Thirteen years ago, Nealy Moyer was diagnosed with uterine fibroids. Although the diagnosis was not life-threatening, Moyer spent the next decade suffering from painful periods with very heavy bleeding, lasting seven days and longer. She had painful cramps, anemia and the symptoms were progressively getting worse.
Between 20 and 40 percent of U.S. women over 35 develop fibroids, tumors of the uterus that almost always are non-cancerous and may not cause serious health problems. Fibroids are more common in African American women, but the reason for this is unknown. For many women like Moyer, fibroids can cause pain, excessive bleeding during periods, a sensation of pressure, painful intercourse and bowel and urinary problems.
When Moyer was diagnosed, her treatment options were few. She could elect to have a hysterectomy, in which the uterus is surgically removed; a myomectomy, in which the fibroid itself is surgically removed; she could treat her symptoms with medications with no guarantee the symptoms would not recur, or she could endure the pain until menopause. Since she still wanted more children, Moyer elected to wait it out.
Since her diagnosis, Moyer had two children and was finally ready to seek treatment options, but she didn't want to undergo an invasive surgery that would take weeks of recovery.
"A lot of women want alternatives to surgery," says Michael Hanelin, M.D., an Emory Crawford Long Hospital interventional radiologist who has a special interest in fibroid embolization.
Moyer chose to undergo uterine fibroid embolization (UFE). The procedure is based on a simple principle: starve the tumors of the blood they need to grow, and they will shrink. This involves blocking the blood flow to the tumor by injecting tiny particles into the blood vessels feeding the tumor.
The procedure's primary advantage is that it is minimally invasive; UFE typically is performed under local anesthesia and conscious sedation. A small puncture is made in the groin to access the femoral artery. Guided by flouroscopy, the radiologist threads a catheter through the femoral artery and into the uterine artery, then injects particles to embolize, or block, the vessels directly feeding the fibroid. The fibroids eventually shrink to approximately half their original size.
Hanelin says UFE is appropriate for women who have fibroids and suffering from the symptoms, are not planning on any or more children and have not had previous pelvic radiation. He also notes the type of fibroids and where they are located are factors in determining if a woman is a candidate for this procedure. UFE, which has a success rate of roughly 80-95 percent, may not work for all women. Those whose symptoms fail to improve may need to consider repeating the procedure or seek surgical options.
"For many women, one of the biggest advantages is the relatively simple procedure combined with the short recovery time," Hanelin says. The actual procedure only lasts from 45 minutes to two and a half hours, and most patients go home after an over-night hospital stay. "Most patients are back to normal in about eight to 10 days," he says. The most common post-operative complaint is pain, which can be controlled with medication. By contrast, women undergoing abdominal hysterectomy usually require at least four to six weeks to recover.
For Moyer, the short recovery time for UFE was a major plus. "The recuperative period was painful, but it only lasted for about seven days. Compared to the six weeks it takes to recuperate from a hysterectomy or the pain I felt during my periods, I think it was well worth it to have the procedure done," she says.