A New Treatment For Uterine Fibroids

by Darline Turner Lee, Physician Assistant, ACSM Exercise Specialist

Article Last Reviewed: Sept. 9, 2006

Symptoms often begin subtly. Normal period bleeding gets a little heavier. Menstrual cycles get longer, become more irregular and have more days of heavy bleeding. Sometimes there’s cramping, pain and bloating. Sometimes urinary or bowel patterns change. Often the first symptom is a miscarriage or infertility. For most women there are no symptoms, just an irregularly enlarged uterus noted on routine pelvic examination. Welcome to the world of uterine fibroids.

According to the National Women’s Health Information Center, uterine fibroids are benign growths occurring in as many as 50% of all pre-menopausal women (up to 80% of African American women). They develop from the smooth muscle inside the uterus in response to estrogen, and grow in the uterine cavity (submucosal), in the uterine walls (intramural), or on the outer walls of the uterus (subserosal). Imaging studies, typically ultrasound but also MRI, hysterosalpingogram and hysteroscopy diagnose fibroids and determine their size and location.

Until recently, women had few options for fibroid management. Today, women have several treatment options as listed below.

Watching and waiting is appropriate if the fibroids are not symptomatic or if a woman is near menopause.

Medical management regulates estrogen levels to reduce the symptoms and slow the growth of fibroids. Oral contraceptives, Depro Provera (progesterone injections), and Gonadotropin Releasing Hormone agonists such as Lupron are routinely used.

Surgical options vary depending on the size, number and location of the fibroids.
A myomectomy removes the fibroids leaving the uterus intact. It is performed laparoscopically or through an incision in the abdomen. A Hysteroscopy removes fibroids in the uterine cavity via the vagina. Endometrial Ablation destroys the lining of the uterus, destroying the fibroids but also a woman’s ability to have children. During Myolysis electrical needles are inserted into the blood vessels of the uterus destroy blood supplying the fibroids, starving and shrinking them. A hysterectomy removes the uterus and the fibroids.

Uterine Artery Embolization requires a small incision into the groin. Interventional radiologists thread a catheter through the artery to the uterus. They insert tiny plastic beads into the vessels to block uterine blood flow starving and shrinking the fibroids.

Approved by the FDA in October 2004, the ExAblate® 2000 system uses MRI to guide focused ultrasound beams to destroy the fibroids. The ultrasound beams heat the core of the fibroids obliterating the blood supply, shrinking the fibroids over the next several months. According to Mark Akins, MD, one of the medical directors of Central Texas ExAblate, complications are minimal and most women manage pain with over the counter medications resuming full activity in 48 hours. The ExAblate® 2000 system is not approved for women who desire children, although 8 pregnancies have occurred worldwide after the procedure and there were no complications. The procedure cannot be used if the fibroids are near vital organs such as the bladder or bowel, near the spine or for fibroids close to the skin surface.

The ExAblate 2000 System effectively treats any solid mass and is currently being tested for treatment of solid breast tumors, metastatic bone masses and prostate tumors.

For More Information (sidebar)
American College of Obstetricians and Gynecologists – www.acog.org
Austin Radiological Association (For Uterine Artery Embolization) – www.fibroidtexas.com
Central Texas ExAblate (For ExAblate® 2000) – www.centraltexasexablate.com or 512-459-4276
Fibroids1.com – A resource for fibroid and uterine health information. www.fibroids1.com
The National Women’s Health Information Center – www.4women.gov or 800-994-9662