pain medicine. Dr. Antani is dedicated to improving the patient experience by working to create a treatment plan that fits each person individually. 

REFERENCES

  1. McLucas, B., Voorhees Iii, W. D., & Elliott, S. (2015). Fertility after uterine artery embolization: a review. Minimally Invasive Therapy & Allied Technologies, 2: 1-7.

Childhood Abuse May Increase Risk of Uterine Fibroids
By Alicia Armeli

fibroids-abuse

Uterine fibroids is a condition that’s often linked to several adult-related risk factors such as increasing age, low vitamin D levels, and high blood pressure. But could the risk for developing these noncancerous growths start well before adulthood? According to a study published in the American Journal of Obstetrics and Gynecology1, women who had a history of childhood abuse were also more likely to have uterine fibroids.

The study was led by Lauren A. Wise ScD, Senior Epidemiologist at Slone Epidemiology Center at Boston University and Professor of Epidemiology at the Boston University School of Public Health. With a team of experts, Wise explored the possible association between lifetime abuse and fibroids among over 9,000 premenopausal women enrolled in the Black Women’s Health Study.

Between 2005 and 2011, participants reported diagnoses of uterine fibroids as well as their experiences with physical and sexual abuse throughout childhood (age 11 and younger), adolescence (ages 12-18), and adulthood (age 19 and older).

After comparing the data, Wise found that fibroids were more common among women who had reported childhood abuse—specifically sexual abuse—in comparison to those who hadn’t.

What’s more, the risk for fibroids increased with abuse severity. Women who experienced childhood physical and sexual abuse categorized as the most severe were 57 percent more likely to have fibroids.

But are these results race-specific?

In a similar study2 that spanned over 16 years, Renee D. Boynton-Jarrett, MD, ScD, Pediatrician, Social Epidemiologist, and Associate Professor of Pediatrics at Boston University School of Medicine examined the possible relationship between early life abuse and the risk of fibroids in over 60,000 premenopausal women enrolled in the Nurses’ Health Study—97 percent of whom were Caucasian.

Overall, there were nearly 10,000 cases of fibroids; a staggering 65 percent reported also being abused. This risk was seen to increase with severity and frequency of both childhood and teen physical and sexual abuse.

From altering the body’s stress response and hormone levels to increasing the risk for obesity, there are a number of reasons researchers have connected early life abuse with fibroids.

But there was also a major finding that weakened this link. Results showed that abused girls who had a supportive relationship with an adult were less likely to have fibroids later on. This suggests that positive relationships are protective against the harmful impacts abuse can have on health and development.

A leading cause for hysterectomy in the US, uterine fibroids affect between 80 and 90 percent of African American women and 70 percent of Caucasian women by age 503. And although benign, uterine fibroids can be responsible for debilitating health problems like unbearably heavy painful periods, anemia, incontinence, constipation, painful intercourse, fertility complications, and depression.

At this time, the exact etiology of fibroids is still unknown but, fortunately, studies like these can aid in finding a cause and cure to what Boynton-Jarrett refers to as a “far-too-common condition.”

ABOUT THE AUTHOR Alicia Armeli is a Health 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 within her community.

REFERENCES

  1. Wise, L. A., Palmer, J. R., & Rosenberg, L. (2013). Lifetime abuse victimization and risk of uterine leiomyomata in black women. American Journal of Obstetrics and Gynecology, 208(4): 272.e13. doi: 10.1016/j.ajog.2012.12.034
  2. Boynton-Jarrett, R., Rich-Edwards, J. W., Jun, H. J., Hilbert, E. N., & Wright, R. J. (2011). Abuse inchildhood and risk ofuterine leiomyoma: the role of emotional support in biologic resilience. Epidemiology, 22(1): 6-14. doi: 10.1097/EDE.0b013e3181ffb172
  3. US Department of Health and Human Services. (2013). How many people are affected by or at risk of uterine fibroids? Retrieved April 12, 2016, from https://www.nichd.nih.gov/health/topics/uterine/conditioninfo/Pages/people-affected.aspx
Green Tea Extract:
A Natural Approach to Treating Uterine Fibroids?
By Alicia Armeli

GreenTea

Second to water, tea is the most frequently consumed beverage on the planet.1 But beyond its array of palatable aromas and flavors, tea—particularly green tea—offers an abundance of antioxidants that may play a role in disease prevention.

According to a study published in the International Journal of Women’s Health,2 one such antioxidant called epigallocatechin-gallate (EGCG) found in green tea and its extracts has been shown to significantly shrink uterine fibroids and improve symptoms.

