Dr. McLucas comments on a recent U.S. study about the effects of the ‘morning after’ progesterone contraceptive in shrinking fibroid tumors.

A recent U.S. study published in the medical literature described the effects of the ‘morning after’ progesterone contraceptive in shrinking fibroid tumors.  While the drug is still experimental, this could be a welcome addition to help treat a problem affecting 40% of women over the age of 40, and the cause of nearly 500,000 hysterectomies and fibroid removal surgeries performed each year in the United States.

We don’t know what causes fibroid tumors to grow in the uterus. We do know that fibroids are stimulated by estrogen. Women have two periods in their reproductive lives when fibroids will undergo ”growth spurts.” First, during pregnancy, fibroids will often grow with rising estrogen levels. Second, in the years leading up to the menopause, when estrogen is not produced any longer by the ovaries, the menstrual cycle is dominated by estrogen.

So it is reasonable to expect that any hormone which is an ‘anti-estrogen’ such as progesterone will decrease the growth of fibroids. In some cases, fibroids will shrink, temporarily under the influence of progesterone. We have know for years that intra-uterine devices [IUDs] containing progesterone can decrease the size of fibroid tumors. So can depo-lupron injections which create an artificial menopause while the hormone is in the blood stream. These hormones have side effects ranging from spotting to decreased sex drive, oily skin, and hot flashes which cause many women to stop taking the pills or injections. When the medicine is out of the system, fibroids regain their normal growth pattern, and may enter a period of accelerated growth!

“We believe that progesterone works by decreasing the size of the blood vessels feeding fibroids. On the other hand, Uterine artery embolization [UAE] permanently blocks the blood supply to fibroids,” according to Bruce McLucas, MD, founder of the Fibroid Treatment Collective, and Assistant Clinical Professor of Obstetrics and Gynecology at the University of California, Los Angeles. McLucas introduced UAE to the U.S. in 1994. Since then, the FTC has treated more than 5,000 women from all over the world. Many have gone on to have successful pregnancies. Embolization is an outpatient treatment allowing women to retain their fertility and return to work in a few days, rather than the months required to recover from major surgery. In addition, compared to myomectomy, the surgery where fibroids are removed and the uterus preserved, UAE allows women to breathe freely, knowing this procedure permanently treats fibroids without the risk of future recurrence,” McLucas adds.

A small womens group in Pennsylvania is making fibroid education and other health issues faced by women a priority.

Fibroid education for women is becoming a priority with a small womens group in East Stroudsburg, Pennsylvania. The group, called Spirit of Women, has teamed up with the Pocono Health System to present seminars that address sensitive health issues faced by women, including fibroids and treatment alternatives that are minimally invasive.

Fibroids are the most common reason for hysterectomy in the US and many women don’t realize that there are hysterectomy alternatives available. You can read the entire article from the Pocono Record.

* Please note, articles linked to outside sources in this blog do not necessarily reflect the medical opinions of the FTC.

UFE or uterine artery embolization (UAE) is a non-surgical treatment alternative to hysterectomy that takes less than one hour to complete. First performed in 1994, more than 50,000 women worldwide have been treated with the procedure.

UFE or uterine artery embolization (UAE) is a non-surgical treatment alternative to hysterectomy that takes less than one hour to complete. First performed in 1994, more than 50,000 women worldwide have been treated with the procedure. Clinical studies have shown that UFE provides substantial improvement in major symptoms, including pain, pelvic discomfort and urinary problems.

These improvements are similar to those experienced by patients who underwent hysterectomy — but without the long recovery. Significant adverse events are rare in women treated with UFE and overall adverse events are fewer — in number and severity — than in the hysterectomy group.

A five-year study shows that UFE provides long-term symptom improvement in more than 70 percent of women treated compared to fibroid recurrence rates as high as 62 percent following a myomectomy.

View from source…

Do you have questions about fibroids and uterine fibroid embolization (UFE)? Leave a comment below.

I believe my symptoms started around the age of 30. I just remember feeling very tired all the time. I felt so tired that I really didn’t want to go out. I also had very heavy periods. As I got older, it just got worse. I progressively started to have more pain and more of the heavy bleeding. My quality of life was not there just because I was so tired all the time. So I started with the iron. But over the years, it’s just gotten progressively worse instead of better.

I knew that there were surgeries available to me. There was also some procedure to shrink the fibroid. I discussed this with my physician, and she referred me to the gynecology doctor, who in turn suggested I have surgery. So about 3 years ago, I had 11 fibroids removed. And I felt much better. But, unfortunately, they returned. Probably a year after the surgery, I started to feel once again that I was tired all the time.

I have my menstrual cycle for 5 days. I have 4 days of heavy, constant bleeding where I’m changing pads basically every hour. Then I have 1 day of very light bleeding. I have 1 week off with no symptoms. Then I start to “pre-menstruate” for 2 weeks. So I have a total of 3 weeks of this; I’m not feeling well, there’s fatigue and all the premenstrual symptoms: the bloating, the pain in the legs, the tenderness in the breasts. I don’t have the energy to do those things that I like to do, especially in the summertime, when I like to do outdoor activities. If I have really heavy bleeding or if I’m just in my cycle, I don’t want to do anything. I’d just rather stay home.

