What are uterine fibroids?      They are very common non-cancerous (benign) growths that develop in the muscular wall of the uterus, ranging in size from very tiny to larger than a cantaloupe. In some, they can cause the uterus to grow in the size of a five-month pregnancy or more.  They are commonly found in women in their 30s and 40s.      How common ?  20-40 percent of women age 35 and older have uterine fibroids of a significant size. African American women are at higher risk for fibroids: as many as 50% have fibroids of a significant size.

What are the symptoms?   Most fibroids don't cause symptoms — only 10 percent to 20 percent of women who have fibroids ever require treatment. Depending on location, size and number of fibroids, a woman might experience the following: Heavy, prolonged menstrual periods and unusual bleeding, often leading to anemia Pelvic pain Pelvic pressure or heaviness caused by the bulk or weight of fibroids  Pain in the back or legs as the fibroids press on nerves that supply the pelvis / legs Pain during sexual intercourse Bladder pressure leading to a constant urgef to urinate Pressure on the bowel, leading to constipation and bloating Abnormally enlarged abdomen
Are there different types of fibroids?
There are 3 primary types:
Subserosal: These develop under the outside covering of the uterus and expand outward. They typically do not effect menstrual flow, but can cause pain and pressure.   Intramural: They develop within the lining of the uterus and expand inward. These are the most common fibroids and can result in heavier menstrual bleeding and pelvic pain, back pain or generalized pressure. Submucosal: These are just under the lining of the uterus and the least common fibroids. However, they tend to cause the most problems; even a tiny submucosal fibroid can cause heavy bleeding - gushing, very heavy and prolonged periods.

How to make diagnosis?

Typically, fibroids are first diagnosed during a gynecologic internal examination. Your doctor will conduct a pelvic exam to feel if your uterus is enlarged. The presence of fibroids is most often confirmed by an abdominal ultrasound. In some cases, a transvaginal ultrasonography may be necessary. Fibroids also can be confirmed using magnetic resonance imaging (MRI) and computed tomography (CT) imaging techniques.

Any changes in uterine fibroids with pregnancy or menopause?

Fibroids can dramatically increase in size during pregnancy. This is thought to occur because of the increase in estrogen levels during pregnancy. After pregnancy, the fibroids usually shrink back to their pre-pregnancy size. They typically improve after menopause when the level of estrogen, the female hormone that circulates in the blood, decreases dramatically. However, menopausal women who are taking supplemental estrogen (hormone replacement therapy) may not experience relief of symptoms.

What is the treatment?

a - Drug Therapy

b - Surgery (Hysterectomy or Myomectomy)

c - Embolization (Minimally Invasive procedure)

Symptomatic fibroids can be treated by means of medical (medication), surgical, or interventional measures. Medical treatment consists of the use of several medications, eg, nonsteroidal anti-inflammatory drugs (NSAIDs), birth control pills, gonadotropin-releasing hormone analogs (Lupron), and antiprogesterones (RU-486). Uterine fibroids are the most frequent indication for hysterectomy in pre-menopausal women and, therefore, are a major public health issue. Of the 600,000 hysterectomies performed annually in the United States, 1/3 of these are due to fibroids. Surgical treatment of fibroids includes hysterectomy or myomectomy, both of which require general anesthesia and hospitalization. A myomectomy is a local treatment and has a high recurrence rate. 

Transcatheter embolotherapy is a well recognized therapeutic alternative to surgery with a high patient satisfaction rate and positive therapeutic results. This approach to the treatment of fibroids blocks ther arteries that supply blood to the fibroids causing them shrink. It is a minimally invasive procedure, requiring only a tiny nick in the skin, and is performed while the patient is conscious but sedated - feeling no pain or significant discomfort. 

A small catheter catheter is advanced into the feeding artery during the procedure. Following angiographic evaluation, this catheter is used to deliver tiny embolization particles.

- An estimated 13,000 - 14,000 procedures are performed annually in the U.S.

- The embolic particles are approved by the FDA specifically for this procedure

- Embolization of the uterine arteries is not new, used more than 20 years to treat heavy bleeding 

- Embolization was first used as an adjunct to help decrease blood loss during myomectomy

- This procedure is covered by most major insurance companies

- Most women with symptomatic fibroids are candidates for this procedure

What is embolization and who performs this procedure?

