Symptomatic Fibroids? Talk to an Interventional Radiologist

Uterine fibroids are common: these non-cancerous tumors develop in up to 77 percent of women at some point during their lifetimes. Some women will experience symptoms which significantly affect their health and interfere with their daily lives. For these women, finding the right treatment for their fibroids can be challenging, especially for women who do not want surgery.  

One non-surgical treatment for symptomatic uterine fibroids, called uterine fibroid embolization or UFE, is performed by an interventional radiologist, a physician who uses tiny tools and image guidance to perform treatments that might otherwise require major surgery. During a UFE procedure, tinyround beads—each measuring the size of a grain of sand—are injected into the blood vessels that feed the fibroids. These tiny beads block the blood flow to the fibroids, causing them to shrink and die.

We spoke to Lindsay Young, MD, an interventional radiologist at Columbia University Irving Medical Center, about why UFE is a good option to learn about for any woman experiencing symptoms from fibroids.  

Q&A with Dr. Lindsay Young

Describe a typical patient who might benefit from UFE.

A large variety of women can benefit from UFE. We see women who are young and experiencing symptoms and also women in their perimenopausal phase. Women who come in for UFE consultations generally have a variety of symptoms, including excessive bleeding with periods, very painful periods, abdominal distension or bloating, constipation, urinary frequency, or pain with intercourse. Many women don't even realize that some of these symptoms are related to fibroids.

The patients who usually have the most dramatic response to the procedure are women with heavy bleeding and painful periods. These patients typically respond with over 90 percent success, meaning they are very satisfied with their result. They can see a significant reduction in the length and painfulness of their periods. Some women present mostly with what we call ‘bulk symptoms’, meaning that they have large fibroids that cause abdominal distention, or they push on surrounding organs. These patients may not experience bleeding, but the fibroid may push on the bladder, for example, and cause urinary symptoms. We can see up to a 50 percent reduction in the size of these fibroids, which for many women hoping to avoid surgery is an excellent result. One nice thing about UFE is that if you have a UFE procedure, it does not prevent you from having surgery on your uterus later, such as myomectomy or hysterectomy, if you decide that is what’s right for you.

A perimenopausal woman who comes in for fibroid treatment has just been living with these symptoms?

Many perimenopausal women have been living with symptoms of fibroids for their whole lives, however these symptoms tend to get worse in the perimenopausal years. Fibroids are hormonally responsive, so the symptoms tend to be exacerbated during menstruation. A woman may have excessively painful or heavy periods, but at other times in her cycle the fibroids are not so bothersome. During perimenopause, your hormones can kind of ‘rev up’. You might start having more irregular periods, and your fibroid symptoms may be a bit more erratic and extreme. So we do see a lot of women during perimenopause, because their symptoms tend to get worse.

How do patients typically find you, given that most people haven't heard of interventional radiology?

Occasionally we see women who are referred by their primary care physicians, or they are referred by an Ob Gyn who has had a conversation with them about all the options for treating their fibroids. Most patients we see have been offered surgery—either total hysterectomy or myomectomy—and strongly prefer not to have surgery. They are still very symptomatic, and so in their attempt to find another option for treatment, they search online and find us.

What are the advantages of choosing UFE over a hysterectomy or myomectomy?

Hysterectomy and myomectomy are major abdominal surgeries with significant recovery time. Occasionally these procedures are done minimally invasively, but the recovery is still much longer than UFE. We typically tell women who are having UFE to take one week off from work. After a UFE, you typically will experience significant cramping – like bad period cramps – and that is how you know the procedure is working to kill the fibroids. Usually, the bad cramping lasts for 24 to 48 hours and then starts to slowly improve. Many women take very little pain medication after UFE and feel okay to go about most of their daily activities after a few days.

I've had women come in for a UFE procedure on a Thursday and go to work on Monday or get a UFE on a Monday and go to a wedding on Saturday. There are a lot of women who wouldn't feel up for doing those things, but with UFE you have no significant physical restrictions. So for the most part, whatever you feel like doing, you can safely do. That's not necessarily true of surgery.

Are patients concerned about blocking their arteries with beads?

People do ask about that. We explain that it’s a tiny hydrogel bead, which we use all over the body for other types of treatments, and they are generally considered completely safe. There is actually evidence that has shown that the arteries open up over time. The beads work to starve the fibroids of blood for long enough to kill them, and then the arteries reopen later, which helps to explain why women are able to get pregnant after the procedure. The arteries are not permanently shut down.

How long does it take for symptoms to improve after a UFE procedure?

Usually women have a significant reduction in their bleeding and pain symptoms after three  menstrual cycles but for some women it happens earlier. For purely bulk symptoms, the procedure may take longer to take effect. We do an MRI around six months after the procedure and we typically see a significant reduction in the size of the fibroids. The fibroids can continue to shrink for up to a year after UFE and sometimes even longer.

In the best-case scenario, we see a 50 percent reduction in the size of the fibroid. It's dead, so it's not hormonally reactive, and it's not bleeding and causing pain, which is why women see such a dramatic reduction in those symptoms. But for those really large fibroids, the maximum we're going to reduce its size with UFE is about 50 percent. Again, for many patients who are certain that they do not want surgery, they are very happy with that result.

What advice would you give to a patient with fibroid symptoms that are affecting their quality of life?

I’d say come in for a consultation with an interventional radiologist. Some women with fibroids don't know that the symptoms they are experiencing could be related to their fibroids. For example, we see women who have been told that they have a bowel or bladder problem, when in fact their symptoms could be related to large uterine fibroids. You can learn a lot just by coming in for a consultation, and we can help you decide if UFE is the right answer for you.