Kate Henshaw Talks about UFE noninvasive fibroid treatment

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UFE is the most advanced fibroid treatment in the last 20 years. No open surgery required. Quick recovery. Low complications. Non-invasive. No Knives, No Cuts. Essentially No Blood loss. Preserve Fertility. 

Uterine fibroids are noncancerous growths of the uterus that often appear during childbearing years. Also called leiomyomas (lie-o-my-O-muhs) or myomas, uterine fibroids aren’t associated with an increased risk of uterine cancer and almost never develop into cancer. Fibroids range in size from seedlings, undetectable by the human eye, to bulky masses that can distort and enlarge the uterus. You can have a single fibroid or multiple ones. In extreme cases, multiple fibroids can expand the uterus so much that it reaches the rib cage. Many women have uterine fibroids sometime during their lives. But most women don’t know they have uterine fibroids because they often cause no symptoms. Your doctor may discover fibroids incidentally during a pelvic exam or prenatal ultrasound.

Doctors don’t know the cause of uterine fibroids, but research and clinical experience point to these factors:

Genetic changes. Many fibroids contain changes in genes that differ from those in normal uterine muscle cells.
Hormones. Estrogen and progesterone, two hormones that stimulate development of the uterine lining during each menstrual cycle in preparation for pregnancy, appear to promote the growth of fibroids. Fibroids contain more estrogen and progesterone receptors than normal uterine muscle cells do. Fibroids tend to shrink after menopause due to a decrease in hormone production.
Other growth factors. Substances that help the body maintain tissues, such as insulin-like growth factor, may affect fibroid growth.

Doctors believe that uterine fibroids develop from a stem cell in the smooth muscular tissue of the uterus (myometrium). A single cell divides repeatedly, eventually creating a firm, rubbery mass distinct from nearby tissue.

The growth patterns of uterine fibroids vary — they may grow slowly or rapidly, or they may remain the same size. Some fibroids go through growth spurts, and some may shrink on their own. Many fibroids that have been present during pregnancy shrink or disappear after pregnancy, as the uterus goes back to a normal size.

Most American women will develop fibroids at some point in their lives. One study found that, by age 50, 70 percent of whites and 80 percent of African Americans had fibroids. In many cases, fibroids are believed not to cause symptoms, and in such cases women may be unaware they have them.

Fibroids are an important public health concern, both because of the large number of women affected by them and the large number of hysterectomies undertaken to treat the symptoms they cause.

Many women who have fibroids don’t have any symptoms. In those that do, symptoms can be influenced by the location, size and number of fibroids. In women who have symptoms, the most common symptoms of uterine fibroids include:

• Heavy menstrual bleeding
• Menstrual periods lasting more than a week
• Pelvic pressure or pain
• Frequent urination
• Difficulty emptying the bladder
• Constipation
• Backache or leg pains
• Rarely, a fibroid can cause acute pain when it outgrows its blood supply, and begins to die.

Fibroids are generally classified by their location. Intramural fibroids grow within the muscular uterine wall. Submucosal fibroids bulge into the uterine cavity. Subserosal fibroids project to the outside of the uterus

Pelvic exam

Uterine fibroids are frequently found incidentally during a routine pelvic exam. Your doctor may feel irregularities in the shape of your uterus, suggesting the presence of fibroids. If you have symptoms of uterine fibroids, you doctor may order these tests:

• Ultrasound. If confirmation is needed, your doctor may order an ultrasound. It uses sound waves to get a picture of your uterus to confirm the diagnosis and to map and measure fibroids. A doctor or technician moves the ultrasound device (transducer) over your abdomen (transabdominal) or places it inside your vagina (transvaginal) to get images of your uterus.
• Lab tests. If you have abnormal menstrual bleeding, your doctor may order other tests to investigate potential causes. These might include a complete blood count (CBC) to determine if you have anemia because of chronic blood loss and other blood tests to rule out bleeding disorders or thyroid problems.

Other imaging tests

If traditional ultrasound doesn’t provide enough information, your doctor may order other imaging studies, such as:

• Magnetic resonance imaging (MRI). This imaging test can show the size and location of fibroids, identify different types of tumors and help determine appropriate treatment options.

Watchful waiting: Many women with uterine fibroids experience no signs or symptoms, or only mildly annoying signs and symptoms that they can live with. If that’s the case for you, watchful waiting could be the best option. Fibroids aren’t cancerous. They rarely interfere with pregnancy. They usually grow slowly — or not at all — and tend to shrink after menopause, when levels of reproductive hormones drop. Most fibroids do not cause symptoms and are not treated. When they do cause symptoms, drug therapy often is the first step in the treatment. This might include a prescription for birth-control pills or the use of non-steroidal anti-inflammatory drugs, such as ibuprofen. In many patients, symptoms are controlled with these treatments and no other therapy is required. Some hormone therapies do have side effects and other risks when used long-term so they are generally used temporarily. Fibroids often grow back after therapy is discontinued. When watchful waiting or medical therapy fails or symptoms become a significant detriment on quality of life, The next step is to try more invasive therapy. Options inlude

SURGICAL OPTIONS

• Myomectomy: Myomectomy is a surgical procedure that removes visible fibroids from the uterine wall. It is however very difficult to remove all of the fibroids in the uterus especially with women with multiple fibroids in many locations. Myomectomy,  leaves the uterus in place and may, therefore, preserve the woman’s ability to have children. This is performed under General Anesthesia. 
• Hysterectomy. In a hysterectomy, the uterus is removed completely in an open surgical procedure. This operation is considered major surgery and is performed while the patient is under general anesthesia. It requires three to four days of hospitalization and the average recovery period is about six weeks.

