1. What are uterine fibroids?
Fibroids are benign (non-cancerous) tumours of the uterus and occur in women of reproductive age. They are common but less than half are symptomatic. The symptoms depend on the size, location and number of fibroids. The most common symptoms are menorrhagia, pain and pressure on the bladder and bowel. The fibroids have a rich blood supply, are dependent on female sex hormones for their growth and shrink after menopause.
2. Where are the fibroids in the uterus?
Fibroids are classified by their position in the uterus. The outercovering of the uterus is the serosa and the inner lining is the endometrium (mucosa). Subserosal fibroids are on the outside wall of the uterus and may even be connected by a stalk (pedunculated fibroid). Submucosal fibroids are partially in the endometrial cavity and partially in the wall. Most fibroids lie within the muscular wall and are “intramural”.
3. What are the typical symptoms?
The symptoms vary and depend on the size, number and location of the fibroids
- pelvic pain or heaviness
- abnormally enlarged abdomen
- heavy menstrual periods which may lead to iron-deficiency anaemia
- pressure on the bladder leading to increased urge to urinate
- pressure on the bowel causing constipation or haemorrhoids
4. How are fibroids diagnosed?
Your doctor will conduct a pelvic examination to feel if your uterus is enlarged. This may include a gynaecologic internal examination. Also an ultrasound examination will confirm the diagnosis and show the size and location of the fibroids.
5. What are the treatment options?
- hysterectomy. Hysterectomy is the conventional treatment and can be performed vaginally, abdominally (open) or laparoscopically (keyhole surgery). The cervix and ovaries can be removed or conserved
- myomectomy
- uterine artery embolisation
- MR guided focused ultrasound ablation (MRgFUS)
- high intensity ultrasound is used to heat and destroy the fibroid. Currently it is only available at the Royal Women’s Hospital in Melbourne
- hormone treatment such as with gonadotropin-releasing hormone analogues which induce a chemical menopause
6. What are the advantages of UAE?
- no general anaesthetic
- minimally invasive
- shorter hospital stay
- faster return to work
- fewer adverse events than hysterectomy
7. What are the risks of fibroid embolisation?
Generally the procedure is safe but as with any medical procedure there are some associated risks. The major risk is the 1% chance (1 in 100) that an urgent hysterectomy may have to be performed if overwhelming infection occurs as the blood supply is occluded. There is also a 2% chance of premature menopause if the uterine arteries also supply the ovaries. A small number of women may be troubled by vaginal discharge for a few months after the procedure.
8. Can fibroid embolisation fix my infertility?
The Royal Australian and New Zealand College of Obstetricians and Gynaecologists recommend myomectomy as the best option for women wanting a future pregnancy.
9. What is an interventional radiologist?
Radiologists are medical specialists trained in interpreting radiological (medical imaging) tests. Interventional radiologists use their anatomical knowledge in performing invasive tests such as angiograms and as an extension to this skill, can block (embolise) the arteries if indicated.