Treatment for uterine fibroids

Treatment options for Uterine Fibroids

6/13/2022 healthcare; quality

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What are fibroids?Fibroids are a non-cancerous growth within the muscle of the uterus (womb). They are very common, affecting about half of all women at some stage in their lives, usually during the reproductive years.What symptoms I'm I likely to present with?Often fibroids do not cause any symptoms and can be left alone without treatment. After the menopause when periods have stopped usually in the early 50's they shrink naturally.However, sometimes they cause pressure symptoms such as a feeling of fullness in the abdomen or the need to empty the bladder frequently, menstrual problems especially heavy bleeding during periods and fertility problems if the fibroids distort the cavity of the uterus or block the fallopian tubesIf I have symptoms, what are my treatment options?
Depending on the size, location and symptoms caused by the fibroids, different treatment options are available:
Medical treatment with tablets/injections reduces levels of certain hormones such as oestrogen and cause fibroids to shrink. However, these can cause symptoms of the menopause and can only be taken for about six months. Therefore, they may be an option for women nearing menopause.
Hysterectomy is a surgical procedure sometimes recommended where a patient has completed child-bearing and has large fibroids. It involves an open abdominal cut to remove the entire uterus. In certain patients, it is possible to remove the uterus via the vagina using key-hole surgery (avoiding the need for an open cut and, therefore, resulting in a quicker recovery). It is effective in essentially all cases in which bleeding and pressure symptoms are a problem, however it is more invasive than other treatments with a longer recovery time.Myomectomy is a surgical procedure in which only the fibroids are removed, leaving the rest of the uterus intact. This can be performed through various methods including traditional surgery (involving an open cut), key-hole surgery and hysteroscopic resection (involving a telescope in the vagina and uterus). Myomectomy can be performed for certain types of fibroids and preserves the potential for childbearing.
Uterine Fibroid Embolisation (UFE) is a non-surgical treatment for women who want to avoid a traditional surgical procedure (or who are deemed high risk for surgery) in which the blood supply to the fibroids is blocked off causing the fibroids to shrink. All the fibroids are treated in the same procedure. The success rate of UFE is up to 95%, with a very low recurrence rate long term. As this procedure involves no open cut, you can resume normal activity quite fast.Is UFE an experimental procedure?No, it is well established internationally as a well proven mainstream interventional radiology treatment. At the Aga Khan University Hospital in Nairobi (AKUH), we have been performing this procedure since 2009. In the UK and USA, national guidelines recommend that the procedure should be offered to women with symptomatic uterine fibroids.Where is UFE procedure carried out?At AKUH, UFE is carried out in a Catheter Laboratory (Cath Lab). Patients normally need to spend one night in the ward after the procedure, usually being discharged the following morning. Certain patients can be discharged the same evening of the procedure.What preparation is needed before UFE?Following a full gynaecological review and discussion of the treatment options, an MRI scan is carried out to look at the uterus and fibroids in great detail and help determine the most appropriate treatment option. In addition, a few blood tests may be required in preparation for UFE.On the day of the procedure: You will attend AKUH on the morning of the procedure. You must not eat or drink for atleast 6 hours. You also should continue with most of your medications (these would have been discussed with you in clinic). If you have any intra-uterine devices, please ensure it is removed prior to this treatment.What is involved in the UFE procedure itself?The procedure is carried out by a consultant interventional radiologist (a doctor who has specialised in treating a variety of conditions using minimally invasive techniques under X-ray guidance). Other staff in attendance includes an anaesthetist, nurses and radiographers. After being lightly sedated, a tiny cut in the skin (mostly in the left wrist, but sometimes above the right leg) is made to allow a very fine tube to be passed into a blood vessel. The tube is moved along the blood vessels until the blood vessels supplying the uterus and fibroids are reached. A special substance is then injected to block the blood vessels. All of this is visible on an X-ray screen.What can I expect after UFE?Immediately after the procedure, you will be taken to the recovery area where the nurses will monitor your heart rate and blood pressure and check that you are not in any pain. Once they are satisfied, you will be sent to the ward to recover further.The procedure itself is painless. Following the procedure, painkillers are given through a drip at the back of your hand to keep you comfortable. The dose can be controlled by you through pressing a button.
You are usually able to go home the morning after the procedure (certain patients are able to be discharged on the same evening). We will give you a prescription for painkiller tablets which you can take for 3-5 days (if needed).
Avoid driving for at least 2 days after UFE. You are usually able to return to work after a week or 2. Women generally feel completely back to normal after 2 weeks.Fibroids shrink slowly over the following 6-12 months and symptoms continually improve during this time.
Can I conceive after UFE?It is possible to have successful pregnancies after UFE. Most studies suggest a similar rate of pregnancy complications to other mothers, but the numbers studied so far are small.However, the scientific evidence for the beneficial effect of UFE, and even myomectomy, on fertility and pregnancy is currently uncertain.Various international guidelines recommend that each case be considered individually and that treatment of fibroids in women wishing to become pregnant in the future only be undertaken after a detailed discussion.How long do I need to wait after the procedure before trying for a pregnancy?We would advise you wait at least 6 -12 months before attempting to conceive.Is UFE more expensive than surgery?The cost of UFE is, on average, slightly less than surgery. However, the choice of procedure should be made on the basis of what is best for the individual patient rather than on cost alone. By Dr Timona Obura, Consultant Obstetrician Gynaecologist and Dr Ravjit Sagoo, Consultant Interventional Radiologist at Aga Khan University Hospital NairobiThis article was first published in Business Daily on June 13, 2022
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