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Uterine fibroids are benign growths of the uterine muscle that occur in 30 to 40% of women. Although many fibroids do not cause any problems and require no treatment, some fibroids cause heavy periods leading to anaemia and debilitation or, as the fibroids grow larger, can lead to compression syndrome whereby adjacent organs are compressed leading to further complications. For instance, if the bladder is compressed urination is more frequent, while compression of the bowel will cause constipation and bloating, the fibroids can also press on nerves leading to backache and sciatica or they may bulge out of the abdomen and be cosmetically unsightly.
The standard treatment for women who do not wish to get pregnant was) is a hysterectomy while surgical myomectomy (cutting the fibroids out) was used for those patients who desire pregnancy. Hysterectomy is a major surgical operation with a serious complication rate of 2-4% and a mortality rate of around 1 in 1,000. Similar complication rates apply to myomectomy.
In December 1996 we at the Royal Surrey County Hospital with the London Clinic in Harley Street began a trial of fibroid embolisation, then a relatively new procedure, to see if the outcomes were preferable. Since then we have treated over 2,300 cases and published extensively on the outcomes of the procedure. Fibroid embolisation is a method that involves the insertion of a tiny catheter into an artery in the right groin which is then introduced under X-ray control into the pelvic arteries that supply the fibroids. Tiny particles of PA (polyvinyl alcohol) are then injected which kill the fibroids. For video explanation see here
Long-term studies of more than five years demonstrate that the success rates for fibroid embolisation are around 90% (today the current experience is over 95%). Moreover, the complication rate of fibroid embolisation is minimal in comparison with any form of surgery. There is a tiny rate of ovarian failure and a small incidence of infection leading to hysterectomy (although, we have had no such cases in over 1,700 patients). The main advantage of fibroid embolisation is that in the overwhelming majority of cases it kills all the fibroids in one hit, thus, there is only a minimal recurrence rate. This is compared to the recurrence rate following myomectomy in patients with multiple fibroids which in one series is as high as 75%. Furthermore, after the menopause, because the fibroids are all dead, patients can have hormone replacement therapy without any fear of oestrogen stimulation of the fibroids. Additionally, in the case of patients wishing to become pregnant we have now had 76 successful completed pregnancies following fibroid embolisation and have published the largest pregnancy series in the world (our pregnancy data can be accessed here).
We now know from multiple trials that all types of fibroid are suitable for embolisation whether multiple, single, large or small including pedunculated fibroids (fibroids which stick outside the womb). The American College of Obstetrics and Gynaecologists recommended uterine fibroid embolisation as safe and effective based on good consistent Level A scientific evidence. It was also passed by NICE for routine use in 2007 and has been elevated to a Best Practice Tariff for uterine fibroid treatment by the NHS. Fibroid embolisation is a skilled procedure which needs to be performed by Interventional Radiologists who have performed many fibroid embolisation procedures as there is a significant learning curve.
In subsequent Blogs, I will be dealing with specific issues related to fibroid embolisation including further information on patients wishing to become pregnant.
See fibroids part two – who is suitable for embolisation?
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Great site, continue the good work!