NONSURGICAL TREATMENT OF UTERINE FIBROIDS
Uterine fibroids are benign tumors that are seen in 1/3 of women with reproductive age. They originate from the muscular layer of the uterus and do not transform into cancer. According to their location, fibroids are divided into three types.
In some women, fibroids do not cause any symptoms and are diagnosed incidentally during a routine ultrasound or MRI examination performed for other reasons. In some however, they cause severe complaints including heavy mensturation, anemia, urinary frequency, bloating and pain. If the fibroids do not grow and cause any symptoms, treatment may not be necessary. If they grow or cause symptoms, treatment is indicated.
There are two types of surgical operation for uterine fibroids, myomectomy (surgical removal of fibroids) and hysterectomy (surgical removal of uterus). Myomectomy can be a good treatment if the fibroids are few and subserosal in location. If the fibroids are many and deep (intramural) in location, myomectomy is less successful, more risky and has a higher recurrence. In such patients, hysterectomy is preferred over myomectomy. In hysterectomy, ovaries are frequently removed with the uterus. Although hysterectomy solves the “fibroid problem” radically, it must be reserved as the last choice since it obviates fertility and may cause osteoporosis, coronary heart disease and psychological problems.
Today, there are a number of nonsurgical treatment options for uterine fibroids. These are uterine fibroid embolization (UFE), percutaneous ablation and high intensity focused ultrasound (HIFU).Among them, UFE is the best known, most commonly used and probably the most successful one. The goal of the UFE is to kill all the fibroids in the uterus by blocking their feeding arteries. For this, first, an angiography is done from the groin, the uterine arteries are identified on films, a catheter is placed from the groin into the uterine arteries and by injecting very small particles via this catheter, the feeding arteries of the fibroids are occluded. After UFE, fibroids die in a short time and become smaller gradually, causing their symptoms to decrease or disappear. After UFE, the fibroids die but the normal uterine tissue keeps its viability. This can be readily appreciated on follow-up MRI films taken after UFE.
Another nonsurgical treatment method for fibroids is percutaneous ablation. This is a well-known method for the treatment of cancers located in the liver and lung, and is also used for fibroids. For percutaneous ablation, a special needle is placed into the fibroid under ultrasound guidance, and the tumor is burnt by using radiofrequency or microwave energy. The ablated fibroids die, become smaller by time and stop causing symptoms. However, since percutaneous ablation requires placing a needle and burning each fibroid separately, it can only be used for fibroids that are few in number and can be reached easily from the skin.
Another nonsurgical treatment for fibroids is HIFU. In this method, high energy ultrasound waves are focused into the fibroid, which produce heat and burn the tumor. HIFU is able to treat fibroids without putting any needle into the body. However, it is suitable for only a limited number of patients.