Uterine Fibroids Treatment; Progesterone Therapy and Embolization
Uterine fibroids are the most common pelvic tumors in women, occurring in approximately 30% of women over the age of 35. Although fibroids are benign (non-cancerous), they may produce a wide variety of symptoms including excessive bleeding leading to iron deficiency anemia, pain and pressure sensations, and even obstruction of the bowel or urinary tract. Women with fibroids often complain of painful intercourse, and the presence of fibroids may result in pregnancy loss. Each year, approximately 200,000 hysterectomies are performed in the United States for uterine fibroids. Despite this large number of operations, the vast majority of women with symptomatic fibroids are "silent sufferers".
Until recently, the only effective treatments for fibroids were hormonal therapy and surgery. Because fibroids grow in response to the female hormone estrogen, anti-estrogen hormones such as progesterone can shrink fibroids and may result in dramatic improvement in symptoms. However, until women have been able to obtain natural bioidentical progesterone, synthetic hormones, like (premarin) have had many untold side effects, stroke, heart attacks, beast cancer, thrombophelbitis and osteoporosis, according to the WHI, women’s health initiative. Consequently, past conventional hormonal therapy can only be used for a short time and, unfortunately, once it is discontinued, symptoms usually return.
Therefore, natural bioidentical hormonal therapy is considered one of the most treatments successfully shrinking fibroids prior to surgery and in most instances surgery is not needed when committing to a course of natural bioidentical progesterone treatment, that should be done over the course of 6 to 12 months and then be reevaluated. It may take another course of treatment with bioidentical progesterone if your fibroids are large but by the end of the first year there will be a vast shrinkage of the fibroids.
There are chat rooms all over the Internet now that have testified to the incredible positive results from natural bioidentical progesterone cream. There are dozens of books and author's in the medical field and PhD’s that have spoken up against the pharmaceutical industry educating women on the difference between progestin’s, artificial progesterone as in premarin made with pregnant horse mare urine and natural progesterone which is not patented because no natural occurring substance can be patented, and made from a plant.
Surgery for uterine fibroids
There are two general types of surgery available for fibroids, hysterectomy and myomectomy. Hysterectomy is the complete removal of the uterus with or without removal of the ovaries. In some cases hysterectomy can be performed through the vagina, avoiding an incision through the abdominal wall. However, with large fibroids, an abdominal hysterectomy (that is, a hysterectomy through an abdominal wall incision) is often necessary. Abdominal hysterectomy is a major surgical procedure requiring general anesthesia, approximately 6 days of hospitalization, and at least 6 weeks of recuperation. Obviously, pregnancy is no longer possible following a hysterectomy.
Myomectomy is an alternative surgical procedure for the treatment of fibroids. The object of myomectomy is to remove only the fibroid while leaving the uterus intact and preserving reproductive potential. Depending on the location and size of the fibroid, myomectomy may require an abdominal incision or may be done through a laparoscope (a telescope-like instrument inserted through an abdominal wall puncture) or a hysteroscope (a telescope-like instrument inserted through the vagina). With larger fibroids, attempted myomectomy frequently results in hysterectomy due to uncontrollable bleeding in these highly vascular tumors. Even when successful, myomectomy offers only temporary improvement in about one-third of patients because smaller untreated fibroids continue to grow.
Uterine Fibroid Embolization
Embolization (embolotherapy) is a procedure used to block blood vessels from the inside. Embolotherapy is performed by Interventional Radiologists, physicians who specialize in the treatment of a variety of diseases using catheters (tiny tubes) and medical imaging techniques. For nearly thirty years, embolotherapy has been used as a means of stopping uncontrollable bleeding from the uterus due to cancer, blood vessel malformations, trauma, and complications of pregnancy. In the early 1990's, investigators in France began using embolotherapy of the uterine arteries to prevent excessive bleeding in women about to undergo myomectomy for uterine fibroids. A surprising and wholly unexpected result of these uterine artery embolization procedures was that many of the patients had such significant improvement in their symptoms that surgery was postponed. Over the course of months it became clear that the improvement noted in these women was not only significant, it was durable. Consequently, a pilot study was begun to evaluate the long-term results of uterine artery embolization for the primary treatment of fibroids.
In the initial pilot study, 85% of women undergoing uterine artery embolization experienced significant improvement or complete resolution of symptoms. In 75% of cases the size of the uterus decreased by 20-80% within 3 months, and these results remained stable with an average follow-up of more than 18 months (11 to 38 months). In a second study from UCLA, 77% of patients reported "significant improvement" or "complete resolution" of their dominant fibroid symptom at 2 to 9 months follow-up. In this group, 2-month follow-up revealed an average 40% (22-61%) reduction in uterine volume with the dominant (largest) fibroid decreased by an average of 58% in 55% of the patients studied. In one-third of the patients the fibroids were no longer visible by ultrasound.
On the basis of these studies, uterine artery embolization programs for the non-surgical treatment of fibroids have been established at several academic medical centers in the United States. The experience gained at these centers will optimize treatment protocols and provide in-depth answers to questions regarding the durability of symptomatic relief and preservation of reproductive function.
