Does UFE Put Me at Risk for Early Menopause?
Alicia Armeli

A common question among women exploring uterine fibroid embolization (UFE) as treatment for uterine fibroids is whether or not they’re at risk for early menopause following the procedure. Although infrequent, early menopause is a possibility, but the risk lies almost exclusively among women who are over the age of 45.1

There are a few factors that contribute to early menopause post-UFE, which by definition is when menopause happens before the age of 40. One such factor is called non-target or inadvertent embolization, a rare complication that can happen during the UFE procedure. According to a literature review published in the Journal of Vascular and Interventional Radiology, non-target embolization of the ovarian blood vessels at the time of UFE is believed to be one cause of premature ovarian failure.1

During UFE, a doctor called an interventional radiologist makes a nick in the patient’s upper thigh or wrist and inserts a tiny tube called a catheter. With the help of real-time imaging, the catheter is guided through the arteries that lead to the uterine arteries supplying fibroids with blood. By embolizing the uterine arteries—a process that involves injecting tiny particles called embolic material through the catheter—blood flow to the fibroids is blocked, causing them to shrink and symptoms to subside. Safe and effective, UFE has a nearly 90% cure rate.2

Post-UFE data show that most patients treated with the procedure resume normal periods. According to the national FIBROID data registry, only 7% of women 1-year post-UFE experience ovarian failure and no longer menstruate.3 However, among these women, another correlation was seen. Eighty-six percent of women who lost menstruation were older than 45.3

Why is this the case? Uterine-ovarian vessel cross-connections called anastomoses have been recognized where blood flows between the uterus and the ovaries.4 During UFE, if inadvertent or non-target embolization of the ovarian arteries happens, it may be that older women are already more susceptible to any damage caused. In comparison, any disruption in ovarian blood flow among younger women under the age of 45 was seen to be only temporary.1

Women over the age of 45 with utero-ovarian anastomoses were also more likely to have increased levels of follicle-stimulating hormone (FSH) after UFE, which is indicative of declining ovarian reserve or being closer to menopause.1 However, this same outcome has also been seen after uterine surgery like hysterectomy, which may indicate other factors beyond the UFE procedure itself.1

Early menopause is a risk after UFE but is more likely for women older than 45. Based on current data, UFE doesn’t significantly affect the ovarian reserve of younger women. However, because the uterine and ovarian arteries can be intricately connected and this could affect the outcome of UFE, it’s suggested that women seek out experienced interventional radiologists well trained in the UFE technique and be examined for any unique vascular variations.

ABOUT THE AUTHOR   Alicia Armeli is a Health Freelance Writer and Editor, 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. Kaump, G. & Spies, J. (2013). The impact of uterine artery embolization on ovarian function. J Vasc Interv Radiol, Apr; 24(4): 459-467.
  2. McLucas, B., Voorhees Iii, W. D., & Elliott, S. (2015). Fertility after uterine artery embolization: a review. Minimally Invasive Therapy & Allied Technologies, 2: 1-7.
  3. Spies, J., Myers, E., Worthington-Kirsch, R., et al. (2005). The FIBROID Registry: symptom and quality-of-life status 1 year after therapy. Obstet Gynecol, Dec; 106(6): 1309-1318.
  4. Razavi, M., Wolanske, K., Hwang, G. et al. (2002). Angiographic classification of ovarian artery-to-uterine artery anastomoses: initial observations in uterine fibroid embolization. Radiology, Sep; 224(3): 707-712.

UFE Improves Sex and Overall Quality of Life for Women with Fibroids
Alicia Armeli

Uterine fibroid embolization (UFE)—a non-surgical procedure that treats troublesome uterine fibroids—improves both sex and quality of life among women who have the procedure, according to a French multicenter study.1

“Women with uterine fibroids often experience troubling symptoms and significant discomfort, which diminish their sex lives and reduce their quality of life, “ says Helene Vernhet- Kovacsik, M.D., the study’s lead researcher and an interventional radiologist in the department of vascular radiology at Centre Hospitalier Universitaire in Montpellier, France, in a Society of Interventional Radiology Press Release.1 “These symptoms include heavy menstrual bleeding, pain during sexual intercourse, pelvic pain and back and leg pain.”

