Uterine fibroids are benign tumors that originate in the uterus (womb). Although they are composed of the same smooth muscle fibers as the uterine wall (myometrium), they are much denser than normal myometrium. This condition affects approximately 20 to 40 percent of premenopausal women but only 5 to 10 percent of premenopausal women actually develop symptoms due to fibroids.
These benign growths typically do not spread to other regions of the body, as with other tumors, and are usually not dangerous. Symptoms caused by uterine fibroids include pelvic pressure or pain, heavy menstrual bleeding, abdominal bloating, back pain, pain with intercourse, constipation, and frequent urination. Women are at increased risk for developing fibroids if they are overweight, African-American, over the age of 40, have high blood pressure, have had no children, or have first-degree relatives with fibroids. Because most women will not exhibit every potential symptom, the diagnosis is usually confirmed by using imaging of the pelvis, with transvaginal ultrasound or MRI.
Location of Fibroids
INTRAMURAL FIBROID TUMORS
The most common type of fibroids, intramural fibroid tumors, typically develop within the uterine wall and expand from there. When an intramural fibroid tumor expands, it tends to make the uterus feel larger than normal, which can sometimes be mistaken for pregnancy or weight gain. This type of fibroid tumor can also cause “bulk symptoms”: excessive menstrual bleeding, which can cause prolonged menstrual cycles and clot passing and pelvic pain which is caused by the additional pressure placed on surrounding organs by the growth of the fibroid which consequently can cause frequent urination and pressure.
Subserosal fibroids typically develop on the outer uterine wall. This type of fibroid tumor can continue to grow outward increasing in size. The growth of a subserosal fibroid tumor will put additional pressure on the surrounding organs. Therefore, symptoms of subserosal fibroid tumors usually do not include abnormal or excessive menstrual bleeding or interfere with a women’s typical menstrual flow. These fibroid tumors instead cause pelvic pain and pressure.
The least common of the various types of fibroid tumors are submucosal fibroids. These fibroids develop just under the lining of the uterine cavity. Large submucosal fibroid tumors may increase the size of the uterus cavity, and can block the fallopian tubes which can cause complications with fertility. Some fibroid tumors don’t produce any symptoms at all, while others can be severely symptomatic. Associated symptoms with submucosal fibroids include very heavy, excessive menstrual bleeding and prolonged menstruation. These symptoms can also cause the passing of clots, and frequent soiling
Pedunculated uterine fibroids occur when a fibroid tumor grows on a stalk, resulting in pedunculated submucosal or subserosal fibroids. These fibroids can grow into the uterus and also can grow on the outside of the uterine wall. Symptoms associated with pedunculated fibroid tumors include pain and pressure as the fibroids can sometimes twist on the stalk.
TREATMENTS FOR UTERINE FIBROIDS
Fibroids require a blood supply (for oxygen and nutrients) to continue to grow. Without it, some or all of the tumor will die. To treat the uterine fibroids, an interventional radiologist performs a treatment called uterine fibroid embolization, or UFE.
MINIMALLY INVASIVE ENDOVASCULAR SURGERY
Dr. Kahn is Board Certified and Fellowship Trained in Vascular and Interventional Radiology specializing in minimally invasive procedures. Using specialized X-ray equipment, Dr. Kahn passes a catheter (small tube) into the incision to the uterine artery, and guides it near the location of the fibroid tumor. When the fibroids are reached, embolic material (small spheres) is injected through the catheter and into the blood vessels feeding the fibroid, depriving the fibroids of oxygenated blood. The oxygen deprivation results in the fibroids shrinking. The embolic material remains permanently in the blood vessels at the fibroid site. The catheter is then moved to the other side of the uterus. Once the Dr. Kahnhas completed embolization of the uterine artery on both sides, the catheter is gently removed.
Almost all minimally invasive uterine fibroid embolization cases are outpatient procedures and have major advantages compared to traditional surgery.
These Advantages include:
- Preservation of the uterus
- Decrease in heavy menstrual bleeding from symptomatic fibroids
- Decrease in urinary dysfunction
- Decrease in pelvic pain and/or pressure
- Virtually no blood loss
- Typically performed as an outpatient procedure
- Overall, significant improvement in patient’s physical and emotional well-being
Dr. Kahn is a nationally recognized expert in minimally invasive therapies for uterine fibroids. To learn more about treatments available at New England Endovascular Center call 413-693-2852 to make an appointment.