Women’s Health: Uterine Fibroids
The problem of Uterine Fibroids is one that is often ignored for reasons ranging from embarrassment to lack of knowledge about the magnitude of the problem. More common than one would think, most women live with them for years and bear the accompanying challenges. What most women do not realize is that this suffering is no longer a ‘given’ and that technological advances have now made it possible to address this issue with minimal discomfort. It is important for women to know that today there are minimally invasive non-surgical alternatives available that they can ask their gynecologists about. Today we have Dr. Bhavin Jankharia who is a consultant radiologist at SRL Diagnostics - Jankharia Imaging, Mumbai take us through the A-Z of understanding uterine fibroids in women.
What are uterine fibroids?
Fibroids are “benign tumors” of the uterine wall that affect approximately 20-25% of women in the childbearing age group. Also known as myomas, they are the most common tumours to affect women in the reproductive age group.
What are its symptoms?
Some of the symptoms of uterine fibroids are excessive bleeding (menorrhagia), pain during the menstrual cycle (dysmenorrhea), pelvic pain, frequent micturition or urge and overall extreme discomfort and agony.
What are the available treatment options?
The mainstay of treatment of symptomatic fibroids has been surgery, which could be either
- Myomectomy (removal of the fibroid), or
- Hysterectomy (removal of the uterus)
Of these, only hysterectomy ensures that the patient will never suffer from fibroids again, but is a rather radical option for a benign tumour that only requires symptomatic relief. Also, a hysterectomy is followed by a lengthy recovery period before the patient returns to normal activities. Both hysterectomy as well as myomectomy can also be done laparoscopically (key-hole surgery), dramatically reducing the post-operative morbidity. However, even these are invasive techniques, and the risks and possible complications of surgery and anesthesia remain a constant threat.
The newest treatment available is the MRI-HIFU (Magnetic Resonance Guided High-Intensity Focused Ultrasound). This treatment has been used for the treatment of uterine fibroids in the United States since 2004. The principal aim of MRI-HIFU is to achieve symptomatic cure for the patient.
How does MRI-HIFU work in uterine fibroids?
The MRI acquires high resolution 3-D images of the fibroid and surrounding structures. These images are used for accurate planning and mapping of the treatment. During treatment, the ultrasound beam is focused on the fibroid as per the planned areas. This is called sonication.
The therapeutic HIFU beam is delivered to the target, at which point the sound energy in the beam is converted to heat energy. This technique of ablation relies on heat-induced tissue necrosis (coagulative), which is achieved when the target is heated to a temperature at or beyond 57C. Importantly, this technique leaves the normal uterine muscle intact. Targeted ablation of the vessel supplying the fibroid can result in tissue infarction. The principal determinants for the procedure duration include the size and location of the fibroid. This step is repeated till an adequate volume of the fibroid is ablated.
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