Overall, 264 women spanning 25 medical centers in France participated in the study and underwent UFE for treatment of fibroids.1 Women enrolled in the study completed a Uterine Fibroid Symptom and Health-related Quality of Life Questionnaire (UFE-QoL), an assessment that measures quality of life on a 0-100 scale with increasing scores denoting better quality of life. Woman also completed a Female Sexual Function Index (FSFI), an additional questionnaire designed to track sexual function, which touched on factors such as feelings of desire, arousal, lubrication, and orgasm. Using these tools, women were able to report their quality of life and sexual function before UFE treatment and one year after.

When the study started, 189 of the 264 women (71.6%) suffered from heavy periods and 171 (64.8%) had pain, along with other symptoms like pelvic pressure. When Vernhet-Kovacsik and her team followed up with the women one-year post-UFE, only 39 of the initial 189 women (20.6%) still had abnormal bleeding and only 42 of the 171 (24.6%) experienced pelvic pressure.

In terms of sexual function, almost 80% of women who completed the survey one year after treatment reported a better sex life—which included improved feelings of desire, arousal, satisfaction, and decreased pain. What’s more, about 90% of women who filled out the quality of life questionnaire said they had a better overall quality of life, with average scores improving from 45 at the time of treatment to 71 a year after the procedure.

How does UFE make such significant improvements possible?

Because UFE is a minimally invasive alternative to surgery, it only requires making a small nick in the wrist or upper thigh. Through this small incision, a doctor called an interventional radiologist inserts a thin tube called a catheter into a nearby artery. With real-time imaging, the catheter is then threaded into the uterine arteries that supply blood to the fibroids. The doctor then releases tiny particles that resemble grains of sand into the uterine arteries in order to block the blood flowing to the fibroids. Without a blood supply, fibroids shrink and symptoms subside.

Studies examining the importance of sex in both short- and long-term relationships have consistently indicated that relationship satisfaction and sexual satisfaction go hand in hand.2,3 For couples affected by fibroids, sexual satisfaction can be a challenge. But because of effective treatment options, like UFE, women with fibroids can reclaim their sexuality without the need for surgery.

“Through our expertise in performing image-guided therapy, interventional radiologists pioneered the treatment of uterine fibroids using this much less invasive technique,” the authors explain. “Working in collaboration with a patient’s gynecologist, interventional radiologists can now offer these women a treatment option which alleviates chronic pain within the female reproductive system and allows the opportunity to lead a full and more normal life.”1

REFERENCES

  1. Society of Interventional Radiology. (2016). Non-surgical fibroid treatment: Research shows improved sexual desire, function. Retrieved December 20, 2016, from http://www.sirweb.org/misc/2016_ASM_releases/UFE_sexualfunction_finalembargoed.pdf
  2. McNulty, J., Wenner, C., & Fisher, T. (2016). Longitudinal associations among relationship satisfaction, sexual satisfaction, and frequency of sex in early marriage. Archives of Sexual Behavior, 45(1): 85-97. doi: 10.1007/s10508-014-0444-6. https://www.ncbi.nlm.nih.gov/pubmed/25518817
  3. Fallis, E., Rehman, U., Woody, E., & Purdon, C. (2016). The longitudinal association of relationship satisfaction and sexual satisfaction in long-term relationships. Journal of Family Psychology, 30(7): 822-831. https://www.ncbi.nlm.nih.gov/pubmed/27077235

Foods & Phytochemicals: A New Area of Fibroid Research
Alicia Armeli

Phytochemicals are substances found in plants that are believed to prevent and possibly treat disease. Using this knowledge, researchers are now exploring how different plant foods could affect the growth and development of uterine fibroids.

What are phytochemicals?

