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DEFINITION OF UTERINE
FIBROIDS.

Uterine Fibroids are benign (non-cancerous) tumors
of the uterus.

They are clinically apparent in up to 25% of women
and, with newer imaging techniques, the true clinical
prevalence may be higher up to 77%)

Most do not cause symptoms, uterine fibroids can
cause severe problems for some women.
Types of and location of
uterine fibroids.
CAUSES

The exact reasons why Uterine Fibroids develop is
unknown. However, two factors have been identified by
researchers. They are GENETICS and HORMONES.

- Genetics: There is a strong genetic component to
fibroid development, which causes fibroids to occur
at least three [3] times more frequently among black
women.
Causes (continued)
 Hormones:
Uterine Fibroids can dramatically
increase in size during pregnancy. It is
thought that this effect is due to increase in
the amount of estrogen - the female hormone
- that naturally occur during pregnancy. After
delivery, the fibroids usually shrink to the
size they were before pregnancy.
SYMPTOMS

Heavy menstrual bleeding in 84.5%

Pain in 62.1%

Bulk related symptoms in 82.9%

Heavy menstrual bleeding being the most troublesome
feature.
DIAGNOSIS

Uterine Fibroids are usually first diagnosed during a
gynaecologic internal examination. This pelvic
examination allows the physician to check the size of
the uterus. An ultrasound examination may detect if
fibroids are present, as well as determine their
location and size.

The presence of fibroids can also be diagnosed using
a more precise investigation - magnetic resonance
imaging scanning (MRI).
MRI
TREATMENT

MEDICAL THERAPY - Use of drugs to control symptoms
i.e. birth control pills, Hormones and NSAIDS.

SURGICAL THERAPY - Myomectomy which removes
individual fibroids from the uterus.

HYSTERECTOMY- is a surgical procedure which
removes the entire uterus.

NON-SURGICAL THERAPIES - (Uterine Fibroid
Embolisation or Uterine Artery Embolisation, MRI guided
focused Ultrasound ablation, MRgFUS)
2007 NICE HMB Guideline

‘When surgery for fibroid related heavy menstrual
bleeding is felt necessary then UAE, myomectomy and
hysterectomy must all be considered, discussed and
documented’
NICE clinical guideline 44
January 2007
FIBROID EMBOLISATION
NON SURGICAL
TREATMENT
Work-up

Counselling and informed consent. Sent info booklet
and then seen in IR OPD clinic

Imaging with MRI (at least US)

Recent Gynae assessment

Exclude infection

Pregnancy test

Baseline pre-procedure FSH
Technique – Principles

Occlusion of uterine artery
branches with particles

Ischaemic necrosis of the
highly vascular fibroids

Unilateral or bilateral
femoral artery approach.
COMPLICATIONS

Pain should be pre-empted and treated expectantly

Infection

Post Embolisation syndrome.

Non-target Embolisation, ovarian failure

Vaginal discharge and expulsion of fibroids

No histology obtained, risk of missing a malignancy.
FOLLOW UP
 Pain
management
 Early detection of infection
 Prompt treatment of infection
 Continuity of care by team
 Follow up scan at 6 and 12 months
 Coordination of care by Clinical Nurse Specialist
 Dedicated contact phone number
After treatment patient
feedback
ADVANTAGES OF FIBROID
EMBOLISATION

LESS INVASIVE

PRESERVES THE UTERUS & FERTILITY

TREATS MULTIPLE FIBROIDS

SHRINKS FIBROIDS

EXCELLENT SYMPTOMATIC RELIEF

REDUCED TIME OFF WORK 6-10 DAYS
Modern Woman
Normal life and quality of life has
resumed – thank you!
‘My life has completely turned
around’
‘I would recommend the procedure
thoroughly. The symptoms that
affected me have disappeared
completely.’
‘Overall I feel a lot better and
improving each month.’
‘I can now chair a meeting at work
without having to get up and rush
out of the room midway through.’
Fertility Issues
UAE Was not initially indicated for women
wishing to retain fertility due to fears about
IUGR.
All large series now report pregnancies post
UAE
Advise against pregnancy within 12 months
Effective symptomatic treatment of fibroids
that keeps fertility options open
Patient choice
MR Guided Focused US Ablation

MRI used to image and target fibroids

High powered US generator in base of MR table
focuses beam on point in fibroid and it is ablated using
the MR scanner as a thermal imaging camera

Completely non-invasive

Can take 3-4 hours per treatment!
MR Guided Focused US Ablation
REFERENCES

www.drpaulcrowe.com

Boston Scientific Corporation 2007 “Uterine Fibroids”

Royal College of Obstetricians and Gynaecologists
“Modern Management of Fibroids Embolisation”

www.birminghamfibroidclinic.co.uk

www.insightec.com
THE END
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