- August 3, 2020
- Posted by: cmcdonald
- Category: Uterine Fibroid Embolization (UFE)
Dr. Abadir earned his medical degree and completed his internship at the Albert Einstein College of Medicine, followed by a Diagnostic Radiology residency at Montefiore Hospital and Medical Center. In this interview, he explains the causes and treatments for uterine fibroids.
Q: Why are so many women affected by fibroids and what causes fibroids?
A: Fibroids in general are a very common issue with women. Up to 60% to 70% of all women have some fibroids. Only a small number of those actually become symptomatic, but it’s a very common issue. Some muscle cells in the uterus stop obeying the normal commands that say “stop growing” so they form a little tumor that’s not malignant and not dangerous, but it can cause symptoms. Nobody has been able to identify any major causes, it seems to be mostly genetic and runs in families. If your mother or sister has fibroids, you’re much more likely to have fibroids. It also varies by race. Black women are affected at least twice as much as white women. There are very few factors you can modify in terms of fibroids because they are genetically-based.
Additionally, fibroids seem to be affected by the body mass index. If you are overweight you may have increased production of estrogen. Fibroids seem to be responsive to estrogen, so that’s one modifiable factor.
Other things that we’ve seen associated with fibroids include the age that you have your first menses. If it’s early, you’re exposed to estrogen longer and you seem to have a higher incidence of fibroids. Also, having children early seems to increase your risk of fibroids later in life.
Q: When should women with fibroids schedule an appointment?
A: Fibroids are benign tumors of the uterus. However, they do cause symptoms. Usually, the most problematic symptoms are pain during the menstrual cycle or excessive bleeding. Other symptoms that women can notice include that the fibroids can be big enough to cause a bulge in the belly, and they can also cause back pain if they get big enough to push on the spine. Most of the time, patients complain of the excessive bleeding, sometimes having to change feminine products every half hour during the heavy flow days, or having really excessive cramps. Some women can’t even leave home because the pain is so bad. Those are the usual symptoms I see in patients coming to me.
Q: What treatment options are available for uterine fibroids?
A: Uterine fibroids are benign tumors of the uterus and they are treated when they cause symptoms typically of excessive bleeding or pain during the menstrual cycle. The standard treatment for many years has been to advise patients to have a hysterectomy, which removes the whole uterus, ends the menstrual cycle, and ends the symptoms associated with the menstrual cycle. Some women are opposed to that as they desire future childbirth or they just want to avoid a major operation, which can have a significant recovery time of up to six weeks. Based on that, some less invasive treatments have been developed in recent years.
One of them would be Uterine Fibroid Embolization, which is a procedure that deprives the fibroids of their blood supply. Any part of your body that doesn’t have a blood supply can’t survive, so the body essentially just slowly removes them over time. UFE is usually an outpatient procedure with a very short recovery time. It has a very high effectiveness of 92 – 95% and is very low in complications.
Other treatments are available for uterine fibroids. If you have one or two fibroids and the primary issue is bleeding, sometimes your OB-GYN can do an endometrial ablation, which is removing the inside lining of the uterus. It doesn’t do much in the way of getting rid of menstrual cramps, but it does get rid of the source of bleeding. If you’re desiring a future pregnancy, however, this is not an option for you, and it can have a relatively high rate of failure as the lining of the uterus can regrow.
Instead of doing a full hysterectomy, your doctor can do what’s called a myomectomy, which is trying to take out the individual fibroids and then sewing back the uterus once they’ve been removed. It is the most commonly prescribed treatment for women who are strongly desiring a future pregnancy. However, not all patients are candidates for it.
An experimental treatment that has been used in several locations is MRI guidance to take a high energy ultrasound. This destroys the fibroids in a manner much like Uterine Fibroid Embolization. It actually kills the fibroids where they are, and the body slowly resorbs them. Unfortunately, it has its limitations in terms of size and numbers of the fibroids, and it’s only offered in specific centers.
Q: Are there any non-surgical treatment options for fibroids?
