Uterine fibroids: alternative treatments to surgery

Written by: Dr Leto Mailli
Published: | Updated: 13/05/2020
Edited by: Laura Burgess

Uterine fibroids are the most common benign tumours of the uterus (womb). About 30% of women at fertile age will have uterine fibroids. Fibroids are the result of excessive growth of the uterine smooth muscles. They are usually multiple, of variable size and can be situated anywhere within the uterus.
 

A woman's abdomen is showing underneath a blue T-shirt. Women with fibroids and experience symptoms such as heavy periods.

Symptoms of uterine fibroids

More than half of the women diagnosed with fibroids will have no symptoms. A minority of women are unfortunately suffering very distressing fibroid symptoms such as:

  • Heavy bleeding during the menstrual cycle (menorrhagia)
  • Significant abdominal pain during the menstrual cycle (dysmenorrhea)
  • Enlarged uterus (belly appearing larger than normal)
  • Pressure to the urinary bladder causing urinary frequency
  • A pressure at the bowel causing bloating and constipation
  • Pain during sexual intercourse (dyspareunia)
  • Infertility (depending on fibroid location)
  • Infrequent but potential back and leg pain due to nerve compression.

 

Diagnosis of uterine fibroids

The above-described symptoms can raise the suspicion of fibroids yet to confirm this a set of diagnostic imaging is required. The first and most-used imaging examination is an ultrasound scan, which only provides a limited amount of information. A magnetic resonance imaging (MRI) examination is the modality of choice as it can guide towards giving appropriate treatment.
 

Treatment of fibroids using uterine artery embolisation (UAE)

UAE is performed by an interventional radiologist through “pin-hole” surgery. The procedure will take place, guided by a technologically advanced X-ray machine, in an operating theatre environment. The procedure doesn’t require general anaesthesia and only a 2mm nick is necessary at the skin. A fine catheter is passed into the arteries and guided towards the arteries that supply the fibroids (uterine arteries). When the catheter is in an accurate position, specific sized particles are injected to block the blood supply to the fibroids, which is referred to as embolisation. As a result, the fibroids die and shrink, but most importantly the symptoms experienced will be resolved.
 

Benefits of uterine artery embolisation:

  • It is a relatively short procedure, lasting thirty minutes or up to one hour.
  • No general anaesthesia is required.
  • There is only a 2mm nick at the skin and no stitches needed.
  • Usually requires 24-hours of hospital stay.
  • Overall risks of UAE are much lower than surgery.
  • Faster return to previous usual activities.

 

The results of uterine artery embolisation:

The satisfaction rate for the procedure is reported being over 90%. The success rate of uterine artery embolisation is more than 80-90% in achieving relief of symptoms. Usually, no further treatment is required as UAE treats all fibroids.

 

By Dr Leto Mailli
Interventional radiology

Dr Leto Mailli is a Consultant Interventional Radiologist at St George’s Hospital and a Senior Honorary Lecturer at St George’s University of Medicine in London. She has completed her Interventional Radiology fellowship at Guy’s and St Thomas Hospital of London. She is the lead of undergraduate radiology at St George’s University of Medicine, thus heavily involved with teaching and the lead interventional radiologist for major trauma in this big, busy trauma centre.

Leto holds a PhD, MsC and Masters in interventional radiology. She was awarded 4 funded grants for research and training while both her PhD and Master thesis was scored “excellent”. She is recognised by the European Board of Interventional Radiologist gaining the EBIR title. She is also a member of the cardiovascular and interventional radiology society of Europe.

Leto has been invited as a moderator, speaker and trainer in international conferences and has given more than 100 lectures in national and international conferences. She is actively publishing in scientific journals and is a co-investigator in several research trials.

In regards to her clinical activities and interests, she is interested in trauma and as a lead interventional radiologist for major trauma she is involved in setting pathways, raising awareness, auditing and optimising the quality of IR trauma services. 

Apart from the trauma, she is particularly interested in innovative endovascular treatments for both arterial and venous diseases (ranging from varicose veins, peripheral arterial disease, vascular malformations, aneurysm embolization and others). She has been a co-investigator in several large trials associated with innovative endovascular peripheral vascular interventions and has been invited several times as an instructor in international conferences. 

Gynaecologic interventions is another area of interest that she is passionate about as it involves female health and wellbeing. She is part of a multidisciplinary team addressing problems such as fibroids, adenomyosis, pelvic congestion syndrome and postpartum haemorrhage. She is active in these areas both clinically and research-wise. She specialises in new innovative minimally invasive techniques “pin-hole surgery” to address the above problems. She has published her series on postpartum haemorrhage and recently on imaging findings following fibroid embolization. She has been invited in international conferences both as a lecturer and leading expert forum on fibroids. She has also contributed as co-investigator in a large multicentre randomised control trial across the UK for the management of fibroids.

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