Checkup

Eliminating Uterine Fibroids
without Hysterectomy

Minimally Invasive Procedure Provides effective Alternative

Drs. Paul Pettit (left) and J. Mark McKinney say that many women with fibroid-related symptoms may not realize they are candidates for uterine fibroid embolization (UFE).

For an estimated 20 to 40 percent of women over age 35 who have uterine fibroids large enough to cause symptoms, hysterectomy remains the most common treatment. However, many women with fibroid-related symptoms don't realize that they are candidates for a minimally invasive procedure known as uterine fibroid embolization (UFE).

"Women don't always get the word that this is a therapeutic option for uterine fibroids," says Dr. J. Mark McKinney, an interventional radiologist at Mayo Clinic who has been performing UFE since 1999. "Women should be given the option. The problem is one of communication."

Uterine fibroids are noncancerous growths that develop in the uterine wall. They can be as small as the head of a pin and grow as large as a cantaloupe. Usually, they do not cause problems. However, as women age, they are more likely to experience symptoms, which can include pain, bladder pressure, heavy or prolonged menstrual periods and unusual monthly bleeding.

UFE involves guiding a catheter through the femoral artery in the groin to one of the uterine arteries and injecting tiny plastic spheres. The particles, about the size of grains of sand, lodge in the smaller arteries that branch out to the fibroids and choke off the blood supply. Doctors repeat the process on the opposite uterine artery. With their blood supply cut off, the fibroids begin to shrink.

Patients are sedated for the procedure. They stay overnight at St. Luke's Hospital and are given pain and anti-inflammatory medications for discomfort and cramping. These side effects usually subside in a few days. Patients return for follow-up visits in two to four weeks and again at six months.

Nine years ago, Darlene Melton had a surgical procedure called myomectomy to remove uterine fibroids. When bothersome symptoms returned, she thought she would need a hysterectomy. Mayo Clinic gynecologic surgeon Dr. Paul Pettit referred her to Interventional Radiology. She was relieved when McKinney told her she had an alternative.

"I felt there was no need to lose my female organs if it wasn't a life-threatening situation," Melton says. "I can't describe how much better I feel to have found out about this procedure and not to have had a hysterectomy."

"A uterine-sparing procedure is a very personal decision for many women," McKinney says. "UFE and myomectomy are uterine-sparing procedures. One advantage of UFE is it can treat every fibroid, whereas myomectomy can only treat the largest ones or the ones doctors can see during the procedure."

Another advantage: UFE has a higher success rate in relieving symptoms than myomectomy. About 85 percent of women experience marked improvement in symptoms following the procedure.

"I talk about the benefits of each procedure, even hysterectomy (surgical removal of the uterus), with my patients," McKinney says. "I try to have an honest discussion about the various options. Ultimately, the choice of procedure is their decision."

One issue to consider is fertility. Myomectomy preserves a woman's fertility; UFE may not.

"There are reports in the literature of women who have become pregnant after UFE," McKinney says. "And there are some articles that state that UFE poses an increased risk of pre-term labor and Cesarean sections for those women. But other women have successfully gotten pregnant, carried to term and delivered. We just don't know yet. So I tell women if they plan on future pregnancies, they should consider an alternative."

Before undergoing uterine fibroid embolization, women must be evaluated by a gynecologist to make sure that their symptoms are not caused by anything more serious than fibroids.

"An MRI can tell us a few important things," says Pettit. "Candidates for this procedure need to have good blood supply going to the fibroids for it to be effective, and an MRI can determine that. It also allows us to see if we are overlooking anything such as an ovarian mass or a suspicious growth in the uterus."

For the women who do go on to have UFE, Pettit says recovery is quicker and less painful than the other treatments.

Info:
Interventional Radiology
(904) 296-3867

Learn more about the Department of Radiology and the Department of Medical and Surgical Gynecology.

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