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How long does it take for fibroids to shrink?

Dr Eisen Liang - Friday, August 31, 2018

woman smiling on grass

How long does it take for fibroids to shrink?

It takes about 3 months to shrink 30% and 6 months to shrink 60%. However, symptoms of heavy menstrual bleeding (HMB) are usually relieved within the first 2-3 months of UFE treatment. 

Oral pill that shrinks fibroids linked to serious liver injury

Dr Eisen Liang - Monday, August 20, 2018


Oral pill that shrinks fibroids linked to serious liver injury

What’s the next best non-surgical option?  


For women suffering from fibroids (non-cancerous tumors), every day could be a physical and emotional agony. And many of these women don’t want to go under the knife just to take out their fibroids or lose their uterus for a lot of reasons. This is why nonsurgical approaches to treating fibroids make it a reasonable alternative for women.


Among the few nonsurgical options available, taking oral medication to shrink fibroids could just be the easiest and most convenient treatment there is. Recently, a new fibroid-shrinking drug called ulipristal acetate under the brand name Esmya® has been made available to patients with a promising efficacy to remove the need for future surgical fibroid treatment. However, Esmya was removed from the market following safety concerns regarding liver toxicity requiring transplantation.


Regulators from the European Medicines Agency’s (EMA) are currently reviewing the benefits and risks of Esmya usage and have advised patients and healthcare providers to follow specific temporary safety measures to minimize potential risks to patients.


In the meantime, the EMA has recommended healthcare professionals to refrain from using Esmya to treat new patients and those who have already finished previous treatments with the said pill.


As for women who are currently taking Esmya for uterine fibroids, they are advised to monitor their liver function at least once a month during treatment. If they ever experience symptoms related to liver problems like nausea, vomiting, yellowing skin/eyes, anorexia, weakness, and/or upper abdominal pain, they must stop treatment and seek medical help right away. Liver tests are also highly advised to be repeated 2-4 weeks after stopping treatment.


With this impending health and safety risk and concern, what could be the best treatment for fibroids? In the past, the only possible options involved major surgeries such as removal of fibroids (myomectomy) and removal of the whole uterus (hysterectomy). These treatments require general anaesthetics, longer hospital stay and recovery period, and a higher risk of complications compared with today’s available non-surgical treatments.


One non-surgical treatment option is uterine fibroid embolization (UFE), which shrinks fibroids by placing tiny “plastic” particles into the artery that feeds the fibroids. This blocks the blood supply of fibroids, leading them to shrink. The procedure is relatively simple and minimally invasive, performed under local anesthetic, requiring 1-night stay in the hospital and 1-week recovery.


Want to learn more about fibroids and UFE? Visit our website at fibroid.com.au for more information.


 


How much will my fibroids shrink?

Dr Eisen Liang - Wednesday, August 15, 2018


How much will my fibroids shrink?


Everyone is different and every fibroid is different. A "juicy" fibroid that is higher in cellular content than fibrous content, and richer in blood supply is likely to shrink more than a “dry” fibroid that is largely fibrous and poor in blood supply. MRI can help to predict the outcome.

On average, after UFE, each fibroid shrinks 60% of its original volume, to about 40% residual. The total uterine volume shrinks about to 50% of its original volume.

Fibroids don’t have to completely disappear in order for women to achieve significant symptom relief.


How does UFE work?

Dr Eisen Liang - Monday, July 30, 2018



How does UFE work?


During UFE, small particles are injected to the uterine arteries. As the plastic particles restrict blood supply to the fibroids, these benign tumours shrivel and die as it is starved with lack of oxygen and nutrients.


Normal uterine tissue (myometrium) has an immense capacity to recruit dormant blood vessels to re-nourish itself. As a result, it will survive and remain largely unharmed.


However, the fibroids do not have the capacity to recruit new blood vessels so these benign tumours die and shrink, eventually becoming scar-like tissues.


UFE utilizes the difference in the arrangement of blood supply between fibroids and normal uterine wall tissue (myometrium).


Normal uterus is quite small, only 60-100 mls in size. During pregnancy, the uterus enlarges enormously, and carries with it 40 times in blood flow.  Uterine blood vessels have to increase in size, length and numbers during pregnancy. When the uterus is not pregnant, these blood vessels shrivel up and are mostly shut down.


