What Are Uterine Fibroids?Uterine fibroidsare noncancerous(benign) growthson or within themuscular wallsof the uterus.They can be assmall as a pea,or as large as a cantaloupe.Women maydevelop any ofthree primarytypes of uterine fibroids in various parts of the uterus:

• Intramural fibroids are the most common.They develop within the lining of the uterusand expand inward.They make the uterus feellarger than normal and often cause heavymenstrual bleeding, pelvic pain, back pain orurinary frequency.

• Subserosal fibroids develop under theoutside covering of the uterus and expandthrough the wall, giving the uterus a knobbyappearance.They can cause pelvic pain and back pain.

• Submucosal fibroids are the least commontype.They develop just under the lining of theuterus. Even small ones can cause heavy andprolonged periods.

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Inova Alexandria Hospital islocated 4 blocks east of I-395at 4320 Seminary Road.

Cardiovascular and Interventional Radiology at Inova Alexandria Hospital

UterineFibroidUterineFibroidEmbolization:

A Safe, Effective Alternative to Surgery

Inova Health System is a not-for-profit health care system based inNorthern Virginia that consists of hospitals and other health servicesincluding emergency and urgentcare centers, home care, nursinghomes, mental health and blooddonor services, and wellness classes.Governed by a voluntary board of community members, Inova’smission is to provide quality careand improve the health of thediverse communities we serve.

www.inova.org

G22400/4-04/2,000

4320 Seminary RoadAlexandria, Virginia 22304

703-504-3000

Uterine FibroidsWhat Are the Symptoms?Some women may not know that they havefibroids, while others experience symptoms, suchas pain, heavy bleeding or abdominal swelling.The symptoms depend on the size and locationof the fibroid, but may include one or more ofthe following:

• heavy, prolonged menstrual periods,sometimes with clots

• pelvic pain, pressure or heaviness• pain in the back or legs• pressure on the bladder causing a constant

urge to urinate• pressure on the bowel causing constipation

and bloating• abnormally enlarged abdomen

Who Is Most Likely to Have Uterine Fibroids?Approximately 20 to 40 percent of women age35 and older have uterine fibroids. AfricanAmerican women are at higher risk and as manyas 50 percent have fibroids.

How Are Uterine Fibroids Diagnosed?Most fibroids are diagnosed when a physicianfeels an enlarged uterus during an internalgynecologic exam. Fibroids can be confirmed by an abdominal ultrasound, magnetic resonance(MRI) or computed tomography (CT), all ofwhich are painless diagnostic procedures.

Intramural fibroid

Subserosalfibroid

Submucosalfibroid

Excerpts in this brochure werereprinted with permission of theSociety of Interventional Radiology©2004, www.sirweb.org.

Image reprinted with permission ofSociety of Interventional Radiology ©2004

Treatment Options

How Are Uterine Fibroids Treated?Most fibroids do not cause symptoms and are nottreated.When they do cause symptoms, the first lineof treatment is usually drug therapy. Birth controlpills or other hormone therapy may be prescribed,along with nonsteroidal anti-inflammatory drugs(NSAIDs) such as ibuprofen or naproxen sodium.

If symptoms persist, your physician can help youdecide which treatment is best for you based onyour medical history, the location and size of thefibroids, and the severity of your symptoms.Youroptions may include the following:

• Myomectomy removes only the fibroids,not the uterus.This surgery is performed usinga hysteroscope (a small scope inserted throughthe vagina and cervix), a laparoscope (a scopeinserted through small incisions in the abdomen),or abdominal surgery (requiring incisionsthrough the abdomen and the uterus).

• Hysterectomy removes the entire uteruseither by a laparoscopic procedure through the vagina, or by an open surgical procedure.Uterine fibroids are the most common cause of hysterectomy in the country.

Either of these surgical procedures requires a six-week recovery period.

• Uterine fibroid embolization (UFE), alsoknown as uterine artery embolization, is an alternativeto surgery that preserves the uterus.A non-surgical,minimally invasive procedure, UFE blocks the bloodsupply to fibroids, causing them to shrink.

Uterine Fibroid Embolization (UFE)

How Is UFE Performed?UFE is performed by an interventional radiologist — a doctor specializing in the use of imaging techniquesto see inside the body and treat conditions withoutsurgery.

During UFE, the patient is given pain medications butremains awake. The interventional radiologist inserts asmall tube, called a catheter, through a tiny incision inthe skin, less thana quarter of aninch, into anartery at the top of the thigh.Using X-rayimaging, thecatheter is guided into theuterine artery.

Then tiny, roundparticles, the size of grains of sand, are injected throughthe catheter into the blood vessels leading to thefibroids.These particles cut off the blood supply to thefibroid.This process is repeated in the other uterineartery, completely blocking the blood flow feeding thefibroid. Blocking the blood flow to the fibroids causesthem to shrink and alleviates symptoms.The particlesremain permanently in the blood vessels at the fibroidsites, and cannot travel to other parts of the body. Theprocedure typically takes less than one hour to complete.

Image courtesy of BioSphere Medical Inc.

Cardiovascular andInterventional Radiology atInova Alexandria Hospital

Inova Alexandria Hospital’s Cardiovascular andInterventional Radiology program treats avariety of medical conditions withouttraditional surgery.

Our nationally recognized, board-certifiedinterventional radiologists perform minimallyinvasive procedures using small incisions, tinyinstruments and imaging techniques.Theseprocedures are generally less traumatic topatients than surgery, and result in less painand shorter hospital stays.

They were some of the first doctors in theMid-Atlantic region to perform uterinefibroid embolization (UFE).They currentlyhave one of the largest and most successfulUFE programs in the country. In addition,they performed the first peripheral and renalangioplasty and stent placement in NorthernVirginia.The first abdominal aortic stent graftin Northern Virginia also was performed bytheir team.

They are experts at treating varicose veins,peripheral vascular disease (PVD), spinal bonefractures, abdominal aortic aneurysms andstroke. Each year they perform thousands ofprocedures. For more information, call 703-504-7950 or visit www.inova.org.

For more information or to make an appointment, call

703-504-7950

Uterine artery

Catheter

Fibroid

Uterus

Minimally Invasive

What Happens After the Procedure?Typically, patients stay in the hospital overnight.Shortly after the procedure, most women experienceabdominal cramping similar to menstrual cramps, ornausea. During the hospitalization, the patientreceives medications to control these common sideeffects. By the morning after the procedure, thesesymptoms are usually gone.At home, the patient willlikely have several days of intermittent cramps, andmay feel somewhat weak.These symptoms usuallybegin to resolve within several days and most patientswill fully recover in seven to 10 days.

How Successful Is UFE?Approximately nine women out of 10 who have thisprocedure experience significant or total relief ofheavy bleeding, pain and other symptoms. Theprocedure is effective for multiple fibroids, and therecurrence of treated fibroids is very rare.

Is This a Safe Procedure?Fibroid embolization is considered a very safeprocedure. For more than 20 years, interventionalradiologists have used embolization in the uterus totreat heavy bleeding following childbirth. Embolizationhas been used since 1995 to treat fibroids. All devices,equipment and medications used for fibroidembolization are FDA approved. However, as withany medical procedure, there are risks. There is abouta one percent chance of injury to the uterus. Youshould talk with your doctor about the possible sideeffects of any procedure you may choose.

How Will UFE Affect My Fertility?By preserving the uterus, women may have anopportunity for future pregnancy, but the full effectof UFE on fertility has not been evaluated. Ourinterventional radiologists are actively conductingresearch on this aspect of UFE treatment.

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