Up to 30% of American women have uterine fibroids. Fibroids are also called leiomyomas and are benign uterine tumors. Uterine fibroids are responsive to high estrogen levels which can cause rapid growth. With the onset of menopause, and corresponding decrease in estrogen, most uterine fibroids will decrease in size and symptom severity.
The most common symptom of uterine fibroids is progressively heavier menstrual bleeding that lasts longer than the normal duration of menstruation. This blood loss may also cause symptoms due to chronic iron deficiency anemia.
A sense of pelvic fullness, pelvic pain, and/or pelvic pressure are other common symptoms. Leiomyomas can become quite large. In fact, the size itself can cause additional problems such as hydroureter or hydronephrosis caused by compression of the ureters.
Many women with uterine fibroids will not require surgical or medical treatment. If the symptoms are mild a woman may choose to postpone treatment waiting for the leiomyomas to decrease in size with the onset of menopause.
However, some women with severely symptomatic or very large uterine fibroids will require treatment. Some women who have had miscarriages that may be due to fibroids will opt for treatment in order to increase their chance of carrying a healthy full term pregnancy.
Medications are available in order to provide symptomatic relief or to temporarily shrink the uterine fibroids prior to surgery or menopause.
Uterine artery embolization is a recent addition to uterine fibroid treatment options. The safety and efficacy of uterine artery embolization has been studied to the point that it is considered a useful alternative to other surgical options for fibroid treatment.
Embolization of the uterine arteries may be used as an alternative to myomectomy, in which only the fibroid tumor is removed, or hysterectomy which involves removing the entire uterus.
Uterine artery embolization begins with the selective catheterization of the uterine artery. Once the target artery has been identified the next step is to occlude the artery, a process called embolizatoin. Uterine artery embolization is often done using polyvinyl alcohol particles.
When the uterine artery is successfully embolized this creates an acute infarction (obstruction of blood supply) of the target leiomyomas. Uterine artery embolization is most effective if done bilateral on both the left and the right uterine artery.
Uterine artery embolization is still being studied as a procedure for fibroid treatment in women who plan to bear children. The embolization of the uterine arteries is currently not recommended in women who desire future pregnancy.
The majority of women who undergo uterine artery embolization will experience relief of symptoms. In fact, 85% of women have a decrease in bleeding, pressure, and pain.
However, complications following uterine artery embolization do occur. Approximately 10% to 15% of women will require hospitalization due to acute post-embolization pain.
Other complications that occur following uterine artery embolization as a treatment for uterine fibroids include delayed infection and passage of necrotic fibroids through the cervix and vagina up to 30 days after uterine artery embolization.