Uterine Fibroid Embolization (UFE)

Definition

Fibroids are benign (noncancerous) growths in the wall of the uterus (womb). The uterus is the organ where a fetus grows during pregnancy.

Fibroids are common. They may be very small or they could grow to 8 or more inches in diameter. Most fibroids remain inside the uterus. Sometimes, they may stick out and affect nearby organs. It is common for there to be more than 1 fibroid.

Uterine Fibroid

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Causes

The cause of fibroids is unknown.

Fibroid growth is stimulated by female reproductive hormones. As a result:

• Fibroids grow larger during pregnancy and shrink after childbirth.
• Fibroids become less of a problem after menopause. However, symptoms may return with hormone replacement therapy (HRT).

Genetics may make some women more prone to fibroids. Substances that control blood vessel growth may also affect fibroid growth.

Risk Factors

African American women are at increased risk. Other factors that affect your risk of fibroids include:

• Risk increases with age until menopause
• Family history

Obesity and high blood pressure may also be linked to fibroids.

Symptoms

There may be no symptoms, or they may be mild or severe. This depends on the size and location of the growths.

Symptoms may include:

• Pelvic pain or pressure
• Heavy menstrual bleeding
• Clots in menstrual flow
• Long periods
• Bleeding between periods
• Increased cramping during periods
• Pain during sex
• Frequent need to urinate
• Constipation
• Bloating
• Abdominal swelling
• Low back or leg pain
• Infertility by blocking the fallopian tubes
• Miscarriage

If menstrual bleeding is heavy, you may be develop iron-deficiency anemia. Symptoms of iron-deficiency anemia include fatigue and exercise intolerance. If you experience these symptoms, talk to your doctor.

Diagnosis

Most fibroids are found during routine pelvic exams.

Images may be taken of your bodily structures. This can be done with:

• Abdominal ultrasound
• Transvaginal ultrasound
• CT or MRI scan
• Hysteroscopy

Treatment

Most women with fibroids do not have symptoms and do not need treatment. Your doctor may recommend monitoring any changes on a regular basis. Treatment may be done later if needed.

Treatments include:

Medication

The doctor may advise:

• Over-the-counter pain relievers to ease mild symptoms
• Nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce inflammation and relieve cramping
• Prescription pain medication—if pain cannot be managed with medications above

Hormonal Therapy

Hormone medications may be an option for those who are not trying to become pregnant. These medications can shrink fibroids, reduce abnormal bleeding, and lessen pain. However, fibroids can return after these medications are stopped. These medications may be used to make fibroids smaller just before surgery.

Surgery

Surgery may be considered if:

• The uterus becomes extremely large
• The fibroids are interfering with fertility
• Symptoms are severe

Surgical procedures include:

• Myomectomy—The fibroids are removed from the uterus through open or laparoscopic surgery. This can also be done using hysteroscopy, in which a long, thin telescope with a camera along with other surgical tools are used to remove the fibroids.
• Hysterectomy—The entire uterus is removed. You will be unable to have children if you have this surgery.

Other options include:

Other options include:

• Uterine fibroid embolization—This is a minimally invasive procedure. It blocks blood flow to the fibroids. This will make the fibroids shrink.
• Focused ultrasound therapy—Energy is centered on the fibroid to destroy it. This procedure may not be ideal for those who are overweight, have very large fibroids, or have extensive scars from prior abdominal surgeries.

Prevention

There are no current guidelines to prevent uterine fibroids.