NON SURGICAL MINIMALLY INVASE OPTIONS

• Uterine Fibroid embolization: We have introduced minimally invasive uterine fibroid embolization into Nigeria. Embolization requires no major surgery. See details below, 

Information adapted from the Mayo Clinic

it is a minimally invasive procedure, which means it requires only a tiny nick in the skin. It is performed while the patient is conscious but sedated (drowsy and feeling no pain.). Fibroid embolization is performed by an interventional radiologist, a physician who is specially trained to perform this and other minimally invasive procedures. The interventional radiologist makes a small nick in the skin in the groin or wrist and inserts a catheter into an artery. The catheter is guided through the artery to the uterus while the interventional radiologist guides the progress of the procedure using a moving X-ray (fluoroscopy). The interventional radiologist injects embolic material (small spheres) into the artery that is supplying blood to the fibroid tumor. This cuts off the blood flow/oxygen supply to the fibroid tumors and causes them to shrink. The artery on the other side of the uterus is then treated.

Fibroid embolization usually requires a hospital stay of one night. Pain-killing medications and drugs that control swelling typically are prescribed following the procedure to treat cramping and pain. Fever sometimes occurs after embolization and is usually treated with acetaminophen. Many women resume light activities in a few days and the majority of women are able to return to normal activities after one week. 

• 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
• Over 99% of women go home with 12 to 23 hrs of the procedure. 
• Offers a shorter hospital stay and a faster return to work when compared to having a hysterectomy.
• Safe procedure that involves minimal risk and fewer complications after 30 days when compared to having a hysterectomy.

Pam 40 years old at time of UFE: 4 weeks after UFE.  "Hello Doc, Trust everything is going well, Wanted to thank you for everything.....Its like a miracle, no more heavy bleeding.....almost nothing. Though the growths are still visible, but the biggest issue resolved...its unbelievable....oh plus pain is gone also....My energy level is eh....just been suffering for years.....I am spreading the word oh.

Chinye 43 years old at time of UFE: 7 week follow up. " My bleeding has significantly improved, I now have energy again. Plus remember that pain I told you I was taking meds for all the time? No more pain meds."

Abi 50 year old at time of UFE: 8 week follow up. " Doc look at me I am glowing, I lost 7 pounds already, bleeding is gone, i now have energy again to live life. How do more women not know about this?"

What if I desire Children in the Future? Every woman's situation is different and everyone has to be evaluated independently. What we know so far from research is that spontaneous pregnancy and live birth has been achieved in many women after UFE. Two major studies have looked at this question.

1. Uterine Artery Embolization and Its Effect on Fertility. Mohan et al ’ JVIR 2013 24: 925-

930. Systematic review of the literature to date analyzing pregnancy and complications of

pregnancy following UFE. 34 studies reviewed and 21 studies in final analysis

•  The cumulative pregnancy rate from the pooled analysis was 58.6%, and the mean age was 35.9 years. This rate is comparable to the age-adjusted pregnancy rates in the general population.
• The cumulative miscarriage rate of 28% is also comparable to the rates quoted inpatients with untreated fibroid tumors.
•  The cumulative preterm delivery rate of 7.3% was similar to that in the general population.

2.  Spontaneous Pregnancy with Live Birth after Conventional and Partial Uterine Fibroid

Embolization. Radiology: Volume 285: Number 1—October 2017. A retrospective

analysis of data collected prospectively was performed for 10 years in a cohort of 359

women (mean age, 35.9 years 6 4.8) with uterine fibroids and/or adenomyosis who were

unable to conceive. The median follow-up period was 69 months (range, 6–126 months).

• 149 women became pregnant, 131 women had live births, and 16 women had several pregnancies, resulting in a total of 150 live newborns.
•  It was the first pregnancy for 85.5% (112 of 131) of women. Spontaneous pregnancy rates at 1 year and 2 years after UFE were 29.5% and 40.1%, respectively. The probability of successful pregnancy with live birth at 1 year and 2 years was 24.4% and 36.7%, respectively.
• Clinical success for fibroid-related symptoms was 78.6% (282 of 359). A dominant submucosal fibroid and ischemia greater than or equal to 90% had greater likelihood of spontaneous pregnancy.

We have shown and remain committed to bringing minimally invasive options to women in Nigeria while maintaining world class standards in service delivery and patient experience. We strive to continue to get better through local research and academic affiliations.