Plants naturally make phytochemicals as a way to protect themselves from harmful things such as disease, UV damage, and pollution. Once plants are ingested, phytochemicals are thought to provide the human body with same protection. Common foods that have phytochemicals are fruits, vegetables, cereals, legumes, herbs, spices, nuts, and certain beverages.1

What are uterine fibroids?

Uterine fibroids are common noncancerous tumors that grow in the wall of the uterus and affect an estimated 70% of women.1 For some, fibroids may not be bothersome. However, approximately one in four women with fibroids suffer from severe symptoms like heavy painful periods, pelvic pressure, urinary incontinence, and infertility.1 Despite how common they are, it’s still unclear why and how fibroids develop.

Can phytochemicals help?

Research has identified specific factors that are important for fibroids to thrive: inflammation, the thickening of tissue, the replication of abnormal cells, and the growth of new vessels that give fibroids their own blood supply.1 By targeting the cell-to-cell communication responsible for these factors, phytochemicals could be beneficial in the future prevention and treatment of fibroids.

The following infographic shows the 14 phytochemicals that may influence fibroid growth and development. In laboratory studies, these phytochemicals have been found to similarly change cell communication pathways in other diseases. In this way, researchers are hopeful they could have the same effect in fibroid therapy.1

ABOUT THE AUTHOR   Alicia Armeli is a Health Freelance Writer, Editor, 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. Islam, M., Segars, J., Castellucci, M., & Ciarmela, P. (2017). Dietary phytochemicals for possible preventive and therapeutic option of uterine fibroids: Signaling pathways as target. Pharmacological Reports, 69(1): 57–70. doi: 10.1016/j.pharep.2016.10.013. http://www.sciencedirect.com/science/article/pii/S1734114016302973

Uterine Artery Embolization: A Versatile Approach to Treating More Than Fibroids
Alicia Armeli

preview-full-uae

Before it was known as uterine fibroid embolization (UFE), this highly effective nonsurgical procedure was referred to as uterine artery embolization (UAE) and treated much more than uterine fibroids.

At the 2016 Society of Interventional Radiology Annual Scientific Meeting in Vancouver, British Columbia, UAE was presented as a safe and effective uterus-sparing treatment for both gynecological and obstetric conditions.

“The existing literature indicates that UAE for adenomyosis is associated [with] symptom reduction in 70%,” reported Dr. Nainesh S. Parikh, MD, of Brigham and Women’s Hospital in Brookline, Mass.1 “UAE for peri and postpartum hemorrhage has about a 90% rate of clinical success with major complication rate of about 5%, and a subsequent viable gestational outcome of about 80%.”

During UAE, a doctor called an interventional radiologist makes a tiny nick in the wrist or groin, and through real-time imaging guides a thin catheter into the arteries that lead to the uterine arteries. The doctor then injects tiny particles to stop blood flow to affected uterine tissue—as seen with fibroids or adenomyosis—or to control bleeding accompanied by birthing complications.

Adenomyosis—a noncancerous disease that causes the lining of the uterus to grow into the uterine wall—affects up to 70% of women and has many of the same symptoms as fibroids, like heavy painful periods and a swollen uterus.2 Adenomyosis and fibroids can coincide, often making it difficult to know which is the culprit. Medications and hormonal therapy are temporary options to manage symptoms, but hysterectomy has been by far the most common treatment.

Hysterectomy has been linked to poor quality of life outcomes and high financial burdens. To avoid such adverse effects, minimally invasive treatment options are being explored—like UAE.

A study published in CardioVascular and Interventional Radiology tracked UAE’s potential long-term success treating adenomyosis among 40 women between 1999 and 2006.3 Half of these women also had uterine fibroids.

Smeets et al. used magnetic resonance imaging (MRI) to assess each woman at the time of UAE, 3 months afterward, and then surveyed their symptoms and quality of life scores approximately 5 years following the procedure. The 5-year follow-up showed that over 70% reported complete symptom relief.

UAE has also been a historically life-saving treatment for women who suffer from postpartum hemorrhage or heavy bleeding following delivery.

