Information about uterine fibroids
Minimally Invasive Therapy Unit & Endoscopy Training Centre
University Department of Obstetrics and Gynaecology
Royal Free Hospital
Pond Street
London NW3 2QG, UK


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A new website for gynaecologists interested in the surgical management of fibroids is now on line.

Uterine artery embolisation

Uterine 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. 

Fibroid 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.

World 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.

The 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 the procedure.

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

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MRI scan

Magnetic 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 this field.

When 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 tissue.

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.

In 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 room.

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.