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Health & Wellness: Uterine Fibroids Can Be Debilitating

Variety of new options available

by Melissa W. Seely-Morgan, M.D.

March 1, 2007

Every month, Vanessa suffered in bed while enduring painful cramps. She usually ended up missing work. Vanessa had been experiencing pain from uterine fibroids for years, but put off having anything done because she didn't like surgery. But as the fibroids grew, her periods got worse, causing frequent urination and more pain.

Vanessa doesn't suffer alone. More than 70 percent of Caucasian women and 80 percent of African-American women develop fibroids before they reach menopause, according to the National Institutes of Health (NIH). It is estimated that uterine fibroids are present in 20-25 percent of reproductive age women.

“I was tired of the pain taking away my time at work and more importantly time with my family,” saysVanessa. “I decided that I had to look at my options and make a change.”

Fibroids are benign growths in the uterus that consist of bundles of smooth muscle surrounded by uterine tissue. While they often develop in women during their 20s, most women usually don't have symptoms until their 30s or 40s.

While the cause of uterine fibroids is still unknown, symptoms include: heavy bleeding or painful periods; bleeding between periods; feeling “full” in the lower abdomen; frequent urination (resulting from a fibroid pressing on the bladder); pain during sex; and lower back pain.

African-American women have a three to five times greater risk for developing uterine fibroids and women who are obese or overweight have a slightly higher risk of fibroids.

There are several treatment options for women. If symptoms aren't severe, women are often counseled to take a watchful waiting approach. Hormonal therapy is used to slow or stop the growth of fibroids by blocking production of the hormones that regulate menstruation. Hormonal therapy provides temporary relief and symptoms, but fibroids grow back once therapy is stopped.

Surgical removal of the uterus, called a hysterectomy, is also an option that is used when a woman's fibroids are large or cause heavy bleeding. It requires a three to four day hospital stay and a recovery time of approximately six to eight weeks. Another surgery option is a myomectomy, which is the surgical excision of the tumor, leaving the healthy areas of the uterus in place. This may preserve a woman's ability to have children. It requires a hospital stay of several days and a recovery time of two to four weeks.

Uterine artery embolization (UAE) is another option in which the blood vessels that supply the tumor are blocked by injecting small particles into the arteries feeding the uterus. Fibroids are deprived of oxygen and nutrients, causing them to shrink and die. UAE often requires a day of hospitalization and a week of recovery time.

Magnetic Resonance guided Focused Ultrasound (MRgFUS), or ExAblate ¯ 2000, is a new treatment option that is being offered for the first time in Georgia. It is the only FDA-approved non-invasive procedure for the treatment of uterine fibroids.

The treatment usually takes three to four hours depending on the size of the targeted fibroid and because it is an outpatient procedure, patients typically return to work and normal activities in one to two days. During the procedure, the patient lies inside the MR scanner, which provides precise guidance of the ultrasound waves to the target tissue. The heat of intense ultrasound waves destroys the affected tissue and the process is repeated as many times as necessary until the tumor is destroyed. The patient's body then naturally disposes of the tissue.

“This is break-through technology because it offers women who suffer from fibroids an alternative to surgery and doesn't require anesthesia,” says Henry J. Krebs III, M.D. who is affiliated with MRI & Imaging of Georgia where the ExAblate procedure is being performed. “What is even more exciting is that this may change the future of surgery because the ExAblate system may have future applications for treating breast have future applications for treating breast cancer, brain tumors and prostate cancer.“

The ExAblate system has an impressive list of awards. It was awarded the 2004 Grand Prize Winner of the European Union's IST award for innovation and potential to benefit mankind, The Wall Street Journal's 2004 Technology Innovation Awards, and Advanced Imaging's 2005 Solutions of the Year. The U.S. Food and Drug Administration (FDA) highlighted the ExAblate 2000 system as one of the 14 medically significant products it approved during fiscal 2005.

As with any medical procedure, there are risks involved in these treatments. There is a risk that the treatment may be successful, but more fibroids may grow at a later time and require additional treatment. This is true for all fibroid treatment alternatives, except hysterectomy. “ The choice of uterine fibroid treatment depends on several factors, including degree and frequency of symptoms, fertility considerations, fibroid size, patient age and a patient's willingness to undergo invasive procedures,” says Dr. Krebs. “As with any treatment, women should consult with their personal physician and weigh all their options.” Dr. Melissa W. Seely-Morgan graduated from the Medical College of Virginia and completed her fellowship in Interventional Radiology at Emory University Hospital. She is one of two doctors in Georgia performing the ExAblate ¯ 2000 procedure.