Diagnosis

The easiest method to diagnose uterine fibroid is an ultrasound investigation. It is important to remember that uterine fibroid may not manifest itself for a long time, therefore all women need to perform an ultrasound investigation annually, starting from the age of 20 years old, irrespective of presence of complaints or not. If the disease is advanced, when large nodes appear, they may be physically felt during a standard examination on a gynecological chair, whereas small nodes during the early stages of development of the disease may be unnoticeable. In more complex cases ultrasound investigation is accompanied with an MRT for a thorough diagnostic.

Treatment options

The approach for the treatment of uterine fibroid has significantly changed over the last few years. As stated earlier, a dissection and removal of the walls of the uterus with fibroid nodes was the most common method of treatment. This surgical intervention has been the most widely practiced so far, but it is more and more seldomly applied. A complete dissection of the uterus is nowadays only recommended in more serious cases, where fibroid nodes enlarge within the uterus to giant proportions (potentially filling out the entire abdominal cavity) or when it is combined with malignant gynecological disorders.
Typical and usual uterine fibroids do not require uterine dissection.
It is highly desirable to avoid uterine dissection, since irrespective of whether the uterus is dissected with or without the ovaries, more than a half of women who have been through this form of treatment developed different complications, such as hormone deficiency, or an increase in risk of cardiovascular diseases, such as myocardial infarction and/or strokes.
Myomectomy – limited use
Surgical treatment of uterine fibroid in the form of nodes dissection may be performed using two different approaches: a laparotomical one, where an abdominal incision is performed and a surgeon operates directly with his/her hands, and a laparoscopic one, where the operation is performed through 3 or 4 small holes in the abdomen using devices with camera guidance. The latter kind of operations is most commonly used. It is reasonable to conduct nodes removal from the uterus only if the woman is interested in becoming pregnant in the near future. In other words, a myomectomy is a temporary uterine restoration to realize a specific pregnancy. This treatment option is associated with a high recurrence rate, with rates reaching between 7-14% per year (reference), and several years after undergoing a myomectomy, the uterine fibroid problem will have to be tackled again. Uterine fibroid relapse occurs in more than 50% of patients after a myomectomy.
It is important to further understand that removing nodes from the uterus leaves scaring, which may be torn open again whilst giving birth; and following their removal, the more nodes there were in the uterus and the deeper they were, the greater the danger for a consecutive pregnancy. Furthermore, this invasive surgical treatment is associated with serious risk and trauma, connected with narcosis, hemorrhage, inflammation, and injury of the bowels as well as thrombotic complications. Rehabilitation after surgical intervention takes up to 2 months.

UFE

Uterine Fibroid Embolization (UFE) is the most recent and current treatment option of uterine fibroid, notwithstanding that its first application in medicine took place as far back as the 1970s. The essence of this option is in the devascularisation of all uterine fibroid nodes, which results in their destruction or nonreversible decrease in dimensions. As a result patients do not experience most or any complications. The efficiency of UFE is 98-99%.
This intervention is not performed by a gynecologist, but by a different medical profession – an interventional radiologist. The gynecologist’s function is limited to the examination, diagnosis, and recommendation of which treatment option would be most appropriate for the patient. It is perhaps due to a lack of expertise that some gynecologists may be unwilling to recommend UFE, ascribing to the method non-existent complications, restricting UFE usage. Actually UFE is one of the most secure procedures in gynecology – the risk of any complications is 20 times lower, than after any other variant of surgical treatment. The procedure is performed under local anesthesia (as there is no need for general anesthesia) and takes no more than 15-20 minutes. It is painless and relatively comfortable.

General procedure and Feelings

During UFE, the interventional radiologist firstly carries out a local anesthetization of the femur skin. Then a puncturing of the femoral artery is made – this stage is already absolutely painless. Through the femoral artery a special catheter is introduced, which is manipulated under fluoroscopic guidance. Uterine arteries and blood vessels feed the nodes; therefore the surgeon’s aim is to enter at first in one uterine artery, then into the other so that he can introduce Embozene in order to block the supply of the nodes which consequently makes them shrink from lack of supply. As a rule, this stage takes no more than 10 minutes and is accompanied with a feeling of warmth flowing through the body. The procedure ends with the application a special vascular seal where the femoral artery was punctured.
During the aftermath of the procedure, for a few hours the patient may develop a moderate pain (mostly located in the lower abdomen), nausea, and general feeling of weakness. This condition can last until evening and is managed with anesthetics. The next day after the UFE, moderate abdominal pains, weakness and temperature elevation may remain. Such condition is named “postembolic syndrome” and lasts for up to 7 days.
Only one or two days at hospital
As the course of this syndrome is rather mild, the patients are discharged from hospital either the following day, or on the second day, depending on their desire.
Recovery after Uterine Artery Embolization takes on average just one week.

After UFE

Control analyses are made 3, 6, or 12 months after UFE. Already, by the third month after the procedure heavy menses, a sense of weight on the bladder, and abdominal pains will have disappeared; and the size of the abdomen will have significantly reduced.
The nodes dimensions decrease on average by 30%, and in the year following the procedure, the irreversible involution of the nodes reaches 50-70%. The major difference of UFE when compared to medicinal treatment of uterine fibroid with hormones is the total destruction of all uterine fibroid nodes and the irreversibility of their decrease.

Relapses

Relapses are not practically reported after UFE. Throughout the whole history of its observation, the relapse rate is near 1%. This fact makes UFE highly recommendable to patients with uterine fibroid who plan on a pregnancy in the indeterminate future.
It is important to note, that even in 1% of cases, when the blood flow in the uterine after UFE reverts, and an additional embolization procedure of these new vessels may be needed, it is performed free of charge in our clinic.