Uterine fibroids: how can an interventional radiologist help?

Uterine fibroids are the most common benign tumours in women. Throughout women's lives, the prevalence is about 30% or otherwise, 1 in 3 women will develop fibroids. Dr Leto Mailli is highly-experienced when it comes to treating the condition. 

Whilst you might expect a gynaecologist to manage cases of uterine fibroids, interventional radiologists can also treat them using a procedure known as uterine artery embolisation (UAE). Here, Dr Mailli explains everything you need to know about UAE in comparison to traditional open surgery.

Who is most likely to develop uterine fibroids?

There is a genetic predisposition for developing fibroids with black women affected more than white women. Other potential contributory factors are being overweight and nulliparous (not having children).
 

Is treatment always necessary?

The majority of fibroids cause no symptoms and thus need no treatment. Fibroids are only treated if they become symptomatic or if they are in such location that they could potentially compromise fertility. Approximately one in four women having fibroids will be symptomatic.

Symptoms can vary and could be one or more of the following:
 

• Heavy menstrual bleeding
• Pain during your period cycle and intercourse
• Dull lower abdominal pain/sensation
• Urinary frequency
• Bowel disturbances.

Especially when these symptoms are felt to have a negative impact on the woman’s life, then intervention is warranted.
 

How does an interventional radiologist treat uterine fibroids?

An interventional radiologist is a surgeon that uses sophisticated imaging equipment and miniature tools to treat the fibroids. The treatment of fibroids performed by an interventional radiologist is called uterine artery embolisation (UAE) or uterine fibroid embolisation (UFE).

The procedure is performed without general anaesthetic but may require conscious sedation for greater comfort. The interventional radiologist starts with a very small nick at the groin about 2mm (the size of a pencil tip). Then a fine tube called a catheter is introduced via this small nick into the artery. The catheter will then be guided into the arteries that feed/supply the uterus and the fibroids. This whole procedure is performed under continuous X-ray guidance (called fluoroscopy) and administration of contrast medium.

When the catheter is confirmed to be at the adequate location, in the uterine artery, then tiny embolic particles are prepared to be injected through the catheter. The aim of injecting these particles is to block the vessels that feed the fibroids. By blocking the blood supply to the fibroids we are able to kill them as nutrients and oxygen can’t reach them anymore. The particles utilised have been in medical use since 1952 and are biocompatible and inert, thus clinically effective and safe.

Finally, the catheter is removed and manual compression is applied at the groin artery for 10-15 minutes to stop bleeding. The woman would need to stay overnight and can be discharged the following day.
 

What is the advantage of UAE?

The advantage of this technique is that all fibroids are treated with a single procedure and women can go back to routine daily activities very fast without any scar. It is a well-established procedure having over 85% success rate and over 90% satisfaction rate. There are significantly less serious complications by performing uterine artery embolisation than any other type of fibroid surgery.
 

When is UAE the preferred procedure over traditional open surgery?

There are only very few scenarios where traditional open surgery would be clinically preferable. If on the MRI investigation there are imaging features suspicious of malignancy, surgery should be the treatment of choice.

In the majority of cases, women can choose between different options ranging from uterine artery embolisation, myomectomy (with different techniques) to hysterectomy. Women need to be consulted for all potential treatment options and make a conscious decision for themselves after knowing all the facts.

For example, hysterectomy (removal of the womb) is the most effective treatment with a 100% success rate in managing the symptoms. The downside of this procedure is the long recovery, high complication rate and potential psychological impact that some women may have by losing their womb.

Myomectomy is a surgical procedure that can only offer satisfactory results if there are a small number of fibroids in the uterus.

Each woman will have a different presentation of fibroid disease (solitary, multiple, different locations) but also age, symptoms and expectations, thus all these parameters need to be factored and discussed during a consultation in order to make a well-informed decision of the type of management that would best achieve her expectations.
 

Can new uterine fibroids grow after UAE?

The fibroids, once successfully killed with UAE, should not regrow. New fibroids can develop no matter if one underwent surgical myomectomy or uterine artery embolisation, especially if a woman is young (usually less than 40 years old). The reason is that developing fibroids is genetic and driven by hormones, thus a young, hormonally active woman may develop new fibroids in the future. Above 40 years old, the hormonal drive is less and thus the chances of developing new fibroids are extremely low. Only a hysterectomy can guarantee no new fibroids developing. 

Do not hesitate to book an appointment with Dr Mailli via her Top Doctor's profile here if you’re concerned about your uterine fibroids and she’ll give you her expert opinion.