Uterine Fibroids - Women's Health Talk


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A presentation on Women's Health topic - Uterine Fibroids

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Uterine Fibroids - Women's Health Talk

  1. 1. What are Uterine Fibroids?<br />Benign (Noncancerous) tumors that develop in the wall of the uterus<br />Can cause problems because of their size and location<br />Typically improve after menopause<br />Can grow in different places in the uterus<br />Typically improve after menopause<br />MR09-001 Rev. B<br />
  2. 2. What are Uterine Fibroids?<br />Benign tumor of uterine smooth muscle<br />Fibroids are not considered to be pre-cancerous<br />Also referred to as myomas or leiomyomas<br />Types: submucosal, intramural, and subserosal<br />
  3. 3. What are Uterine Fibroids?<br />
  4. 4. What are Uterine Fibroids?<br />
  5. 5. What Causes Uterine Fibroids?<br /><ul><li>Exact cause currently unknown
  6. 6. Fibroids linked to estrogen
  7. 7. Evidence that progesterone may stimulate fibroid growth
  8. 8. Genetic Predisposition ?</li></li></ul><li>How Common are Uterine Fibroids?<br /><ul><li>Estimated that 25 to 50% or greater of all women eventually develop fibroids
  9. 9. Fibroids most frequently diagnosed in 30s & 40s
  10. 10. Most common tumor of the pelvis in females
  11. 11. About 10% to 30% of these women are symptomatic </li></li></ul><li>Who Gets Fibroids?<br /><ul><li>Incidence increases with age
  12. 12. 20% of women in their 20’s
  13. 13. 40% of women in their 40’s
  14. 14. Genetic predisposition
  15. 15. African-American women at higher risk
  16. 16. Familial tendencies
  17. 17. Exact cause currently unknown</li></li></ul><li>What Symptoms Occur With Uterine Fibroids?<br /><ul><li>Heavier prolonged menstrual bleeding, sometimes with passage of blood clots. Anemia can occur if bleeding is severe
  18. 18. Pain, pressure, or feeling of fullness in the pelvis, abdomen, or lower back
  19. 19. Frequent urination or constipation
  20. 20. Pain during or bleeding after intercourse
  21. 21. Infertility or miscarriage
  22. 22. Abnormally enlarged abdomen
  23. 23. Bladder pressure leading to a constant urge to urinate </li></li></ul><li>What Symptoms Occur With Uterine Fibroids?<br />Image courtesy of Mark Cockerill, MD, www.ufecenter.com<br />
  24. 24. How are Uterine Fibroids Diagnosed?<br /><ul><li>Fibroids are usually diagnosed during a gynecologic internal examination
  25. 25. Your doctor will conduct a pelvic exam to feel if your uterus is enlarged</li></li></ul><li>How are Uterine Fibroids Diagnosed?<br /><ul><li>The presence of fibroids is most often confirmed by an abdominal ultrasound
  26. 26. Fibroids also can be confirmed using magnetic resonance (MR) and computed tomography (CT) imaging techniques
  27. 27. Other conditions such as adenomyosis or ovarian cysts may be mistaken for fibroids </li></li></ul><li>How are Uterine Fibroids Diagnosed?<br /><ul><li>MRI
  28. 28. Ultrasound</li></li></ul><li>How are Uterine Fibroids Diagnosed?<br /><ul><li>Hysteroscopy</li></li></ul><li>How are Uterine Fibroids Treated?<br /><ul><li>Most fibroids do not cause symptoms and are not treated
  29. 29. When they do cause symptoms, drug therapy often is the first step in the treatment
  30. 30. This might include a prescription for birth-control pills or other hormonal therapy, or the use of non-steroidal anti-inflammatory drugs, such as ibuprofen or naproxen sodium </li></li></ul><li>How are Uterine Fibroids Treated?<br /><ul><li>In many patients, symptoms are controlled with these treatments and no other therapy is required
  31. 31. Some hormone therapies do have side effects and other risks when used long-term so they are generally used temporarily
  32. 32. Fibroids often grow back after therapy is discontinued</li></li></ul><li>How are Uterine Fibroids Treated?<br /><ul><li>LUPRON </li></ul>GNRH agonist blocks ovarian estrogen production<br />Advantages: <br /><ul><li>Not Invasive, shrinks fibroids, often improves symptoms</li></ul>Disadvantages: <br /><ul><li>Induces premature menopause and associated symptoms
  33. 33. Fibroids usually return to original size after cessation of therapy. Only used for short periods of time because of side effects </li></li></ul><li>How are Uterine Fibroids Treated?<br />The next step is to move to more invasive therapy. The most common treatment options include:<br /><ul><li>Myomectomy
  34. 34. Hysterectomy
  35. 35. Endometrial Ablation
  36. 36. MR-guided Ultrasound
  37. 37. UFE</li></li></ul><li>How are Uterine Fibroids Treated?<br /><ul><li>Myomectomy</li></ul> Individual fibroids are resected through an abdominal incision or sometimes with a laparoscope or hysteroscope.<br />Advantages: <br /><ul><li>Fertility can be preserved
  38. 38. Well established procedure, less invasive if laparoscopic or hysteroscopic</li></ul>Disadvantages:<br /><ul><li>Potential surgical complications
  39. 39. Only part of uterus is treated and recurrence can occur; 15 to 25 % need repeat procedure
  40. 40. Not all fibroids are treated via myomectomy</li></li></ul><li>How are Uterine Fibroids Treated?<br /><ul><li>Myomectomy</li></ul>Laparoscopic<br />
  41. 41. How are Uterine Fibroids Treated?<br /><ul><li>Myomectomy</li></ul>Hysteroscopic<br />Submucosal<br />Fibroid<br />
  42. 42. How are Uterine Fibroids Treated?<br /><ul><li>Myomectomy - Abdominal</li></li></ul><li>How are Uterine Fibroids Treated?<br /><ul><li>Endometrial Ablation </li></ul>The lining of the uterus is removed or destroyed to control very heavy bleeding. Endometrial ablation usually just treats bleeding symptoms and not the fibroids themselves.<br />Advantages:<br /><ul><li>Can effectively control bleeding. Preserves uterus.
