A Limited Embolization Approach: Results of a UFE Fertility Study
Alicia Armeli

Fertility After UFE

More than half of women will develop uterine fibroids by the time they reach 50.1 These noncancerous tumors can be the cause of severe menstrual symptoms, leaving many women searching for a cure. Because fibroids are especially common during a woman’s 30s—a time when many women are trying to conceive—finding a treatment that works and preserves fertility can be a challenge.

Uterine fibroid embolization (UFE), a minimally invasive treatment that shrinks fibroids, significantly improves symptoms in 85%–90% of patients;2 and yet it’s still unclear how this procedure affects fertility. But new research is emerging. A recent French study found that women who had UFE performed by way of a limited embolization technique were able to give birth and showed an encouraging delivery rate following treatment.3

The study, published in European Radiology, evaluated the fertility of 15 women who chose to undergo UFE instead of myomectomy, a procedure that surgically removes fibroids and is performed by a gynecologist.3  Women participating in the study were approximately 35 years of age and had no known infertility factors.

Unlike myomectomy, UFE is performed by an interventional radiologist—a type of doctor who uses specialized imaging equipment to see inside the body and treat disease without surgery. A nick is made in the wrist or groin area to access the blood vessels leading to the uterine arteries. By inserting a thin tube called a catheter into the uterine arteries, tiny particles are then injected and block the fibroids’ blood supply, causing them to shrink and symptoms to subside.

Whether or not UFE should be used as a first-line fibroid treatment for women trying to get pregnant is still debated in the medical community. Concerns over how UFE will affect ovarian reserve—the ovaries’ ability to produce viable eggs—and the uterine lining as well as uterine muscle tissue have been expressed.3  Because of this, UFE is commonly recommended as a second-line treatment or for women who are not candidates for myomectomy.3

Taking into consideration these concerns and to better support future fertility, the researchers of this study used a fertility-sparing technique that specifically targets vessels only surrounding the fibroids but spares nearby normal myometrial arteries, or the arteries that flow to unaffected smooth muscle tissue of the uterine wall. “Women without infertility factors suffering from symptomatic fibroids were durably treated by a limited fertility-sparing [UFE] and experienced a substantial rate of subsequent fertility,” the researchers write. “For women choosing [UFE] over abdominal myomectomy, childbearing may not be impaired.”3

During the year following UFE, nine women who were actively trying to conceive had five babies.3  After about three and a half years, data show eight women gave birth to 10 babies.

Ovarian reserve was also tracked as well as uterus size and quality of life after the procedure. The researchers found that ovarian reserve remained stable, fibroid symptoms improved by 66%, and uterine size was reduced by 38%.3  Completed questionnaires showed that quality of life scores improved by 112%. Five women experienced recurring symptoms, needing further treatment.

Despite the positive results seen, the authors also noted that because only select vessels are embolized when using this technique—unlike with traditional UFE—there might be a risk for symptom recurrence in the future, requiring a second treatment.3  In this study, however, UFE was seen to control fibroid symptoms and preserve fertility, allowing women to complete their families.

At this time, myomectomy is often recommended as the fibroid treatment for women wanting to conceive, and the researchers note that more studies are needed before UFE can be recommended as a first-line treatment.3 But this study provides hope and another potential option for women who need immediate relief from fibroid symptoms and who want to retain their fertility.

ABOUT THE AUTHOR   Alicia Armeli is a 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. She is a paid consultant of Merit Medical.

 REFERENCES

  1. Office on Women’s Health, U.S. Department of Health and Human Services. (2019, Apr 1). Uterine Fibroids. Retrieved from https://www.womenshealth.gov/a-z-topics/uterine-fibroids
  2. Silberzweig, J. E., Powell, D. K., Matsumoto, A. H., et al. (2016). Management of uterine fibroids: A focus on uterine-sparing interventional techniques. Radiology, Sep;280(3):675–
  3. Torre, A., Fauconnier, A., Kahn, V., et al. (2017). Fertility after uterine artery embolization for symptomatic multiple fibroids with no other infertility factors. Eur Radiol, Jul;27(7):2850–
Phthalate Exposure Linked to Increased Uterine Volume in Women with Fibroids
Alicia Armeli

Fibroids and Phthalate

It’s officially Women’s Health Week, a full seven days dedicated to your well-being. While this may conjure images of joining a gym or eating more fruits and vegetables, a chance to be healthier could also be sitting right on your bathroom counter: beauty products.

