Uterine Fibroids

 

Background

Uterine fibroids (leiomyomas) are benign tumours which can form at various sites in the uterus.  When they become large they can interfere with a woman’s lifestyle by causing menorrhagia (heavy period bleeding) or cause pressure on the bladder or bowel.

Hysterectomy is the conventional treatment for fibroids but is an irreversible surgical procedure.  Direct removal of the fibroid (myomectomy) can sometimes be performed.

Embolisation is a nonsurgical, minimally invasive procedure performed by interventional radiologists. Uterine artery embolisation (UAE) or uterine fibroid embolisation has become established as a uterus-sparing minimally invasive treatment.  It usually only requires overnight or possibly a two night stay.  Patients are able to return to work or normal duties after one week (much shorter than following a hysterectomy which involves 4-6 weeks recovery).

 

Uterine Artery Embolisation Procedure Steps

  • The patient is sedated and made comfortable with pain-killers and then local anaesthetic is administered to the right groin.
  • The interventional radiologist inserts a catheter into the femoral artery through a small nick in the skin at the groin.
  • The catheter is guided into the left uterine and then right uterine arteries that are supplying the fibroid with blood (angiogram).
  • Special embolic particles are injected which stop the blood supply (The fibroid shrinks over the next 3-6 months).
  • The catheter is removed and digital pressure is applied to the groin until there is no bleeding.
  • The patient is transferred to the Recovery Room where the patient controlled analgesia (PCA) device is set up.
  • After 1-2 hours the patient returns to the ward where she controls the PCA device for overnight pain relief.
  • The following morning oral medication replaces the PCA device and the patient is encouraged to mobilise.

 

An alternative non-surgical treatment is Magnetic Resonance-guided Focused Ultrasound (MRgHIFU).  With this technique, high intensity focused ultrasound is used to heat and destroy the fibroid.  Currently it is only available at the Royal Women’s Hospital in Melbourne.