  43. 43. It can be done on an outpatient basis or even in a doctor's office.
  44. 44. Most people recover quickly. About half of women who have this procedure have no more menstrual bleeding. About three in 10 women have much lighter bleeding.</li></li></ul><li>How are Uterine Fibroids Treated?<br /><ul><li>Endometrial Ablation </li></ul>Disadvantages:<br /><ul><li>May not be possible due to location and size of fibroids
  45. 45. Will not reduce symptoms related to fibroid bulk
  46. 46. Addresses only bleeding symptoms, does not treat the fibroids
  47. 47. Abnormal uterine bleeding may recur, requiring additional procedures
  48. 48. Women cannot have children after this procedure </li></li></ul><li>How are Uterine Fibroids Treated?<br /><ul><li>High Intensity Focused Ultrasound
  49. 49. MR-guided Ultrasound</li></ul> HIFU (high intensity focused ultrasound) is a highly precise procedure using high intensity, focused ultrasound to heat and destroy diseased tissue. <br />Advantages:<br /><ul><li>No incision
  50. 50. One to two day recovery with minimal discomfort
  51. 51. Preserves uterus</li></li></ul><li>How are Uterine Fibroids Treated?<br /><ul><li>High Intensity Focused Ultrasound
  52. 52. MR-guided Ultrasound</li></ul>Disadvantages:<br /><ul><li>Procedure can take several hours
  53. 53. Treats only one fibroid at a time
  54. 54. Usually only appropriate for small fibroids near the surface of the uterus
  55. 55. Insurance may not cover this procedure
  56. 56. Fibroids may recur, requiring additional procedures</li></li></ul><li>How are Uterine Fibroids Treated?<br /><ul><li>Hysterectomy</li></ul>Surgical removal of uterus and fibroids, performed through an abdominal incision, vaginally, or laparoscopically<br />Advantages:<br /><ul><li>100% Curative
  57. 57. No risk of future fibroids
  58. 58. Well established procedure</li></li></ul><li>How are Uterine Fibroids Treated?<br /><ul><li>Hysterectomy</li></ul>Disadvantages:<br /><ul><li>Major surgery with potential surgical complications: infection, hemorrhage, injury to adjacent organs, adhesions
  59. 59. Loss of child bearing potential
  60. 60. General anesthesia
  61. 61. 2 days to 6 weeks recovery time
  62. 62. Hormonal changes (if ovaries are removed)
  63. 63. Long term side effects have been reported
  64. 64. Emotional
  65. 65. Sexual</li></li></ul><li>How are Uterine Fibroids Treated?<br /><ul><li>Hysterectomy
  66. 66. Over 600,000 hysterectomies per year
  67. 67. 40,000 myomectomies, 25,000 UFE
  68. 68. 2nd most frequent surgical procedure in women of reproductive ages (after C-section)
  69. 69. 90% for benign reasons
  70. 70. 35% for fibroids
  71. 71. 20% of women by age 40
  72. 72. 33% of women by the age of 65
  73. 73. A very common procedure, often offered to women promptly following a diagnosis </li></li></ul><li>Why Not Have a Hysterectomy?<br /><ul><li>Patient Reasons
  74. 74. Avoid surgical adverse events
  75. 75. Pelvic support issues
  76. 76. Bladder dysfunction
  77. 77. Menopause & HRT
  78. 78. Hospitalization, recovery
  79. 79. Sexual Dysfunction
  80. 80. Save uterus because
  81. 81. Source of femininity
  82. 82. Fertility
  83. 83. Self image
  84. 84. Sexual image </li></li></ul><li>How are Uterine Fibroids Treated?<br />Uterine Fibroid Embolization performed by an Interventional Radiologist<br />What is an Interventional Radiologist?<br />Interventional radiologists are physicians who are specially trained to diagnose and treat conditions using tiny, miniaturized tools, while watching their progress on X-ray or other imaging equipment <br />Typically, the interventional radiologist performs procedures through a very small nick in the skin, about the size of a pencil tip<br />Interventional radiology treatments are generally better tolerated by the patient than surgery because they involve no surgical incisions, less pain, shorter hospital stays, and a faster recovery<br />
  85. 85. How are Uterine Fibroids Treated?<br /><ul><li>Uterine Fibroid Embolization (UFE)
  86. 86. The interventional radiologist makes a small nick in the skin (less than 1⁄4 of an inch) in the groin and inserts a catheter into an artery.