The Uterine Artery Embolization Procedure
The uterine artery embolization procedure is performed by an Interventional Radiologist in the radiology department of the hospital. Although patients are awake for the procedure, they are sedated and often have no recollection of events during the embolization. The procedure itself consists of introduction of a tiny tube (catheter) into an artery in either the left arm or the groin under a local anesthetic. Except for the injection of the local anesthetic, there is little or no discomfort associated with the catheter insertion. Once in the artery the catheter is manipulated into the uterine arteries and angiography is performed. Patients may experience a mild sensation of warmth during the angiogram. When the catheter is positioned well within the uterine artery, tiny pellets of a material called PVA are injected. (Note: the chemical name for PVA is polyvinyl alcohol, but it is neither vinyl as in flooring nor alcohol as in alcoholic beverages. It is merely an organic [i.e., carbon-based] synthetic compound with properties that make it a useful embolic agent.) The PVA is carried by the flow of blood into the uterus and all of the fibroids present. The particles eventually impact in the very small arteries and produce blockage. Deprived of their blood supply, the abnormal cells in the fibroids die and are slowly removed by the body. Meanwhile, the body restores circulation to the normal tissue by both the in-growth of new arteries and the removal of a portion of the PVA from some of the existing vessels.
Immediately following the embolization procedure the catheter is removed and pressure is applied to the entry site for about 15 minutes to stop any bleeding. Almost all patients experience crampy abdominal pain following the procedure. Consequently, we provide patients with on-demand pain medicine through a device called a PCA (patient controlled analgesia) pump. Many studies have demonstrated that patients experience far less pain, yet actually use far less pain medication when this device is used. Patients are admitted to the hospital overnight and can usually be discharged home the morning following the procedure. Most patients can return to work within a few days. At the current time patients return for an ultrasound examination two weeks and two to three months after the procedure to assess results. The patient will also be asked to complete a short mail-in questionnaire one year after embolization. Additional follow-up may be requested in the future.
What are the risks associated with uterine artery embolization?
The potential risks of the procedure include bleeding from the catheter entry site, infection, adverse reactions to medications or contrast media, blood vessel injury, inadvertent embolization of other tissues. The risk of a significant complication is less than 0.5%.
Does uterine artery embolization result in significant clinical improvement?
In all studies to date, embolization has resulted in significant improvement or resolution of symptoms in more than 75% of patients treated. With improvements in technique, it is anticipated that perhaps 90% of women treated will have substantial improvement in symptoms.
What impact does uterine artery embolization have on reproductive function?
Most studies published thus far have focused on women who did not desire pregnancy. However, pregnancies have occurred and been carried to term following uterine artery embolization for fibroids. Small studies of women who underwent uterine artery embolization to control bleeding complications of labor and delivery have shown the return of normal menses within a few months in all cases and all women desiring subsequent pregnancy conceived and were successful in carrying to term. Since the presence of fibroids already has a negative impact on pregnancy, determining the impact specific to embolization will be difficult and will require a very large number of patients.
Does uterine artery embolization preclude other potential treatments?
In the setting of uterine fibroids, this procedure began as a preoperative measure to control bleeding during myomectomy. Preoperative embolization is commonly used in a variety of settings because it makes surgery easier and safer. Since the only other definitive treatment for fibroids is surgical at this time, the only impact embolization would have on such treatment is complementary.
Is uterine artery embolization cost-effective compared with conventional therapy?
The overall procedure cost is significantly less than abdominal hysterectomy and moderately less than hysteroscopic and laparoscopic myomectomy. When one takes into account the potential economic losses during a 6-week recovery from abdominal hysterectomy, the cost differential becomes astronomical.
Are results obtained with uterine artery embolization durable?
Published reports have shown stable results with follow-up of more than 3 years in a few cases. For women approaching menopause, the results may well be permanent since estrogen production is declining and estrogen is required for fibroid growth. There is insufficient data at this time to predict the long-term durability in younger patients because estrogen secretion will continue for many years and, theoretically, may stimulate the formation of new fibroids. It may be several years before sufficient data is compiled to assess long-term results in younger patients. On the other hand, if fibroids do recur after several years, it should be possible to treat them with repeat embolization.
Where can I find more information about uterine artery embolization?
You should first discuss this procedure with your primary care physician or gynecologist. Unfortunately, many physicians are unaware of this alternative treatment for fibroids despite the fact that this procedure has now been used to treat well over a thousand patients in the United States. For specific information on this procedure you should contact an Interventional Radiologist in your locale. For Kansas, Missouri, Arkansas, Oklahoma and adjacent areas of neighboring states you may find a local Interventional Radiologist in the MIRS Physician Listings. Additional information and Interventional Radiologists in other locales can be found at the Society of Cardiovascular and Interventional Radiology (SCVIR) site on the World Wide Web.
Real News Items
The uterine artery embolization for Condoleezza Rice in the lay press ran as a "surgical procedure" in most papers. It was done by an Interventional Radiologist, Dr. Speis, of Georgetown. While this will help the acceptance of the procedure, we should clarify who does this whenever we have a chance.