A: Unfortunately, there are no simple non-surgical treatments for fibroids. No modifications of diet or other activities have been shown to be tremendously successful. There has been some association with a large meat intake of causing or exacerbating uterine fibroids, but otherwise, the fibroids are fairly on auto-pilot and they respond merely to the presence of estrogen. In terms of non-surgical treatments of fibroids, therefore, one thing to do is to block their ability to access estrogen.
One of the treatments is called GnRH agonists. This treatment stops the production of a hormone and leads eventually to the formation of estrogen. Fibroids essentially regress, as if you went into menopause. Unfortunately, the treatment is somewhat expensive, and it does cause the same symptoms as menopause in terms of hot flashes and other symptoms. Also, it should not be carried on for too much more than six months. Just as early menopause causes issues, this also causes issues over time with a potential increase in the risk of osteoporosis, as well as cardiovascular disease. There are some newer treatments on the horizon that seem to attack the response of the fibroids to progesterone, but they at this point are still experimental and not common to clinical practice.
Q: What is important for patients to know about Uterine Fibroid Embolization and what does the recovery process look like?
A: The procedure itself is fairly straightforward to perform. It involves putting a catheter into the arteries that supply the fibroids and injecting small particles, which essentially clog the arteries and stop the blood flow. Because of that, it can be done very safely as an outpatient procedure, and it is not uncomfortable to undergo the procedure.
The major issue with Uterine Fibroid Embolization is that when a part of the body doesn’t have a blood supply, it hurts. So there can be crampy pain after the procedure. To mitigate that, we have our patients obtain all their post-operative pain medications ahead of time. We start them during the procedure and make sure that everything is well taken care of before you leave our facility. You can expect that for about three to five days after the procedure, there may be some manageable, crampy pelvic pain. It gradually gets better as time goes on.
Usually by about day seven after the procedure, most women report that they’re back to normal. Since it’s not a surgery and there are no sutures, you can do anything you’d like after the procedure. It’s just a matter of what you feel like you can tolerate. Some women have gone back to work the next day, which I don’t advocate, but, most need to have about a week off of any major responsibility before they can really be back on their feet.
Q: What can patients expect the day of their procedure?
A: Typically, we have most patients obtain their medications ahead of time, and if there is anxiety, sometimes patients take an anxiolytic to reduce anxiety just before the procedure. You have to come in with a partner because you will have to have somebody drive you home. When you come in for the procedure, our nurses interview you, make sure that everything is well, get you ready for the procedure, and then we typically do the procedure in the mornings.
The procedure itself is relatively short. It takes anywhere between 45 minutes to one hour to complete, and then there is a recovery time afterwards. We make sure that the site where we enter the arteries to perform the procedure has healed, and we also make sure that all appropriate pain medications are on board and that patients have recovered well after the procedure. Overall, the process lasts about 4 to 6 hours from the time you come into the facility until you’re ready to go home. And then once you go home, you should have all your pain medications and other medications available and be able to recover in the comfort of your home.
Q: What are the potential complications of Uterine Fibroid Embolization?
A: Uterine Fibroid Embolization is a safe procedure. There are no incisions. The whole procedure essentially goes through a needle hole where a catheter is inserted into the arteries and down to the arteries that supply the uterus.
Over the long-term, the potential issues with Uterine Fibroid Embolization are that we are taking away the blood supply to the fibroids. The way the body fights infections is with cells that travel around the bloodstream. When they detect an infection, they attack it. They obviously cannot get into the fibroids anymore so there is a risk of infection. To mitigate that risk, we have patients take antibiotics just before our procedure, and then keep them on them for about five to seven days after the procedure. The numbers that are quoted are around a 2% risk of infection. In our experience, it’s been much lower possibly because we are generous in our use of antibiotics.
The one issue that is still being investigated is the effect of Uterine Fibroid Embolization on the ability to become pregnant. It seems at this time, that it does not reduce fertility, and therefore you cannot consider it as a birth control mechanism. It cannot be said with complete assurance that if you’re strongly desiring to have a pregnancy in the future, that this is the procedure for you.