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A new website for gynaecologists interested in the surgical management of fibroids is now on line. www.fibroidsurgery.org
Uterine artery embolisation
artery embolisation was first performed
approximately 20 years ago to stop uncontrollable
bleeding from the womb due to cancer or
complications of child birth or surgery.
More than 10 years ago, uterine embolisation
started to be used in France prior to myomectomy
to reduce bleeding during surgery. Somewhat
unexpectedly, it was found that some women
no longer required surgery as their symptoms
had subsided and their fibroids begun to
shrink. The procedure began to be used
as the primary treatment for fibroids.
embolisation is performed by an interventional
radiologist (cf. gynaecologist) under
local anaesthesia and, if necessary, light sedation. The procedure involves occluding
blood vessels supplying the fibroids. This is done by injecting small plastic
particles through a narrow catheter which
is inserted into an artery in the groin,
and guided to the uterus. The plastic
particles block the blood supply feeding
the fibroids and this results in embolisation.
Without a blood supply the fibroids degenerate
(waste away) and become smaller in size,
thus reducing the uncomfortable symptoms
associated with them.
experience indicates a success rate
for fibroid embolisation of over 85%, with
an average decrease in fibroid volume
of between 40 - 60%. Up to 90% of women
presenting with abnormal uterine bleeding
and size related symptoms (eg. pressure)
have demonstrated significant improvement.
You can expect improvement almost immediately
with respect to heavy bleeding and
pelvic pain; shrinkage of the fibroids usually
starts within a few weeks.
main complication of the procedure is
infection, leading to hysterectomy. The
incidence of this complication is approximately
1-2%. In addition, patients can become menopausal
following the procedure, the incidence rising with the patient's age. Other serious
complications are rare. Lesser complications include pain, which can sometimes be
severe, and nausea in the first few hours following the procedure.
Symptoms can be controlled with appropriate
medication, and most symptoms are substantially
improved within days although there may
be pain and cramping for several days.
A "Post-Embolisation Syndrome", consisting
of pain, nausea, vomiting and fever affects
some women in the week following the
procedure. Others experience a watery,
non-offensive vaginal discharge in the
weeks following the embolisation. Approximately
7% of patients may pass a degenerating
fibroid in the weeks or months following
the procedure. Many women report returning
to work within a week or two of having
Suitable for large fibroids
Avoids general anaesthesia, surgery and abdominal incisions
Short hospital stay (1-2 days usually)
Quick return to normal activities and work
Good symptom relief (e.g. pressure symptoms, heavy periods)
Considerable post-procedure pain
Small risk of hysterectomy (because of infection)
Chance of early menopause not inconsiderable in women over the age of 40 years
No specimen to check fibroids are benign
Fibroids shrink but do not disappear
Currently not recommended in the UK for women who wish to conceive
Resonance Imaging (MRI) is a non-invasive procedure
that uses powerful magnets and radio waves to construct
pictures of the body.
Unlike conventional radiography and Computed Tomographic
(CT) imaging, which make use of potentially harmful radiation
(X-rays), MRI imaging is based on the magnetic properties
of atoms. A powerful magnet generates a magnetic
field roughly 10,000 times stronger than the natural
background magnetism from the earth. A very small percentage
of hydrogen atoms within a human body will align with
focused radio wave pulses are broadcast towards the
aligned hydrogen atoms in tissues of interest, they
will return a signal. The subtle differences in that
signal from various body tissues enables MRI to differentiate
organs, and potentially contrast benign and malignant
Any imaging plane (or "slice") can
be projected, stored in a computer, or printed on film.
MRI can easily be performed through clothing and bones.
However, certain types of metal in the area of interest
can cause significant errors in the reconstructed images.
Since MRI makes use of radio waves very close in
frequency to those of ordinary FM radio stations,
the scanner must be located within a specially shielded
room to avoid outside interference. The patient will
be asked to lie on a narrow table which slides into
a large tunnel-like tube within the scanner.
addition, small devices may be placed around the head,
arm, or leg, or adjacent to other areas to be studied.
These are special body coils which send and receive
the radio wave pulses, and are designed to improve
the quality of the images. If contrast is to be administered,
an IV will be placed, usually in a small vein of the
hand or forearm. A technologist will operate the machine
and observe you during the entire study from an adjacent
Several sets of images are usually required, each
taking from 2 to 15 minutes. A complete scan, depending
on the organs studied, sequences performed, and need
for contrast enhancement may take up to one hour
or more. Newer scanners with more powerful magnets
utilizing updated software and advanced sequences
may complete the process in less time.