When particles block some of the uterine artery branches supplying the normal uterine tissue, the dormant branches will soon open up to keep the normal part of the uterus alive. However, fibroids do not have the capacity to recruit new blood vessels. That is why once the fibroid arteries are blocked, the fibroid will shrink and die. The fibroid becomes a scar-like tissue, no longer active or viable.

Expert Explains Why Plastic Particles are Safe for UFE

Dr Eisen Liang - Sunday, July 01, 2018

Expert Explains Why Plastic Particles are Safe for UFE

The particles we use are made of PVA (polyvinyl alcohol). PVA has been used safely in many medical prostheses for more than 3 decades.


It is the additives in the plastic when making utensils like water bottles and food containers that are potentially harmful. Pure plastics are chemically and biochemically inert, meaning they will not react with the body.


PVA particles are wrapped up by scar-like tissue, remain in place permanently and will not migrate elsewhere.


Are there fibroids too big or too many for UFE?

Dr Eisen Liang - Friday, May 25, 2018


Are there fibroids too big or too many for UFE?

Generally speaking, there is no fibroids too big or too many for UFE. In other words, there is no fibroid size limit for UFE. The recovery could be longer and more challenging with large fibroids. Giant fibroids as large as 4 kg has been embolised without significant side-effects or complications.

Whether there is one fibroid or multiple fibroids, blood is still supplied through the same 2 uterine arteries. As a result, regardless of how many fibroids there are, they are still treated by the same UFE procedure.

Although there is no upper limit of how big or how many fibroids can be treated, a uterus with bigger or more fibroids will have a larger volume to begin with, which means the treated uterus will also end up being bigger after treatment. We need to be realistic about uterine or fibroid shrinkage. The fibroids will shrink but will not completely disappear. Having said that, our study shows that over 90% of women treated with UFE were happy or very happy with the outcome.

Is UFE still a new procedure?

Dr Eisen Liang - Tuesday, May 01, 2018

female doctor and patient


Is UFE still a new procedure?


Definitely NOT. UFE has been performed since 1995. There have been numerous research publications documenting its safety and effectiveness. Many trials were conducted to compare UFE with hysterectomy. The outcomes are very similar between UFE and hysterectomy, in terms of symptom relief, patient satisfaction and quality of life improvement. Long-term outcome study with 10-year follow up has been done. There are even socioeconomic studies on UFE vs hysterectomy. That’s why UFE is no longer experimental by any means. UFE is a well-established and thoroughly researched procedure for treating fibroids. 


Study finds hysterectomy increases risks of coronary artery disease by 33%

Dr Eisen Liang - Thursday, March 15, 2018
Source: kimt.com 

Study finds hysterectomy increases risks of coronary artery disease by 33%

 

Are you considering hysterectomy (removal of the uterus) to treat non-cancerous conditions like fibroids? Did you know that hysterectomy alone raises women’s risk of cardiovascular diseases and metabolic conditions?

Contrary to the belief that keeping a woman's ovaries intact during hysterectomy poses less health risks for the patient, research has found that hysterectomy is linked to increased cardiovascular risks.


Hysterectomy alone is associated with increased long-term health risks.


According to a recent research from Mayo Clinic on hysterectomy with ovarian conservation (ovaries are kept). The study involved 2, 094 female residents of Olmsted County who had hysterectomy with ovarian conservation for benign reasons (i.e. not due to cancer), and a control group who never had a hysterectomy or ovarian removal before. The control group was age-matched and researchers only looked for new onset of disease after hysterectomy.

It is so alarming to find out that hysterectomy with ovarian conservation increased risks of high blood pressure, obesity, and lipid abnormalities.


The risk of coronary artery disease increased by a shocking 33%.


The risks are even worse if a woman undergo hysterectomy before 35 years old. They were nearly 5x more at risk of congestive heart failure, and 2.5x more at risk of coronary artery disease.


What's the alternative?



As for women suffering from fibroids, what could be an alternative treatment option?

