What are fibroid tumors?

Fibroid tumors are noncancerous (benign) growths that develop in the muscular wall of the uterus. While fibroids do not always cause symptoms, their size and location can lead to problems for some women, including pain and heavy bleeding. Fibroids can range in size from very tiny to the size of a cantaloupe or larger. In some cases, they can cause the uterus to grow to the size of a five-month pregnancy or more.

Which patients are at risk for fibroid tumors?

From 20 to 40 percent of women 35 and older — and as many as 50 percent of African-American women — have uterine fibroids of a significant size. Most women do not experience serious problems and do not seek treatment, and some can be treated with medication. In addition to hysterectomy, myomectomy, the surgical removal of the fibroids, is often recommended to relieve their fibroid symptoms. Typically, however, the more fibroids a patient has, the less successful the myomectomy. Additionally, fibroids grow back several years after the surgery in 10 to 30 percent of cases.

What are the alternatives to hysterectomy?

Women suffering from painful uterine fibroids — the most common cause of hysterectomies — now have an alternative, fibroid embolization, which can save them from having the surgical procedure. Interventional radiologists at The Johns Hopkins Hospital perform the fibroid embolization procedure, which involves cutting off blood flow to the fibroid, causing it to shrink.

More than one-third of the 600,000 hysterectomies performed each year are due to fibroids, making them the No. 1 reason for surgical removal of the uterus. However, all patients need to be evaluated by an interventional radiologist to determine if they are candidates for this procedure.

What is fibroid embolization?

Uterus with blood supply to the fibroids. The catheter is placed directly into the blood supply of the uterus. (Courtesy of SCVIR, www.scvir.org)

 

Small particles are injected directly into the blood supply to stop the flow of blood to the fibroids. By stopping the blood supply to this benign tumor, the fibroids will decrease in size and eventually the symptoms will subside.

Fibroid embolization, also called uterine artery embolization, is done without surgery. It requires only a tiny nick in the skin about the size of a pencil tip. It is performed while the patient is conscious but sedated — drowsy and feeling no pain. Fibroid embolization is performed by an interventional radiologist, a physician who is specially trained to perform this and other minimally invasive procedures.

The interventional radiologist makes a small nick in the skin in the groin, through which a tiny tube called a catheter is inserted into an artery. The catheter is guided through the artery to the uterus while the interventional radiologist watches the progress of the procedure using a moving X-ray (fluoroscopy). When the catheter is in place, the interventional radiologist injects tiny plastic or gelatin sponge particles the size of grains of sand into the artery that supplies blood to the fibroid tumor. The particles cut off the blood flow to the fibroid and cause it to shrink.

How effective is the procedure?

Research has shown fibroid embolization to be at least 85 percent effective in reducing bleeding and alleviating pain. Many women have described significant change in their symptoms within days. Furthermore, since the procedure avoids surgery, many women can go back to routine daily activities by the next day.

Although definitive studies have not been completed on the effect of fibroid embolization on a woman’s fertility, early evidence suggests that fibroid embolization generally does not disrupt reproductive function and may be an option for women who wish to become pregnant in the future.

Is the procedure performed as outpatient?

Fibroid embolization usually requires a hospital stay of one night. Total recovery generally takes one to two weeks, but it can take longer. Fibroid embolization is considered to be very safe, but there are some associated risks, as there are with almost any medical procedure. A small number of patients 45 and older reportedly have entered into menopause after embolization. A number of insurance companies are paying for fibroid embolization procedures.

What can I expect after the procedure?

Recovery time for patients undergoing transcatheter embolotherapy for fibroids is approximately one week. Vaginal spotting and discharge may occur for several weeks after completion of the procedure. We do not yet know the potential long-term impact of uterine artery embolization on fertility. Case reports have appeared in the medical literature of women who have become pregnant after uterine artery embolization for fibroids.

Who does the procedure?

An interventional radiologist is a physician who has special training to diagnose and treat illness using miniature tools and imaging guidance. Typically, the interventional radiologist performs procedures through a very small nick in the skin about the size of a pencil tip. Interventional radiology treatments are generally easier for the patient than surgery because they involve no surgical incisions, less pain and shorter hospital stays. Learn more about our experts in interventional radiology.