Principal Investigator of the study, Dr. Ayman Al-Hendy, MD, PhD, FRCSC, FACOG, formerly of Meharry Medical College in Nashville, Tenn., and a team of researchers investigated the effects of EGCG on 39 women 18 to 50 years of age with symptomatic uterine fibroids. All the women in the study had at least one fibroid of two centimeters or larger, as was confirmed by ultrasound.

The women were randomly divided into two groups and over the course of four months were treated with either 800 mg of caffeine-free green tea extract that contained 45 percent EGCG or a placebo treatment of 800 mg of brown rice. Throughout the study, symptom severity and quality of life scores were collected and at the end of the study, fibroid size was again measured.

Overall, 33 of the 39 women completed the study. In comparison to the placebo group, the authors found that among women who were treated with green tea extract, fibroids shrunk by 32.6 percent.

What’s more, in the green tea extract treatment group symptom severity decreased by 32.4 percent and quality of life scores improved by more than 18 percent. Anemia significantly improved and an average reduction of 26 mL per month of menstrual blood loss was reported.

In contrast, fibroid size in the placebo group grew by nearly 25 percent, symptoms worsened, and quality of life scores increased by only 2 percent—possibly due to the placebo-effect, the authors noted. Additionally, there was no statistical change in monthly menstrual blood loss throughout the study.

Unlike other medications used to treat fibroids, Al-Hendy and his team found that women tolerated the green tea extract well and no adverse side effects accompanied the treatment. Specifically, no diseases of the uterine lining were found; liver and renal function and hormone levels were normal; and inflammatory markers remained within healthy limits.

Why might green tea extract produce such results?

The exact mechanism is unclear, but the authors noted the benefits seen could possibly be attributed to the anti-tumor effects of EGCG.

At this time, green tea extract for the treatment of uterine fibroids isn’t FDA approved and larger longitudinal studies are needed to confirm these preliminary results. Taking supplements should always be discussed with your doctor first.

That being said, this data may be the first step to opening many natural therapeutic doors for women who suffer with fibroids or for those who are predisposed to the condition and want a preventative option that doesn’t include medication or surgery.

“EGCG shows promise as a safe and effective therapeutic agent for women with symptomatic uterine fibroids,” Al-Hendy and his team concluded.  “Such a simple, inexpensive, and orally administered therapy can improve women’s health globally.”

Dr. Ayman Al-Hendy, MD, PhD, FRCSC, FACOG, is currently the Director of Interdisciplinary Translational Research, Assistant Dean for Global Translational Research, and Professor and Director of the Division of Translational Research at the Medical College of Georgia at Augusta University in Augusta, Georgia.

ABOUT THE AUTHOR   Alicia Armeli is a Health Freelance Writer, 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 in her community.

REFERENCES

  1. Tea Association of the USA Inc. (2015). Tea Fact Sheet—2015. Retrieved May 1, 2016, from http://www.teausa.com/14655/tea-fact-sheet
  2. Roshdy, E., Rajaratnam, V., Maitra, S., Sabry, M., Ait Allah, A. S., & Al-Hendy, A. (2013). Treatment of symptomatic uterine fibroids with green tea extract: a pilot randomized controlled clinical study. International Journal of Women’s Health, 5: 477-486. doi: 10.2147/IJWH.S41021
Myomectomy or UFE:
Which Treatment Is Better for You?
By Alicia Armeli

If you’re a woman searching for relief from symptomatic uterine fibroids, you may be left wondering which treatment is best for you. Of the many therapies out there, myomectomy and uterine fibroid embolization (UFE) may stand out as very effective, yet different approaches that still allow a woman to keep her uterus. How each treatment accomplishes this is based on a set of pros and cons that women should consider carefully.

Myomectomy, or the surgical removal of fibroids, can be done one of three ways: through an incision made in the abdomen, laparoscopically through a small scope, or removing fibroids through the vagina (hysteroscopic myomectomy). On the other hand, UFE—a minimally invasive procedure in comparison—blocks blood flow to these noncancerous growths, resulting in fibroid shrinkage with subsequent symptom relief.

The biggest advantage myomectomy may have over UFE is fertility preservation. Although conception rates of myomectomy and UFE are comparable, hovering around 46 and 48 percent respectively1, myomectomy is considered the standard fibroid treatment for women wanting to get pregnant.

“When it comes to myomectomy, we know much more about the fertility outcome than we do UFE,” said Dr. Richard Shlansky-Goldberg, Interventional Radiologist and Professor of Radiology, Obstetrics and Gynecology, and Surgery at the Hospital of the University of Pennsylvania in Philadelphia. “If a woman comes in with a few fibroids and is primarily interested in getting pregnant—I usually suggest she first has a myomectomy in order to better preserve circulation to the uterus and ovaries.”

