Treatment of uterine fibroids - teamwork

FibroidCare is a collective resource in Southern Africa specialising in Uterine Fibroid Embolization (UFE), also known as Uterine Artery Embolization. The team at FibroidCare aims to offer this specialized service to patients across the continent and in their home-towns/countries.

The procedure is a minimally invasive alternative to surgery for the control of symptomatic uterine fibroids. The purpose of embolization is to block the blood flow to the fibroids which ultimately leads to fibroid death and shrinkage. Patients who undergo uterine embolization do not undergo general anesthetic, but are provided with light sedation so that although they are sleepy at the time of the procedure, they remain awake and breathing on their own.

Following UFE, the patient is observed for 6 hours under direct nursing supervision and placed on a patient-controlled analgesic pump. This allows the patient do manage their own pain control. The majority of patients are discharged the day after the procedure. A six week follow up visit is usually scheduled with the referring doctor.

Ideal UFE candidates include women with symptomatic fibroids who express the desire for uterine preservation and/or the avoidance of surgical intervention. Pre-procedure evaluation for UAE should include a comprehensive history and physical examination, a recent gynecologic examination performed by an OB/GYN specialist, a recent Pap smear, an endometrial biopsy for patients with dysfunctional uterine bleeding and imaging documenting the presence of uterine fibroids.

Uterine fibroids are noncancerous growths of the uterus that often appear during childbearing years. Also called leiomyomas (lie-o-my-O-muhs) or myomas, uterine fibroids aren't associated with an increased risk of uterine cancer and almost never develop into cancer. Uterine fibroids develop from the smooth muscular tissue of the uterus (myometrium). A single cell divides repeatedly, eventually creating a firm, rubbery mass distinct from nearby tissue. The growth patterns of uterine fibroids vary – they may grow slowly or rapidly, or they may remain the same size. Some fibroids go through growth spurts, and some may shrink on their own. Many fibroids that have been present during pregnancy shrink or disappear after pregnancy, as the uterus goes back to a normal size.

Fibroids range in size from seedlings, undetectable by the human eye, to bulky masses that can distort and enlarge the uterus. They can be single or multiple, in extreme cases expanding the uterus so much that it reaches the rib cage.

As many as 3 out of 4 women have uterine fibroids sometime during their lives, but most are unaware of them because they often cause no symptoms.

Uterine fibroid embolization (UFE), also known as uterine artery embolization, is a minimally invasive treatment for uterine fibroids. In UFE, a doctor uses a small flexible tube (catheter) to inject tiny particles into the uterine arteries, which supply blood to your fibroids. The goal is to block tiny vessels that lead to your fibroids, starve the fibroids and cause them to die. Without their blood supply, the fibroids shrink and painful symptoms are alleviated.

The hospital stay is usually only 24hrs and the patient will usually recover from the procedure within a few days.

Common symptoms of fibroids

  • Excessive bleeding and prolonged menstrual cycle
  • Pain in the lower abdomen or a bloating sensation
  • Pain during menstruation
  • Pressure in the lower abdomen or pelvic region
  • Pain in back, thighs and legs

Types of Fibroids

Fibroids can be present in the following locations in the uterus:

  • Cervical: grows on the wall of the cervix
  • Intramural: grow in the wall of the uterus, these are the commonest types
  • Subserous: grow on the outer layer of the uterus
  • Sub-mucous: grow beneath the lining of the uterus

Diagnostic and Interventional Radiologist: Uterine Artery Embolization:

Dr. A.J Lawson MBBCh (Wits), FC Rad (SA), MMEd Rad (UCT)


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