View From Source… A 41-Year-Old Woman With Menorrhagia, Anemia, and Fibroids

Uterine artery embolization for symptomatic fibroids: short-term versus mid-term changes in disease-specific symptoms, quality of life and magnetic resonance imaging results

Authors: C. Scheurig, A. Gauruder-Burmester, C. Kluner, R. Kurzeja, A. Lembcke, E. Zimmermann, B. Hamm and T. Kroencke

Hum. Reprod. Advance Access originally published online on July 27, 2006

Summary:

This study aimed to evaluate the changes in severity of symptoms and quality of life for women after uterine artery embolization. The researchers measured uterine and leiomyoma volumne post-UAE to determine if UAE is a good short and mid-term procedure.

To read more about the study

By: Bruce McLucas, MD, FACS, Louis Adler, MD, Rita Perrella, MD JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS
January 2001
Volume 192 pp. 95-105

Summary

BACKGROUND:

Earlier studies demonstrated the efficacy of uterine fibloid embolization (UFE). We seek to demonstrate the success of the procedure in a community hospital setting, and we attempt to identify patients likely not to benefit from embolization, if possible, before the procedure.

STUDY DESIGN:

The study followed all women treated with UFE for menorrhagia or postmenopausal bleeding at a community hospital bentween 1997 and 1999. Relief of symptoms, uItrasound changes, and complications were documented. Six months after the procedure, analysis was performed on ultrasound and interview data from patients who underwent UFE. A smaller number of patients has been followed for 12 months and were available for the analysis. We examined characteristics of patients and procedures performed in an attempt to identify likely failures of treatment. We calculated complication and failure rates based on the entire group of patients.

RESULTS:

From 183 patients who applied for UFE, 16 were excluded because of pathologic conditions found during preembolization evaluation 167 women had an embolization, 163 were successfully embolized bilaterally, and 4 were embolized unilaterally because of technical failure. Eighty-eight percent of the patients (147 of 167 patients) reported an improvement or stabilization ofsymptoms 6 months after UFE. Forty-six patients followed for 12 months experienced myoma shrinkage of 37% (a significant shrinkage over 6 months, p < 0.001), and total uterine volume decreased 52%. Analysis of shrinkage data revealed no demographic or procedure variable associated with shrinkage. Six patients underwent hysterectomy (3.5%) after embolization, one as a result of postprocedure infection. Pain in the first 24 hours postprocedure affected almost all patients. Five percent of the patients passed submucous myomata after UFE all these patients at risk were identified at preembolization hysteroscopy. Four patients experienced premature menopause after embolization early in the study. There were three criteria for failure, of which a patient had to meet only one: hysterectomy, < 10% shrinkage of myoma 6 months after UFE, or worsening symptoms after UFE. No variables of age or size of the uterus could be shown to predict failure. Patients who had undergone earlier pelvic surgery were more likely to fail UFE (p = 0.012).

CONCLUSIONS:

Uterine fibroid embolization, an alternative treatment for myomas, offering low morbidity, can be performed in a community hospitaI setting. Eighty-eight percent of patients reported improvement or stabilization of symptoms. Total uterine volume decreased an average of 43% at 6 months after embolization. Shrinkage was unaffected by the size of the uterus, myoma, or patient characteristic before UFE. Longterm followup study reveals a significant continuing shrinkage of total uterine volume and myomata at 12 months. There has been no regrowth of fibroids. Earlier surgery was a factor predicting failure of UPE in our series. The risks to future fertility were small. (J Am Coll Surg 2001 192:95-105. © 2001 by the American College of Surgeons)

As an educational service, members of the FTC provide questions and answers regarding fibroids. Please note that the questions and answers are not medical advice and there is no substitute for diagnosis and, where appropriate, treatment by a qualified and licensed physician of your own choosing.

By: Bruce McLucas, S.C. Goodwin and D. Kaminsky MIN INVAS THER & ALLIED TECHNOL
1999 Volume 7 No. 3 pp. 267-271

Summary

Embolization of the uterine arteries, used for many types of pelvic haemorrhage, recentiy has been successfully applied to women suffering from myomata uterus. As a side effect of embolisation, myomata shrink more than 50% of their pre-embolisation size, measured by ultrasound. The embolised uterus has not been described elsewhere. Various clinical conditions gave rise to the possibility of viewing the effect of embolisation upon the uterus. Pathologic effects of embolisation of uterine arteries for control of menorrhagia associated with myomata are described, immediately and several months after the procedure.

As an educational service, members of the FTC provide questions and answers regarding fibroids. Please note that the questions and answers are not medical advice and there is no substitute for diagnosis and, where appropriate, treatment by a qualified and licensed physician of your own choosing.