The Wall Street Journal and network TV have given recent publicity to uterine artery embolization. While much of the press had to do with complaints about the primary doctors failing to inform the patients about this alternative new therapy, some have presented it in a balanced form that helps both medicine and interventional radiology serve the patients. This has produced a flurry of interest locally and some actual cases. We must do our part to provide quality information for this new population we serve.
Self Care-Home Treatment
Home treatment can ease menstrual period pain and anemia caused by uterine fibroids.
Painful menstrual periods (dysmenorrhea) are one of the most common symptoms of fibroids.
Why fibroids cause pain is not known. Forceful menstrual contractions may be an attempt to push the fibroids out of the uterus.
Tips for relieving menstrual pain
- Apply heat to the lower abdomen by using a heating pad or hot water bottle or taking a warm bath. Heat improves blood flow and may decrease pelvic pain.
- Lie down and elevate your legs by putting a pillow under your knees. This may help relieve pain.
- Lie on your side and bring your knees up to your chest. This will help relieve back pressure.
- Sexual activity may relieve pelvic cramping and backache.
- Try using sanitary napkins instead of tampons.
- Regular exercise improves blood flow and may decrease pain.
- Try a non-prescription medication to help relieve your pain.
- Non-steroidal anti-inflammatory drugs (NSAIDs) reduce menstrual cramps and pain by lowering the level of the hormone prostaglandin within the uterus. High levels of prostaglandin have been found in the menstrual blood of women with painful periods. These do come with risks as most recently found that it may cause an increase in stroke.
- If NSAIDs do not relieve the pain, or you wish to try something that has shown the least known side affects try acetaminophen, such as Tylenol or Panadol, these are considered the safest of all pain killers.
Be sure to follow these non-prescription medication precautions.
Natural Alternatives for Anti-Inflammatory
- Use, but do not exceed, the maximum recommended doses.
- Carefully read and follow all labels on the medication bottle and box. If you have been told to avoid non-steroidal anti-inflammatory medications, call your health professional before taking them.
- Do not give Aspirin to anyone under age 20 unless directed to do so by your health professional.
- If you are or could be pregnant, call your health professional before using any medication.
Natural anti-inflammatory such as boswellia, cats claw and Curcumin have worked well for a women’s body without the averse side effects that have plagued other anti-inflammatory like the cox-2 inhibitors, Vioxx, Celebrex and most recently sodium naproxen/Alieve.
Start taking the recommended dose of pain reliever when discomfort begins or 1 day before your menstrual period starts.
Take the medication/herb for as long as the symptoms would normally last if you did not take the medication/herb.
Tips for preventing anemia
Anemia occurs when there are too few red blood cells in the blood. A complete blood count (CBC) can determine if anemia is present.
If you have heavy and prolonged periods (menorrhagia) you may develop anemia, because your body cannot produce blood as fast as it is being lost. Your body needs iron to make new blood cells. The recommended dietary allowance (RDA) is 18 mg. You may need to increase your iron intake to 20 mg per day if your periods are heavy or prolonged.
Your diet is the best source of iron. It is better for you to eat a balanced diet than it is to take dietary supplements. Red meats, shellfish, eggs, beans, and green leafy vegetables are the best sources of iron.
Cooking in iron cookware will add small amounts of iron to the food.
Vitamin C improves the absorption of iron. Be sure your diet includes 250 mg of vitamin C per day.
Consider using a non-prescription iron supplement (such as ferrous sulfate) or a multivitamin if you are unable to meet your need for iron through your diet.
You may become constipated when you are taking an iron supplement. To avoid constipation:
- Increase dietary fiber this will help your colon and keep your system clean allowing your liver to detoxify and keep your body from accumulating excess estrogen.
- Eat plenty of fruits, high in pectin’s, this will allow your body the enzymes to metabolize chemical that may have thrown your bodies hormonal balance off, and feed your body the structural precursors to rebuild your body.
- Drink at least 2 to 4 extra glasses of water per day this will build the volume necessary for your body to properly replenish your blood loss.
Natural Alternatives for Uterine Fibroids
Bioidentical Progesterone Cream (Progensa 20)
Bioidentical progesterone minimizes the size and frequency of uterine fibroids by balancing the excess estrogen levels.
Uterine Fibroid Formula (ProSoothe)
ProSoothe is an all natural herbal formula that significantly improves uterine fibroids and pelvic pain/cramps, irritability, tension, mood swings, acne, headaches, breast pain, bloating and weight gain.
This synergistic herbal formula has dandelion and vitex,(chaste tree) that helps the body remove exogenous,(external excess estrogen)from hormone therapy or contaminated food,(xenosteroids).
Milk Thistle (Silymarin)
Beyond the treatment of liver disorders, everyday care of the liver lays a cornerstone for total body health. Naturopaths and holistic doctors who look beneath the symptoms of an illness to its underlying cause, often discover that the liver has had a role to play. This is true across a vast range of different ailments including uterine fibroids.
For More Information-Uterine Fibroids
Uterine Fibroid Embolization
Uterine Fibroids-Condition Treatments