By: Jean Johnson for Fibroids1Women in their child-bearing years with fibroids that need treatment are generally encouraged by two procedures that tend to preserve uterine function and thus their chances of becoming pregnant.
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Fibroids or Not?
Symptoms of several other diseases and conditions, including urinary tract infections, ectopic pregnancy, certain STDs, and even cancer are similar to fibroid symptoms. The following symptoms may be symptoms of fibroids, but could also be due to other problems, so be sure play it safe by seeking the help of a professional medical caregiver before jumping to conclusions.
Painful and/or heavy periods
Uterine or abdominal pain at other times of the month
Unexplained or off-cycle bleeding
Abdominal bloating
Urinary or bowel symptoms (frequent urination, feelings of pressure in the intestinal area)
Lower back pain
Anemia (due to increased bleeding)
Pain during sexual intercourse (dyspareunia)
Reproductive problems (including infertility, miscarriage or premature labor)
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Instead of being automatically scheduled for a hysterectomy (in which the uterus is removed), in many cases female patients can now choose a myomectomy – still major surgery, but one that leaves the uterus intact – or the newer non-surgical option uterine fibroid embolization (UFE). “We do know that only about 35 to 40 percent of women will be fertile after a myomectomy,” said John Lipman, M.D. in 2004, a physician who performs UFE and other interventional radiology procedures in Atlanta. “Although there have been several reports of successful pregnancies following UFE, we need a comparative fertility trial with myomectomies.”
Johns Hopkins study – 2002
A 2002 Johns Hopkins study of 29 patients concluded that for young women in their twenties and thirties, UFE appears to have no adverse affects – no procedure-induced menopause that would preclude pregnancy, uterine walls that had sufficient thickness to support a fertilized egg and blood tests that revealed no significant changes in fertility hormones.
“All of the patients in the study were 39 and younger and were interested in preserving their fertility. In the past, these women didn’t have a choice – the only option was myomectomy, although many weren’t candidates,” said Hyun S. ‘Kevin’ Kim, M.D., assistant professor of radiology and surgery, and director of gynecologic intervention at Johns Hopkins Medical Institutions in Baltimore. “Now many young women can be treated with UFE, most likely maintain their fertility, and they don’t have to go through surgery.”
Anecdotal evidence – 2002
Although statistics on pregnancy outcomes for women in the Johns Hopkins study have not been published to date, there is anecdotal evidence from another 2002 study that women who have undergone embolization can become pregnant. The Inova Alexandria/Albany Medical Center Study compiled data on 65 women, ages 23 to 52 with an average age of 37, and documented that of 10 interested women, six conceived with one of the pregnancies ending in miscarriage. Researchers also noted that none of the patients experienced procedure-induced menopause, excess bleeding stopped in 41 of 43 patients, and that “bulk symptoms or feelings of pressure or heaviness in the abdomen were completely resolved or significantly reduced in 38 of 41 patients after an average of one year.”
“We used gelatin-sponge particles, which are temporary, so that the uterine arteries can reopen quickly after the fibroid treatment in order to support a pregnancy,” said Keith Sterling, M.D., interventional radiologist from Inova Alexandria Hospital and associate professor of radiology at George Washington University School of Medicine and Health Sciences in Washington, D.C. “The women in their twenties and thirties who were actively trying to become pregnant after UFE have had good success.”
British study – 2005
Results from a 2005 study from Britain add to the growing body of information on fertility related to uterine fibroid embolization. Conducted at the Royal Surrey County Hospital and the London Clinic, researchers under the lead of W.J. Walker, M.D., followed 94 UFE patients interested in becoming pregnant. Thirty-one women were able to conceive and 25 carried pregnancies to full term, with the remaining six still pregnant at the time study results were published. Further, of 10 patients who had histories of infertility problems related to their fibroids, eight had successful pregnancies.
Uterine fibroids and how embolization works
Uterine fibroid embolization (UFE) was introduced in the United States in the mid-1990s and has become an increasingly popular treatment for fibroids. These benign tumors affect an estimated 30 to even as high 70 percent of all women. In many cases (around 25 percent according to the National Institutes of Health (NIH)), the growths are so small that they do not cause any symptoms. In a substantial portion of women (as high as 77 percent per NIH), though, larger fibroids interfere with uterine function and also, depending on their location, create pressure on adjacent structures including the bladder, bowel or spinal nerves.
Embolization is a procedure that eliminates blood supply to the fibroid that interventional radiologists accomplish with real time imaging of a catheter inserted into the large artery at the groin. Requiring only an overnight stay at the hospital, UFE is considerably less invasive than major surgery in which either fibroids are removed (myomectomy) or in which the tumors and the uterus itself is taken (hysterectomy).
In sum, since the mid-1990s growing numbers of women have experienced relief from the symptoms of fibroids by opting for embolization. Also, both anecdotal and longer-term studies are appearing that indicate UFE has potential fertility outcomes comparable to the rates of myomectomies. (Myomectomy fertility rates run 35-40 percent according to John Lipman, M.D. in 2004. Britain’s W.J. Walker, M.D. found 33 percent plus of the 94 women in his study had successful pregnancies.)
Walker also observes that 10 of the women who had UFE and carried pregnancies to term had been informed that hysterectomy was their only treatment option for their fibroids. These new mothers have likely pushed away the darker hours when their fertility options seemed limited and their horizons quite clouded. Now they are probably sending their interventional radiologists thank you notes on their babies’ birthdays.