Instagram feeds are full of them and we, as women, can’t seem to get enough. There’s no denying how, even on the worst of days, a brand-new bottle of nail polish or shampoo can make anything seem possible.

But there’s a downside to using many of the beauty and personal care products we see on the market today. A widespread chemical ingredient called phthalates used in hundreds of products may be linked to an increased burden of uterine fibroids,1 a common noncancerous tumor of the female reproductive tract that can cause heavy periods, pelvic pain, and other serious symptoms.

Phthalates, also called plasticizers, are a group of chemicals used to make plastics more flexible; some phthalates are also used as solvents or dissolving agents.2 Along with being found in obvious products, such as vinyl flooring, plastic clothing (raincoats), and plastic food and beverage containers, phthalates are also found in personal care products, such as soaps, shampoos, hair spray, nail polish, deodorant, and perfume.2,3 Phthalates found in personal care items are commonly a fragrance ingredient used to help prolong the scent of the product.4 The ones typically used in these products (and in plastic food and beverage containers) are known as DBP, DEP, DEHP, and DMP.3

According to the Centers for Disease Control and Prevention, human health effects from exposure to low levels of phthalates are unknown, but animal studies have shown some types of phthalates to affect the reproductive system.2 It’s also important to know that reports have shown adult women to have higher levels of urinary metabolites than men for phthalates that are used in shampoos, soaps, body washes, cosmetics, and other personal care products.2

Research examining the possible link between phthalate exposure in women and uterine fibroid burden was published in a recent issue of Fertility and Sterility.1 The study included 57 premenopausal women undergoing either hysterectomy (surgical removal of the uterus) or myomectomy (surgical removal of fibroids) for fibroid treatment. Researchers checked urine samples for 14 phthalate biomarkers and used patient medical records to find the diameter of the largest fibroid as well as uterine size. Factors like fibroid size and number can enlarge the uterus.5

Results showed that higher concentrations of phthalates, especially for individual DEHP metabolites (MEHHP, MEOHP, MECPP), ∑DEHP, and ∑AA phthalates, were linked to an increase in uterine volume.1 Researchers found that twice the ∑DEHP and ∑AA phthalates was associated with a 33.2% and 26.8% increase in uterine volume, respectively. They found few associations between phthalate biomarkers and fibroid size.

Although this was a preliminary study and more research is needed to verify the relationship between phthalates and fibroids, there are steps you can take to reduce your phthalate exposure around the home:3,4

Read labels. Avoid products with “fragrance” or “perfume” ingredients. Go for “phthalate-free” or “no-synthetic fragrance” products instead.

Check your plastic. When using plastic bottles, numbers 3 and 7 may have phthalates. Avoid plastic wrap made from PVC.

Switch to glass. Recycle your plastic food containers and invest in glass and/or stainless steel containers and water bottles. If using plastic, never microwave it. Heat allows chemicals to transfer from the plastic into your food or drink.

Go organic. Eat more organic food items, especially fruits and vegetables. Try to eat less food packaged in plastic.

Filter your water. Purchase a home water-filtration system that removes phthalates.

Exercise more.  Phthalates stored in the body could be excreted in sweat.

Until we know more about how phthalates affect our bodies and reproductive systems in particular, hold onto your credit card the next time you see that must-have beauty product. A little patience and research can go a long way.

REFERENCES

  1. Zota, A. R., Geller, R. J., Calafat, A. M., et al. (2019). Phthalates exposure and uterine fibroid burden among women undergoing surgical treatment for fibroids: A preliminary study. Fertil Steril, Jan;111(1):112-121.
  2. Centers for Disease Control and Prevention. (2017, Apr 7). Phthalates factsheet. Retrieved from https://www.cdc.gov/biomonitoring/Phthalates_FactSheet.html
  3. Kahn, J. (2019). 5 new reasons to avoid phthalates + how to limit your exposure. Retrieved from https://www.mindbodygreen.com/0-24825/5-new-reasons-to-avoid-phthalates-how-to-limit-your-exposure.html
  4. Made Safe. (n.d.). #ChemicalCallout: Phthalates. Retrieved from https://www.madesafe.org/science/hazard-list/phthalates/
  5. Fibroid Treatment Collective. (2016, May 6). Noticing a stomach bulge? You may have fibroids. Retreived from https://fibroids.com/blog/noticing-stomach-bulge-may-fibroids/