  87. 87. The catheter is guided through the artery to the uterus while the interventional radiologist watches the progress of the procedure using a moving X-ray (fluoroscopy).
  88. 88. The interventional radiologist injects tiny plastic particles the size of grains of sand into the artery that is supplying blood to the fibroid tumor.
  89. 89. This cuts off the blood flow and causes the tumor (or tumors) to shrink. </li></li></ul><li>How are Uterine Fibroids Treated?<br /><ul><li>Uterine Fibroid Embolization
  90. 90. Angiography Suite, like an OR with a modern X-ray machine, sterile conditions
  91. 91. Epidural anesthesia or conscious sedation
  92. 92. Procedure typically takes one hour to complete
  93. 93. Fibroid embolization usually requires a hospital stay of one night</li></li></ul><li>How are Uterine Fibroids Treated?<br />Uterine Fibroid Embolization <br />Post Procedure Expectations<br /><ul><li>Pain-management medications and drugs that control swelling typically are administered intravenously immediately post-procedure to treat cramping and pain, which are common side effects
  94. 94. Fever is an occasional side effect, and is usually treated with acetaminophen - Starts a few hours after the procedure and may last 3 to 5 days
  95. 95. Many women resume light activities in a few days and the majority of women are able to return to normal activities within one week</li></li></ul><li>How are Uterine Fibroids Treated?<br />Uterine Fibroid Embolization <br />Post Procedure Expectations<br /><ul><li>Studies show that 78-94% of women who have the procedure experience significant or total relief of heavy bleeding, pain and other symptoms
  96. 96. The procedure is effective for multiple fibroids
  97. 97. Recurrence of treated fibroids is very rare </li></li></ul><li>How are Uterine Fibroids Treated?<br />Uterine Fibroid Embolization<br />Mechanism of Action<br />
  98. 98. How are Uterine Fibroids Treated?<br />Uterine Fibroid Embolization<br />Mechanism of Action<br />Embospheres<br />
  99. 99. <ul><li>Uterine Fibroid Embolization </li></ul>Advantages:<br />Treats all fibroids simultaneously<br />Minimally invasive, complications infrequent <br />Recurrence of treated fibroids rare<br />Shorter recovery period than open surgery<br />No adhesion (scar) formation <br />Minimal blood loss. No need for transfusion<br />Epidural or conscious sedation vs. general anesthesia <br />Emotionally, physically, and sexually - UAE can have advantages over surgery<br />
  100. 100. <ul><li>Uterine Fibroid Embolization </li></ul>Disadvantages<br /><ul><li>10-15% do not respond despite technical success
  101. 101. Up to 2% of procedures technically unsuccessful
  102. 102. Pelvic pain or cramping after procedure can remain moderate to severe for several days
  103. 103. 1% to 2% chance of serious complication i.e. hysterectomy
  104. 104. Patients over 45 have potential for ovarian failure</li></li></ul><li><ul><li>Uterine Fibroid Embolization
  105. 105. FAQ</li></ul>Q. Will my fertility be affected?<br />Conclusive studies with large numbers lacking<br />Dozens of reported healthy pregnancies, with no reports of any adverse outcome due to UAE<br />If infertility due to fibroids, fertility may improve in select patients after UAE. Research ongoing.<br />Women with symptomatic fibroids desiring fertility probably should consider myomectomy first, especially if relatively uncomplicated.<br />Q. Will my insurance pay for the Uterine Fibroid Embolization procedure?<br /><ul><li>Most insurance companies cover UFE. You will want to speak with your interventional radiologist about this before your procedure </li></li></ul><li><ul><li>Uterine Fibroid Embolization
  106. 106. Results
  107. 107. Friday, November 19, 2004 Posted: 4:07 PM EST (2107 GMT)
  108. 108. WASHINGTON (CNN) -- National security adviser Condoleezza Rice, President Bush's nominee to be the next secretary of state, is doing well after successful surgery, Jim Wilkinson, deputy national security advisor, told CNN Friday
  109. 109. Rice 'resting comfortably' after surgery
  110. 110. Expected to return to work on Monday</li>