Embolization is the intentional blocking of an artery by injecting particles (PVA particles or embospheres), coils or other agents through a small plastic catheter, whose tip is placed in the vessel to be blocked. When the catheter is positioned in the target vessel, contrast media (a liquid which is opaque to X-rays) is injected from the catheter to study the vessels (angiography). When the appropriate position of the catheter is confirmed, embolization can be performed. Embolization procedure should be performed only by an appropriately trained and experienced interventional radiologist; otherwise, devastating complications may be unavoidable.

Who is an Interventional Radiologist?

Interventional radiologist is a physician who has undergone specialized training (fellowship) in the conduct of catheter-related procedures following 4 or 5 years of radiology residency. An interventional radiologist is a board-certificated radiologist with additional board certification for vascular and interventional procedures (Subspecialization).  

What are the embolization particles made of?

There are two commonly used embolization particles for fibroid embolization, PVA particles and microspheres (Embospheres). These particles are available in various sizes. Microspheres have an advantage of not clumping together and penetrating well into the vessels supplying the fibroids. Microspheres are believed to be causing more permanent blockage than PVA, although results in patients appear quite similar(*). 

Are embolization particles toxic?

PVA particles have been in clinical use for embolization since 1975 and have a long track record of safety and also FDA approved for embolization procedure. Microspheres (Embospheres) are also FDA approved and have been in clinical use for over 10 years. 

Does embolization procedure hurt?

This procedure is performed under local anesthesia and conscious sedation. Main purpose of conscious sedation is to make patients more comfortable during the procedure so that patient motion does not interfere the precise catheterization and subsequent embolization. The catheterization itself is essentially painless. However, mild to moderate cramping is expected after embolization and begins minutes to hours after the procedure. severe pain is quite uncommon. 

Do I have to stay overnight?

We like to deal with any problems while you are in the hospital rather than sending you home too early. Almost all patients can go home the next day at mid-morning. We will keep you until it is certain that your pain is well-controlled and that you can take food and drink without any difficulty.

What happens after the procedure and risks?

The first two days are the toughest. Uterine cramping is expected, but the discomfort can be managed effectively with the medications prescribed at the time of hospital discharge. Low fever is common after the procedure, usually resolves after day 5 or 6. infection is a risk after this procedure. Tenderness and cramping slowly improve. Some spotting or discharge is common. Small tissue fragments may be passed. During days 7 - 14, most patients feel well enough to consider returning normal activities or regular work. The two most significant complications are amenorrhea (3%) and fibroid slough retention (2-3%). Embolotherapy may hasten or initiate menopause in a perimenopausal patient whose ovaries depended on the contribution of uterine arterial flow. You should fully understand the nature of the procedure, including potential benefits, risks and alternatives.

official press releases

• Study shows UFE treatment offers much quicker recovery, shorter hospital stays, and is safer with lower adverse event rates than myomectomy surgery

• Multi-center study shows high efficacy rate for minimally invasive treatment of uterine fibroids

• Multi-center study shows successful pregnancies following uterine fibroid embolization

• Largest study to date shows uterine artery embolization effective treatment for fibroids

Any radiation risks?

The radiation dose varies, but is similar to standard angiographic procedures. In general, every effort is made to minimize radiation dose during the procedure. Typical doses are similar to those received from two standard barium enema procedures. 

Will my insurance cover it?

This procedure is covered by most major insurance companies. Please check with your insurance company to confirm this.

Does Uterine Fibroid Embolization work?

Almost all fibroid embolization procedures are performed for excessive bleeding, or for symptoms related to significantly large size fibroids causing significant pelvic pressure. For excessive bleeding, approximately 90% of patients get very good to excellent relief of their symptoms. For pressure-related symptoms (frequent urination, pain etc.), 85-90% get very good to excellent relief. 

Who does these procedures & How to make an appointment?

Dr. Konez is a board-certified radiologist and is also certified for added qualifications in vascular and interventional radiology. Dr. Konez is considered a leader in embolization procedures among his peers and has authored nearly 50 scientific papers and several book chapters in the field.  Dr. Konez previously worked at the Children's Hospital Boston and BIDMC (Harvard Teaching Hospitals) and also at the Cleveland Clinic Foundation. To see other online chapters written by Dr. Konez, click below subtitles:

• Embolization (Vascular Anomalies)

• Embolization (E-medicine)