Postpartum hemorrhage is rare, affecting 1% to 5% of women giving birth, and usually occurs right after delivering the placenta but can also happen weeks later.4 Some women are at an even higher risk for postpartum hemorrhage, including those delivering through cesarean section and pregnancies with placental abnormalities. Left untreated, postpartum hemorrhage can lead to dangerously low blood pressure levels, shock, and even death.

UAE has been seen to treat both immediate and delayed postpartum hemorrhaging with some studies showing success rates greater than 90%.5,6,7,8

But instead of waiting to treat postpartum hemorrhage after giving birth, doctors are now reducing this risk by performing UAE weeks before delivery—especially among high-risk patients. Between 2013 and 2015, Niola et al. recruited 50 pregnant women with placental abnormalities who then underwent UAE at 35-36 weeks gestation.9

Results published earlier this year in the Journal of Vascular and Interventional Radiology showed that UAE was successful in every case and reduced postpartum bleeding—with nearly two-thirds of patients not needing a blood transfusion. The procedure also had no negative effects on newborns. At a 6-month follow-up, the 42 infants available for assessment all functioned at normal cognitive levels.

Given its history and long-standing safety and efficacy in treating non-fibroid conditions, many wonder why UAE isn’t used more. “The role of UAE in the treatment of non-fibroid disease is less well known and less utilized,” Dr. Parikh explained. “Requests for UAE for these indications” are “not widespread, possibly from lack of referring clinician awareness and lack of an established collaborative approach to these patients.”

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. She is a paid consultant of Merit.

 

REFERENCES

  1. Parikh, N., & Fan, C. (2016). Non-fibroid indications of uterine artery embolization. Journal of Vascular and Interventional Radiology, 27(3), S215-216. doi:http://dx.doi.org/10.1016/j.jvir.2015.12.556
  2. Taran, F., Stewart, E., & Brucker, S. (2013). Adenomyosis: epidemiology, risk factors, clinical phenotype and surgical and interventional alternatives to hysterectomy. Geburtshilfe Und Frauenheilkunde, 73(09), 924-931. doi:10.1055/s-0033-1350840
  3. Smeets, A., Nijenhuis, R., Boekkooi, P., Vervest, H., van Rooij, W., & Lohle, P. (2011). Long-term follow-up of uterine artery embolization for symptomatic adenomyosis. Cardiovascular And Interventional Radiology, 35(4), 815-819. doi:10.1007/s00270-011-0203-1
  4. University of Rochester Medical Center. (2016). Health Encyclopedia—Postpartum Hemorrhage. Retrieved August 30, 2016, from https://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=90&ContentID=P02486
  5. Inoue, S., Masuyama, H., & Hiramatsu, Y. (2014). Efficacy of transarterial embolisation in the management of post-partum haemorrhage and its impact on subsequent pregnancies. Australian & New Zealand Journal of Obstetrics & Gynaecology, 54(6), 541-545. doi:10.1111/ajo.12228
  6. Xu, J. (2015). Effectiveness of embolization of the internal iliac or uterine arteries in the treatment of massive obstetrical and gynecological hemorrhages. European Review for Medical and Pharmacological Sciences, 19(3), 372-374.
  7. Kim, T., Lee, H., Kim, J., Ryu, A., Chung, S., & Seok, L. (2013). Uterine artery embolization for primary postpartum hemorrhage. Iranian Journal of Reproductive Medicine, 11(6), 511-518.
  8. Li, X., Wang, Z., Chen, J., Shi, H., Zhang, X., & Pan, J. et al. (2012). Uterine artery embolization for the management of secondary postpartum haemorrhage associated with placenta accreta. Clinical Radiology, 67(12), e71-e76. doi:http://dx.doi.org/10.1016/j.crad.2012.07.021
  9. Niola, R., Giurazza, F., Nazzaro, G., Silvestre, M., Nasti, G., & Di Pasquale, M. et al. (2016). Uterine artery embolization before delivery to prevent postpartum hemorrhage. Journal Of Vascular And Interventional Radiology, 27(3), 376-382. doi:10.1016/j.jvir.2015.12.006