For reasons not yet entirely understood, when UFE blocks blood flow to the fibroids, it may compromise circulation to the ovaries, resulting in a decline in ovarian function. However, this almost exclusively occurs in women closer to menopause who are over age 451

Healthy pregnancies are possible following each treatment but are associated with specific complications.

Myomectomy is linked with the rare but serious complication of uterine rupture during pregnancy or labor2 But in comparison to UFE, it was shown to have better reproductive outcomes in the first two years after treatment—specifically among women with fibroids larger than four centimeters.3

UFE is considered risky due to complications like miscarriage and preterm delivery1, but it’s unclear if these risks are related to the procedure, the fibroids, or other factors like age. “Many of the women getting pregnant after UFE tend to be older,” Dr. Shlansky-Goldberg said. “These risks may have more to do with a woman’s age than the procedure.”

As seen with UFE, the advantages of myomectomy may be limited due to fibroid recurrence. For each treatment, the long-term risk of symptoms returning or the need for an additional treatment is similar with some studies placing UFE at a rate of up to 28 percent4 and myomectomy slightly lower around 20 percent.1,5

And yet, myomectomy recurrence rates may be difficult to pinpoint.

Fibroids removed through myomectomy are basically the ones a surgeon can feel and at times small fibroids are missed. Therefore, it may be a challenge to differentiate between old and new fibroids. Also, according to Dr. Shlansky-Goldberg, some fibroids may be left behind for fear that their removal may result in the need to do an unplanned hysterectomy.

“This isn’t the case with UFE,” Dr. Shlansky-Goldberg continued. “With embolization, we know that the more fibroids we can infarct or kill, the better our outcomes will be. It doesn’t really matter if you have one or 20 fibroids—the approach is the same. Recurrence may still be an issue—about 2 to 3 percent per year—but overall success rates are still nearly 90 percent.”

What’s more, recurrence statistics should be considered carefully. “Lower rates of myomectomy reintervention could also be due to women not wanting to undergo another surgery in comparison to UFE patients who have recovered quickly,” Dr. Shlansky-Goldberg reasoned.

Avoiding surgery—especially hysterectomy—is a significant factor in the decision-making process for women who are concerned with going under the knife. Some women worry about surgery itself and also the added risk of losing their uterus—which to them may be a part of their femininity. UFE could be the ideal procedure for these women because it’s minimally invasive and the likelihood of a good outcome is very high with a relatively quick recovery.

When deciding between myomectomy or UFE, another factor to consider is volume loss. Both procedures are quick to relieve bulk symptoms, but after the incision and fibroid removal of myomectomy, women can experience it immediately.

Although not as quickly, Dr. Shlansky-Goldberg pointed out, UFE patients often experience bulk symptom relief within a few weeks because of a decrease in both fibroid size and firmness. He went on to clarify that even without shrinkage, fibroids may get softer relieving a woman of pelvic pressure symptoms “similar to letting air out of car tire.” According to a recent study6 by Bérczi et al., women with fibroids larger than 10 centimeters still experienced relief after UFE.

To surgically remove large fibroids, the most common route is an abdominal myomectomy. With a large incision comes the risk of developing adhesions—or scar tissue—that can cause pain and impair fertility. Infection, blood loss, and the need for a transfusion during surgery are other possibilities, alongside a much longer recovery time of about six weeks.

In contrast, UFE is a minimally invasive outpatient procedure. Women can go home the same day and recover fully in about two weeks. “UFE’s number one advantage is recovery time. It’s a lot faster than recovering from surgery,” Dr. Shlansky-Goldberg told Ask4UFE. “A faster recovery may be important for women who can’t take a lot of time off from work.”

Not without its own need for recovery, UFE patients may experience post-embolization syndrome (PES). After the procedure, women can have pain (often compared to menstrual cramping), nausea, vomiting, and fatigue. Reportedly, cramps worsen within the first two to three hours but then lessen significantly after 12 hours7 PES can be managed easily with medications such as pain relievers and anti-nausea medication.

Other rare complications associated with UFE include vaginal expulsion of an infarcted fibroid, uterine infection, and pulmonary embolism. Despite the risks, multicentre clinical trials consistently show that the rate of major complications following UFE is significantly lower than those related to surgery8

As important as comfort is during recovery, many women may wonder what life will be like in the months to come. Good news is, when it comes to life after myomectomy and UFE, both were given high quality of life scores.

Manyonda and a team of researchers of the Department of Gynecology at St. George’s Hospital in London compared quality of life scores between 81 women who underwent myomectomy versus 82 who had UFE. Results published in CardioVascular and Interventional Radiology9 showed significant and equal improvements in both groups of women. The authors noted that UFE allowed for shorter recovery time and fewer major complications, while myomectomy showed to have a lower reintervention rate.

Given all the information, which treatment is best?

