Acknowledgement:  "Mike and I want to thank the Australian Doctors, women, and uterine fibroid patients for their dedication to this important article." - Mike and Hope Waltman

What are Uterine Fibroids? 

Uterine fibroids are benign tumors of the uterus.  Symptoms from fibroids, the most common of which is excessive bleeding, can be anywhere from mild to disabling.  Fibroids are not cancers, but they can cause symptoms such as the following:

  Heavy menstrual bleeding
  Abdominal swelling (protrusion)
  Pelvic pressure
  Pain or spasms (similar to labor pains)
  Pressure on the bladder (frequent urination)
  Pressure on the rectum (constipation)
  Discomfort during sexual relations
  Interference with fertility
  Premature labor
  Repeated miscarriages

What complications can fibroids cause during pregnancy?

- Spotting or bleeding
- Fibroid degeneration due to the loss of blood supply to the fibroid
- Premature labor
- Premature delivery
- Birth canal blocked by the fibroid causing a c-section
- Infant growth affected
- Emergency hysterectomy during delivery due to hemorrhage
- Fibroid enlarging in size, which causes pain and pressure

Which Doctors perform Uterine Fibroid treatments? 

Many Gynecologists thru the years have expanded their medical knowledge to include more fibroid treatment options.  At one time abdominal hysterectomy was the only procedure, than abdominal myomectomy was discovered, and from the two procedures blossomed the laparoscopic and hysteroscopic hysterectomy and myomectomy procedures.

As technology increased in this field Uterine Artery Embolisation, performed by Interventional Radiologists, became another fibroid treatment option for women to research and discuss with their doctors.  Each one of the medical procedures has a good reason and purpose for existing.  Depending on the woman’s situation (afraid of surgery or high risk candidate, location of the fibroids, size of the fibroids, etc.) one or two treatment options may be more appropriate to treat the disease.  

Gynecologists will always be needed by their patients as medical technology evolves.  Women turn to them for guidance when they have reproductive questions and/or problems.  A special bond is created between the Doctor and patient due to the touchiness of the subject matter, and the private body areas that women must expose at the examination. 

What are the different methods for the management of Uterine Fibroids?

The methods to treat Uterine Fibroids are the following: 

  Hysterectomy
  Myomectomy
  Myolysis
  Endometrial Ablation
  Uterine Artery Embolisation
  Medical drug Therapy
  Watchful Waiting. 

What are the ‘Types of Uterine Fibroids’?

Submucosal (or Submucous) fibroid - This type is located beneath the lining of the uterus.  The fibroid can develop a thin stalk or even enter the vagina.

Intramural fibroid - They stay mostly embedded within the middle of the wall of the uterus.

Subserosal (or Subserous) fibroid - This type grows towards the outside of the uterus and can press on the organs surrounding the uterus such as the bladder or rectum.

Pedunculated fibroid - This type of fibroid can develop when a fibroid grows on a stalk, which is called a pedicle.  This can be a subserosal fibroid growing out into the abdomen or a submucosal fibroid growing into the endometrial cavity. The stalk can get twisted which can cause severe pain, although this is extremely rare.

Interligamentous fibroid - It can grow sideways between the layers of the broad ligament (a band of fibrous connective tissue that supports the uterus). 

Parasitic fibroid - This fibroid attaches itself to another organ, such as the tube, the mesentery, or a loop of bowel.  Its uterine stalk gradually degenerates until the fibroid is no longer a part of the uterus at all. (This fibroid is the rarest of all the types.)

What is Uterine Artery Embolisation?

Uterine Artery Embolisation (UAE) (i.e. uterine fibroid embolisation - UFE) is one of the most effective treatments for bleeding is to stop the blood supply to the area that is bleeding by blocking the vessels from the inside, this is known as “embolisation”.  Embolisation of the arteries to the uterus has been used as a treatment for severe uterine bleeding after surgery or childbirth since at least the late 1970s, and is used as a treatment for uterine fibroids. 

How long has UAE been performed in Australia?

Australia UAE History:  1997 

Dr. Peter Mitchell said, “I performed what I believe to be the first uterine artery embolisation for fibroids in Australia in august of 1997.  I was performing embolisation for neurovascular and peripheral diseases.  I had long used uterine embolisation for other indications (obstetric complications, gynaecologic malignancy palliation), and was aware of the article by Dr. Ravina.  I was asked to assist in patients who had specific problems:  high- risk surgery, young patients with the only surgical option being hysterectomy, complications from previous surgery.

Today our government has "frozen" funding for fibroid related uterine artery embolisation.  I am only performing it on selected higher risk patients within the public hospital system.  I am certain only a small proportion of patients who would potentially benefit from the procedure have access to it currently.”  

Note:  Medical article - Dr. Mitchell and Dr. Kuhn wrote a published case report of 2 UAE cases, “Embolic occlusion of the blood supply to uterine myomas: report of 2 cases”  Aust NZ J Obstet Gynaecol 1999; 39: 1: 120 (Entrez Pubmed).  Arterial embolisation of uterine fibroids (myomas) is a nonsurgical treatment that can be performed as an outpatient procedure. 

