Detecting Uterine Fibroids with Magnetic Resonance Imaging (MRI)

Interventional radiologists provide patients and their doctors better diagnosis and nonsurgical treatment options

Women typically undergo an ultrasound at their gynecologist’s office as part of the evaluation process to determine the presence of uterine fibroids. It is a rudimentary imaging tool for fibroids that often does not show other underlying diseases or all the existing fibroids. For this reason, MRI is the standard imaging tool used by interventional radiologists.

Magnetic resonance imaging (MRI) improves the patient selection for who should receive nonsurgical uterine fibroid embolization (UFE) to kill their tumors. Interventional radiologists can use MRIs to determine if a tumor can be embolized, detect alternate causes for the symptoms, identify pathology that could prevent a woman from having uterine fibroid embolization and avoid ineffective treatments. By working with a patient’s gynecologist, interventional radiologists can use MRIs to enhance the level of patient care through better diagnosis, better education, better treatment options and better outcomes.

Second opinion prior to hysterectomy

For true informed consent before surgery, patients should be aware of all of their treatment options. Patients considering surgical treatment should also get a second opinion from an interventional radiologist, who is most qualified to interpret the MRI and determine if they are candidates for the interventional procedure.

Once you have been diagnosed with fibroids, your doctor will discuss with you the various methods for treating them. These methods range from “watchful waiting” to pharmaceutical therapy for fibroids that may have recently been diagnosed or may have some associated symptoms, but do not interfere with daily living. However, many patients may require additional treatment options to manage more severe symptoms. Your physician may advise you of minimally invasive, uterus-sparing therapy, such as uterine fibroid embolization, to surgical interventions, such as hysterectomy and myomectomy. It is important to be sure to discuss all of these options with your physician to see what is the best option for you.

Diagnosis and watchful waiting

If your fibroids do not cause symptoms, there is no need to treat them. Your doctor may want to watch them and monitor for any fibroid growth at each of your annual examinations. Some women may have fibroids, but do not experience symptoms.

If you begin to experience, or have been experiencing, some or many of the symptoms previously indicated, there are several other treatment options that may be available to you. These include drug therapies, minimally invasive non-surgical options, and surgical options. Your doctor should discuss all the alternatives with you based on your condition.

Non-surgical option: Saves the uterus and stops the fibroids

Uterine fibroid embolization (UFE)is a procedure in which an interventional radiologist uses a catheter to deliver tiny particles that block the blood supply to the fibroids. This is a minimally invasive, non-surgical therapy that treats all fibroids that are present. This procedure usually takes less than one hour. Clinical data suggests that patients treated with uterine fibroid embolization return to work and daily activities on average within 7-11 days.

  • Preservation of the uterus
  • Decrease in menstrual bleeding from symptomatic fibroids
  • Decrease in urinary dysfunction
  • Decrease in pelvic pain and/or pressure
  • No surgical removal of the uterus and possible need for hormone replacement therapy (HRT)
  • Virtually no blood loss
  • Covered by most insurance companies
  • Outpatient procedure (generally an overnight hospital stay)
  • More confidence with less chance of soiling events
  • Overall significant improvement in patient’s physical and emotional well-being

Overall, uterine fibroid embolization is a safe procedure for treating symptomatic fibroids with minimal risk. 90-95% of patients indicated that they are happy with their outcome and would recommend UFE to a friend. Most reported risk factors and complications associated with UFE are transient amenorrhea, common short-term allergic reaction/rash, vaginal discharge/infection, possible fibroid passage, and post-embolization syndrome.

Pharmaceutical treatments

Birth control pills will be prescribed by many as a means of controlling excessive bleeding caused by fibroids. Non-steroidal anti-inflammatory agents (NSAIDs) may be prescribed for pain relief. Certain birth control pills may help to control fibroid symptoms. There are several potential side effects of the use of birth control pills, including risk of high blood pressure, development of blood clots, increased risk of heart disease, and/or liver disease. Data suggests that fibroids may re-grow after this treatment ends.

GnRH agonists can be prescribed by physicians when symptoms are not controlled by birth control pills, or can be prescribed as a first attempt in controlling fibroid symptoms. Generally, they can not be taken for longer than six months. GnRH agonists are used to decrease the production of estrogen in the ovaries, which may reduce the size of fibroids and help manage the associated symptoms. Because of the decrease in estrogen production, there may be menopausal-like side effects, such as hot flashes or mood swings. Furthermore, there may be some bone loss associated with prolonged use of GnRH agonists. In addition, data indicates that fibroids re-grow after this treatment ends.

Surgical treatments

Hysterectomy

Hysterectomy is defined as the “surgical removal of the uterus” (womb). It is one of the most common of all surgical procedures, and can also involve the removal of the fallopian tubes, ovaries and cervix. Following this operation you will no longer have periods, nor will you be fertile or able to have children.

There are two main ways to perform a hysterectomy for fibroids. The most common way is to remove the uterus through an incision in the lower abdomen. The second and less common way, is to remove the uterus through a cut in the top of the vagina, where the top of the vagina is stitched. Each operation lasts between one to two hours and is performed in the hospital under a general anesthesia

There are different types of hysterectomy:

  1. A total hysterectomy removes the entire uterus, including the cervix. This is the operation most commonly performed.
  2. A subtotal hysterectomy removes the uterus, leaving the cervix in place. If you have this operation, you will need to continue to have pap smear tests.
  3. A total hysterectomy with a bilateral or unilateral oopherectomy removes the uterus, cervix, fallopian tubes and one or both of the ovaries. If you have not had your ovaries removed and you have not gone through menopause before your operation, there is a 50% chance that you will go through menopause within five years of having this operation.

Physically, there are a number of issues that are common to all women having a hysterectomy. You will not have any more periods and you will not be able to have children. If you have had your ovaries removed, you will go through menopause regardless of your age. Menopause is not related to age, it is related to the production of the female sex hormone, estrogen. Your physician should discuss Hormone Replacement Therapy (HRT) with you to help you understand the pros and cons of HRT.

Myomectomy

Myomectomy is the surgical removal of the fibroids. While this procedure keeps your uterus intact, it can be a surgically challenging procedure and is not performed by all physicians. In addition, only certain fibroids may be treated with this therapy. An abdominal myomectomy is performed through a horizontal incision through the abdomen – similar to a “bikini cut” used in a cesarean section. Most types of fibroids, even very large ones, can be removed in an abdominal myomectomy. The recovery time varies with each patient, but typically is 4-6 weeks in length. Pedunculated and subserosal fibroids can be removed via a laproscopic myomectomy, which is performed through three small incisions. When a resectoscope is used to remove submucous fibroids, this is called a hysteroscopic resection. The use of a resectoscope requires proper training by the physician prior to use.