FEmISA - Fibroid Embolization: Information, Support & Advice

 About Uterine Leiomyomata   

UTERINE LEIOMYOMATA

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  •   Incidence
  •   Pathology
  •   Symptoms
  •   Diagnosis
  •   Treatment Options

    • Incidence

    Uterine fibroids or leiomyomata are the commonest benign tumours in women of reproductive age having an incidence of up to 80% at post-mortem. [40],[41]  The peak incidence occurs between 35 and 40 years old. [42]

    There is a higher incidence in nulliparous women, Afro-Caribbean women and the obese.  There is a lower incidence in those on the contraceptive pill and those who smoke. [42],[43]

    The aetiology is not known, but thought to be associated with oestrogen and progesterone since fibroids appear in women of reproductive age and can reduce after menopause. [42],[43]

    Pathology

    Fibroids can be classified according to their position:

    •   subserosal
              Symptoms include compression on the
        surrounding tissues, such as the bladder and
        bowel pain.
    •   intramural
              Symptoms include pressure on the bladder
        and/or uterus and infertility or miscarriage
         and menorrhagia.
    •   submucosal
              Symptoms include menorrhagia, pain and
        infertility.       [42],[43]

    Diagram of different types & locations of of fibroid
    Different types of fibroid
    Click here to enlarge

    They can also be pedunculated, or non-pedunculated.  Women can have a mixture of types of fibroid.

    Symptoms

    Approximately 25% of women with fibroids have symptoms.  These vary with the position, type of fibroid and size.  Common symptoms are: -

    •   Menorrhagia

    •   Iron deficiency anaemia

    •   Dysmenorrhea

    •   Bladder incontinence/urgency

    •   Infertility or miscarriage

    •   Pressure symptoms on the bowel leading to constipation

    •   Pressure symptoms on the ureters, bladder and/or kidneys

    •   Back pain and sciatica

    •   Abdominal swelling, as in pregnancy

    •   Indigestion, discomfort sitting, etc., as in pregnancy

    •   Dyspareunia

    •   Dyspnoea

    •   Varicose veins and haemorrhoids[42],[43]

    Diagnosis

    Ultrasound scans have been the traditional method of differential diagnosis between cysts and solid tumours.  However, the size, location and number of fibroids cannot be accurately determined by this method.

    MRI (magnetic resonance imaging) has the advantage that myomata can be mapped exactly, especially multiple fibroids, and adenomyosis and endometriosis can be more accurately diagnosed than with ultrasound.  Diagnosis of the latter has traditionally been by laparoscopy or hysteroscopy. [45],[46],[47],[48],[49],[50]

    Treatment Options

    Until recently only surgical intervention was available for fibroid treatment.  Unless the women was particularly young and wanted a family only hysterectomy was offered.  Now a number of procedures are available: -

    •   Embolisation

    •   Hysterectomy

    •   Myomectomy

    •   Drugs

    •   Myolysis

    Uterine artery embolisation (UAE) is an interventional radiology technique.  Recovery is much quicker than hysterectomy (return to work 2-5 weeks compared with 2-3 months), much less invasive with fewer long term side effects and lower morbidity and mortality.  It requires an overnight hospital stay and no general anaesthetic. [1] - [31],[60],[65],[68]  - see comparison chart

    Hysterectomy is probably one of the most dreaded and feared surgical operations for women.  As well as being a very invasive procedure with a long recovery many feel that it also robs women of their femininity.  Many women suffer terribly from the symptoms of fibroids rather than 'have it all whipped out'.  They also resent the fact that many surgeons do not give them the option of keeping their ovaries.  There is also long term morbidity - urinary incontinence, clinical depression and sexual dysfunction, which can make this a very costly procedure for the women and the NHS.

    In a recent study on women's decision-making in choosing UAE for treating symptomatic fibroids most wanted relief from their symptoms and felt that UAE would provide this.  They cited quality of life reasons for making their decision: -

    •   Avoiding adverse effects of other treatments

    •   Long recovery time from surgery

    •   Avoiding surgery

    •   Loss of femininity

    •   Loss of self-image

    •   Loss of sexual image [69]

    Myomectomy is normally only offered to younger women wishing to have a family, as the high incidence of fibroid re-growth and adhesions makes hysterectomy inevitable for most women.  The procedure takes longer to perform than hysterectomy.

    Myomectomy is normally only offered to younger women wishing to have a family, as the high incidence of fibroid re-growth and adhesions makes hysterectomy inevitable for most women.  The procedure takes longer to perform than hysterectomy.   

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    Last updated: 12 Apr 2004