Dr. Shlansky-Goldberg explained that this question is impossible to answer because every woman is different. “Talk to your doctor and ask questions. It really depends on what a woman wants, needs, and expects to get from her treatment.”

Myomectomy
Advantages
Myomectomy
Disadvantages
UFE
Advantages
UFE
Disadvantages
  • Womb-sparing
  • Fertility preservation
  • Immediate reduction in fibroid volume
  • Increased quality of life
  • Difficult to treat small and multiple fibroids
  • More complications related to surgery
  • Risk of unplanned hysterectomy
  • 6-weeks recovery time
  • Low risk of uterine rupture during pregnancy/labor
  • Risk of recurrence
  • Womb-sparing
  • Minimally invasive
  • Treats all fibroids
  • Less complications
  • 2-weeks or less recovery
  • Increased quality of life
  • 90 percent long-term cure rate
  • Diminished fertility (inconclusive)
  • Pregnancy complications
  • Fibroid shrinkage is not immediate
  • Risk of recurrence

ABOUT THE AUTHOR Alicia Armeli is a Health Freelance Writer, 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 in her community.

ABOUT THE DOCTOR Richard Shlansky-Goldberg is an interventional radiologist and professor of Radiology, Obstetrics and Gynecology, and Surgery at the Hospital of the University of Pennsylvania in Philadelphia. Recognized by Best Doctors in America, as Castle Connolly’s America’s Top Doctors, and showcased in Philadelphia Magazine’s Top Docs issue—Dr. Shlansky-Goldberg specializes in helping women with uterine fibroids find relief. Collaborating with the department of obstetrics and gynecology at the University of Pennsylvania allows him to ensure every woman knows and understands all her treatment options, ensuring the best patient care possible.

REFERENCES

1. McLucas, B., Voorhees Iii, W. D., & Elliott, S. (2015). Fertility after uterine artery embolization: a review. Minimally Invasive Therapy & Allied Technologies, 2: 1-7.
2. Claeys, J., Hellendoorn, I., Hamerlynck, T., Bosteels, J., & Weyers, S. (2014). The risk of uterine rupture after myomectomy: a systematic review of the literature and meta-analysis. Gynecological Surgery, 11: 197-206. doi: 10.1007/s10397-014-0842-8

3. Mara, M. Maskova, J., Fucikova, Z., Kuzel, D., Belsan, T., & Sosna, O. (2008). Midterm clinical and first reproductive results of a randomized controlled trial comparing uterine fibroid embolization and myomectomy. CardioVascular and Interventional Radiology, 31(1): 73-85.
4. van der Kooij, S. M., Hehenkamp, W. J., Volkers, N. A., Birnie, E., Ankum, W. M., & Reekers, J. A. (2010). Uterine artery embolization vs hysterectomy in the treatment of symptomatic uterine fibroids: 5-year outcome from the randomized EMMY trial. American Journal of Obstetrics and Gynecology, 203(2): 105.e1-13. doi: 10.1016/j.ajog.2010.01.049
5. Radosa, M. P., Owsianowski, Z., Mothes, A., Weisheit, A., Vorwergk, J., Asskaryar, F. A., Camara, O., Bernardi, T. S., & Runnebaum, I. B. (2014). Long-term risk of fibroid recurrence after laparoscopic myomectomy. European Journal of Obstetrics & Gynecology and Reproductive Biology, 180: 35-39. doi:10.1016/j.ejogrb.2014.05.029
, 180: 35-39. doi:10.1016/j.ejogrb.2014.05.029

6. Bérczi, V., Valcseva,, Kozics,D., Kalina, I., Kaposi, P., Sziller, P., Várbíró, S., Botos, E. M. (2015). Safety and effectiveness of UFE in fibroids larger than 10 cm. Cardiovascular and Interventional Radiology, 38(5): 1152-1156. doi:10.1007/s00270-014-1045-4
7. Spencer, E. B., Stratil, P., & Mizones, H. (2013). Clinical and periprocedural pain management for uterine artery embolization. Seminars in Interventional Radiology, 30(4): 354-363. doi: 10.1055/s-0033-1359729
8. Memtsa, M., & Homer, H. (2012). Complications Associated with uterine srtery embolisation for fibroids. Obstetrics and Gynecology International, 2012. http://dx.doi.org/10.1155/2012/290542
9. Manyonda, I. T., Bratby, M., Horst, J. S., Banu, N., Gorti, M., & Belli, A. M. (2011). Uterine artery embolization versus myomectomy: impact on quality of life–results of the FUME (Fibroids of the Uterus: Myomectomy versus Embolization) Trial. CardioVascular and Interventional Radiology, 35(3): 530-536. doi: 10.1007/s00270-011-0228-5