Uterine fibroid embolization (UFE) could just be the answer. UFE shrinks fibroid without surgery. Aside from the fact that both ovaries and the uterus are kept intact, UFE is non-surgical and does not require general anaesthetics. It is a minimally invasive angiogram procedure done under local anaesthetic by an interventional radiologist. Compared with hysterectomy, UFE’s recovery period is faster and hospital stay is shorter. Furthermore, the complications and risks are lower.

Learn more about UFE-the non-surgical treatment for fibroids, go to fibroid.com.au

An Introduction to Uterine Fibroids: What Is A Fibroid? What Are The Fibroid Treatment Options?

Dr Eisen Liang - Monday, February 20, 2017


An Introduction to Uterine Fibroids: What Is A Fibroid? What Are The Fibroid Treatment Options?


You've probably heard of uterine fibroids but don't know much about them. Or even if you've read about them, it may be difficult to understand all the medical jargon.

Dr. Eisen Liang is an interventional radiologist and fibroid embolization specialist. Together with obstetrician and gynaecologist Dr. Bevan Brown, they seek to spread knowledge on uterine fibroids and the different treatment options for women in our modern era of advanced medicine. 

Their 5000 words article How to Treat Fibroids was published in the GP Magazine Australian Doctor. Here's a section that's been reworded to help you better understand the nature of fibroids.
 


Uterine fibroids are benign tumours that are commonly present in women. In fact, it's so common that it affects one in four women of reproductive age. While they are non-cancerous, 10-40% women may experience accompanying symptoms that significantly affect their quality of life and may need treatment. Most would find these symptoms bothersome, inconvenient, and painful.

Before, when simple medical measures proved to be ineffective, the only treatment option given was a hysterectomy, the removal of the entire uterus. Now with advancements in procedures in the past two decades, there have been less-invasive options offered. 



(Image via: mirena-us)

One is Mirena, an intrauterine device used for birth control. It releases a steady dose of progesterone hormone. It might help to reduce heavy menstrual flow but does not shrink fibroids.

Another is endometrial ablation, a procedure that destroys a thin layer of the lining of the uterus with heat energy. It stops menstrual flow altogether. 

A very effective non-surgical procedure is uterine fibroid embolization (UFE). It works by blocking blood supply to the uterus, starving the fibroids, and shrinking them without having to remove them. According to many studies, UFE has been proven to be as effective as hysterectomy in relieving symptoms of heavy menstrual bleeding, period pain, and bladder symptoms.



Because of the development of these less invasive treatment options as well as advances in techniques in hysteroscopic, laparoscopic, and robotic surgery, hysterectomies for uterine fibroids are no longer necessary in many cases. In fact, they should only be considered as a last resort when other less invasive treatments have trialed and failed.

Women who are experiencing symptoms related to uterine fibroids should speak with their GP or gynaecologist to discuss the many treatment options and find the one best suited for them. You GP or gynaecologist might not be familiar with UFE. To download a Fact Sheet to take it to your doctors, click this link:
Factsheet For Doctors

To find the full set of articles for you and your doctor on uterine fibroids, its symptoms, and the various treatment options, click on this link below:

Doctor's Resources


6 Alternative Fibroid Treatment Options For Women Considering Hysterectomy

Dr Eisen Liang - Thursday, February 09, 2017

6 Alternative Fibroid Treatment Options For Women Considering Hysterectomy

Just diagnosed with Fibroids? What are the fibroid treatment options?

Before consenting for hysterectomy, be fully informed about other less invasive treatment options.


There are various treatment options for uterine fibroids. However, some women may not be aware of these and are quite often advised that the only solution is a hysterectomy, which is the removal of the uterus from the body. Unless it’s cancerous, hysterectomy may not be necessary. Hysterectomy is, of course, a major surgery and carries with it all the risks of major surgery. Also, some women understandably mourn the loss of their womb.

That's why more women need to be aware of the alternatives to hysterectomy. Below is a brief discussion of various treatment options. Suitability will depends on the type and severity of one's symptoms as well as the location and size of the fibroids, and more importantly, the woman’s personal preference.  Hysterectomy should be considered as a last resort, when all other less invasive treatments have failed or deemed unsuitable.