****

Dr. Ken Thomson said, “I started doing UAE for vascular malformations - our first was about 1985 and it was logical to move to fibroids in 1997.  Dr Peter Mitchell of the Royal Melbourne Hospital (RMH) did the first one I think.  We were part of the Melbourne Fibroid clinic 1998 -2001 when it folded due to lack of funding.  One of the GYN's in this clinic still mentions embolisation on his website URL www.raphaelkuhn.com.au. 

We started doing fibroids to give our patients an alternative and we had 25 years of tumor embolization experience to ensure we could manage it safely.   

Unlike some radiologists we have an excellent relationship with the Melbourne gynecologists.  I moved from RMH to the Alfred in 2000 and continued the UFE there.  We also have a range of women who have had either good, bad or ugly experiences of UAE at our hands who are happy to share their experiences with other prospective patients.

Our process is a consultation with full disclosure prior to any booking for the procedure.  This takes 30-60 minutes.  We require a gynaecological examination prior to UAE and for Medicare purposes we need any medical practitioner's (GP or specialist) referral letter.  The patient will receive discharge information following the fibroid embolisation.

Update - The Medicare Services Advisory Committee of the Commonwealth Department of Health has examined UAE and the outcome was: 

The evidence suggests that UAE is safe, clinically effective and potentially cost effective for the treatment of symptomatic uterine fibroids.  It appears more effective than myomectomy for the control of menorrhagia and pain but less effective in controlling pressure symptoms.  It is safer but less effective in controlling symptoms compared with hysterectomy.

The MSAC recommends that UAE be funded on an interim basis for the treatment of women with symptomatic uterine fibroids with a review within five years.  The MSAC recommends that patients be referred by a specialist gynaecologist. (MSAC Stage 4)     

Endorsed by the Minister for Health and Ageing 28 March 2006.           

During this process the Interventional Radiology Society of Australasia (IRSA) received significant assistance from the Society of Interventional Radiology (SIR) for which we are very grateful. 

The Interventional Radiology Society of Australasia (IRSA) is our equivalent of Society of Interventional Radiologist (SIR).  We maintain a list of IR radiologists at the RANZCR offices in Sydney. 

URL is:  http://www.ranzcr.edu.au/affiliatedgroups/irsa/index.cfm, email: ranzcr@ranzcr.edu.au  

IRSA and the RANZCR have sought funding for UAE from the Commonwealth under Medicare and an application was made to the Medical Services Advisory Committee (MSAC). Their deliberations will result in a publication and I am hopeful that an interim fee will be granted soon. The review (Uterine Artery Embolisation 1081) is listed on the MSAC website http://www.msac.gov.au/app/app1081.htm but there is no decision yet.  We are unlikely to see a Medicare fee until May or perhaps even the November issue of the Fee Schedule.  For those of us in public hospitals it is not critical whether a patient is insured or not and if there is no Medicare rebate this doesn't matter either.

Most of the radiologists who do UAE in Australia are corresponding members of SIR and can be found via the www.SIRWEB.org  Interventional Radiologist (UAE) finder.  Most of our patients find us through Google if they spell embolisation with an s instead of a z. 

The only local forum I know of is the Family Planning Forum of our Health Department, which offers advice on all aspects of treatment for fibroids and has for sale a book on the treatment of fibroids.”

Uterine Fibroids Photos:

 (Click on the thumbnails to enlarge the photos.)

Terumo Progreat microcatheter The angio shows a Terumo Progreat microcatheter deep into the uterine artery. This allows us to avoid embolising the cervical branches and any other arteries we want to keep.	MR to assess large fibroids We use MR to assess large fibroids and to do follow-up if the ultrasound is unhelpful.

(Photos courtesy of Dr. Ken Thomson)

**** 

Dr. Raphael Kuhn is a Gynecologist in East Melbourne, Australia.  He is a Specialist in Women's Health and specializes in uterine fibroids.  (For more information about Dr. Kuhn and uterine fibroids.)

****  

Dr. Murali Guduguntla said, “I started UAE around mid 2000.

We maintain a strict protocol for Workup of UAE patients.  We accept referral from either a GP or a Gynecologist, but definitely involve the Gynecologist prior to the embolisation for all the patients. 

All patients have pre procedural ultrasound, assessment of oestradiol levels and are counseled for the procedure where I discuss the technical details, success rates and possible complications.  Every patient is admitted overnight for pain relief with PCA – (patient controlled analgesia) pump. Ultrasound follow-ups are done.”

I, Hope, asked Dr. Guduguntla, "Why did you decide to perform UAE?"  He said, “Because of the advantages it has over myomectomy and hysterectomy.”      

****

Women of Australia Comment Section
Uterine Fibroids References
Women's Website Links List