DEFINITION OF UTERINE FIBROIDS.

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DEFINITION OF UTERINE FIBROIDS.

• Uterine Fibroids are benign (non-cancerous)
  tumors of the uterus.
• They are clinically apparent in up to 25 of
  women and, with newer imaging techniques, the
  true clinical prevalence may be higher up to
  77)
• Most do not cause symptoms, uterine fibroids can
  cause severe problems for some women.

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Types of and location of uterine fibroids.
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CAUSES

• The exact reasons why Uterine Fibroids develop is
  unknown. However, two factors have been
  identified by researchers. They are GENETICS and
  HORMONES.
• - Genetics There is a strong genetic component
  to fibroid development, which causes fibroids to
  occur at least three 3 times more frequently
  among black women.

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Causes (continued)

• Hormones Uterine Fibroids can dramatically
  increase in size during pregnancy. It is thought
  that this effect is due to increase in the amount
  of estrogen - the female hormone - that naturally
  occur during pregnancy. After delivery, the
  fibroids usually shrink to the size they were
  before pregnancy.

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SYMPTOMS

• Heavy menstrual bleeding in 84.5
• Pain in 62.1
• Bulk related symptoms in 82.9
• Heavy menstrual bleeding being the most
  troublesome feature.

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DIAGNOSIS

• Uterine Fibroids are usually first diagnosed
  during a gynaecologic internal examination. This
  pelvic examination allows the physician to check
  the size of the uterus. An ultrasound examination
  may detect if fibroids are present, as well as
  determine their location and size.
• The presence of fibroids can also be diagnosed
  using a more precise investigation - magnetic
  resonance imaging scanning (MRI).

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MRI
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TREATMENT

• MEDICAL THERAPY - Use of drugs to control
  symptoms i.e. birth control pills, Hormones and
  NSAIDS.
• SURGICAL THERAPY - Myomectomy which removes
  individual fibroids from the uterus.
• HYSTERECTOMY- is a surgical procedure which
  removes the entire uterus.
• NON-SURGICAL THERAPIES - (Uterine Fibroid
  Embolisation or Uterine Artery Embolisation, MRI
  guided focused Ultrasound ablation, MRgFUS)

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2007 NICE HMB Guideline

• When surgery for fibroid related heavy menstrual
  bleeding is felt necessary then UAE, myomectomy
  and hysterectomy must all be considered,
  discussed and documented NICE clinical
  guideline 44January 2007

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FIBROID EMBOLISATION
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NON SURGICAL TREATMENT
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Work-up

• Counselling and informed consent. Sent info
  booklet and then seen in IR OPD clinic
• Imaging with MRI (at least US)
• Recent Gynae assessment
• Exclude infection
• Pregnancy test
• Baseline pre-procedure FSH

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Technique Principles

• Occlusion of uterine artery branches with
  particles
• Ischaemic necrosis of the highly vascular
  fibroids
• Unilateral or bilateral femoral artery approach.

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COMPLICATIONS

• Pain should be pre-empted and treated expectantly
  
• Infection
• Post Embolisation syndrome.
• Non-target Embolisation, ovarian failure
• Vaginal discharge and expulsion of fibroids
• No histology obtained, risk of missing a
  malignancy.

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FOLLOW UP

• Pain management
• Early detection of infection
• Prompt treatment of infection
• Continuity of care by team
• Follow up scan at 6 and 12 months
• Coordination of care by Clinical Nurse Specialist
• Dedicated contact phone number
• .

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After treatment patient feedback
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ADVANTAGES OF FIBROID EMBOLISATION

• LESS INVASIVE
• PRESERVES THE UTERUS FERTILITY
• TREATS MULTIPLE FIBROIDS
• SHRINKS FIBROIDS
• EXCELLENT SYMPTOMATIC RELIEF
• REDUCED TIME OFF WORK 6-10 DAYS

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Modern Woman
Normal life and quality of life has resumed
thank you! My life has completely turned
around I would recommend the procedure
thoroughly. The symptoms that affected me have
disappeared completely. Overall I feel a lot
better and improving each month. I can now
chair a meeting at work without having to get up
and rush out of the room midway through.
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Fertility Issues
UAE Was not initially indicated for women wishing
to retain fertility due to fears about IUGR. All
large series now report pregnancies post
UAE Advise against pregnancy within 12 months
Effective symptomatic treatment of fibroids
that keeps fertility options open Patient
choice
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MR Guided Focused US Ablation

• MRI used to image and target fibroids
• High powered US generator in base of MR table
  focuses beam on point in fibroid and it is
  ablated using the MR scanner as a thermal imaging
  camera
• Completely non-invasive
• Can take 3-4 hours per treatment!

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MR Guided Focused US Ablation
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REFERENCES

• www.drpaulcrowe.com
• Boston Scientific Corporation 2007 Uterine
  Fibroids
• Royal College of Obstetricians and Gynaecologists
  Modern Management of Fibroids Embolisation
• www.birminghamfibroidclinic.co.uk
• www.insightec.com

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THE END

• ANY QUESTIONS