Fibroids are common benign tumours. Many women with fibroids do not experience symptoms.  However if one is suffering fibroid symptoms, treatment may be needed.

 

Medical therapy

To control heavy bleeding during periods, a doctor may prescribe non-steroidal anti-inflammatory drugs, birth control pills, or progesterone agents. Keep in mind though that these do not reduce the size of fibroids.

Gonadotropin Releasing Hormone (GnRH) agonist also controls bleeding and may reduce the size of the fibroid and the uterus. However patients are usually advised to limit their use of this drug to 6 months due to its common side effects such as hot flashes, mood swings, and osteoporosis. After stopping GnRH agonists, fibroids usually start to regrow.

Cyclokapron reduces heavy bleeding by enhancing clotting ability. In rare cases for high risk patients, it can cause serious side effects such as deep venous thrombosis (DVT) and pulmonary embolism (clots in the lung).

 

Mirena IUD

(Source: Image via mirena-us.com) 

A Mirena IUD is an intra-uterine device, which is a device that is inserted into the uterus and stays in for a period of time where it slowly releases the progesterone hormone. While an IUD may be helpful for reducing the heavy periods associated with fibroids, it does not reduce the size of fibroids. Also, if one has large fibroids that are distorting the cavity, the IUD may be difficult to insert or remove and sometimes it may not stay in. Some women may experience prolonged / irregular periods, or continuous spotting with the Mirena IUD.

 

Endometrial Ablation

This procedure involves the use of heat energy to get rid of the inner lining of the uterus. The patient is put under general anaesthesia and the surgery is done in an operating theatre. After the procedure, the patient may no longer have a menstrual period. If the uterine cavity is distorted by fibroids, the procedure may not be successful due to lack of effective contact between the heating device and the lining of the uterus.

The procedure does not shrink fibroids and therefore does not relieve bulk symptoms such as urinary frequency.

 

Uterine Fibroid Embolization (UFE)

UFE is local anaesthesia non-surgical procedure performed by an interventional radiologist. The procedure embolizes or blocks the blood supply to the uterus. The lack of blood supply to the uterus makes the fibroids shrink and as a result alleviates bulk symptoms such as urinary frequency. UFE is also highly-effective in reducing heavy menstrual bleeding and relieving period pain. This non-surgical alternative to hysterectomy is essentially as effective as hysterectomy. UFE has shorter hospital stay and quicker time to return normal life and activities

 

Hysteroscopic Resection

This procedure is much less invasive than a hysterectomy but still need to be performed under general anaesthesia and in an operating theatre. It is only suitable for small fibroids protruding into the cavity of the uterus which are removed with the aid of a camera inserted through the vagina and the cervix.

 

Myomectomy

This procedure is done to surgically remove one or a few fibroids and is offered to women who wish to retain the uterus and fertility. Only when there is a small number of fibroids in suitable locations can this procedure be possible. It is technically more demanding to the surgeon, takes longer time to perform, more likely to require blood transfusion, and requires 5-6 weeks for recovery. Sometimes a myomectomy is converted to a hysterectomy if the surgeon is unable to control the bleeding or reconstruct the uterus.

Myomectomies improve heavy bleeding in 70-80% of patients. Development of internal scarring of the abdomen is a potential side effect. Recurrence of fibroids occurs in 40-50% of women.

Another procedure is laparoscopic myomectomy- a key hole surgery. The recovery time is quicker, although the surgical risks are not lower. Laparoscopic surgery is technically more demanding of surgeons due to limited access and visualization. It also poses the risk of injuries to blood vessels, bowel, bladder, and ureter. Whether laparoscopic surgery is the right choice for a patient depends on the reason for it, the desire for a quick recovery, as well as the skill and the experience of the surgeon.

 

Hysterectomy

When all other conservative treatments failed or deemed unsuitable, a hysterectomy may be needed. This operation removes the uterus from the woman's body. It is a major operation and  carries the risks of a major operation.

There are also potential long-term adverse effects to be aware of, such as vaginal prolapse.  Vaginal prolapse is where the top of the vagina gradually slips out of place, and may fall toward the vaginal opening because the uterus is removed. The uterus serves as important structural support for the top of the vagina. As the top of the vagina falls as a result of missing structural support, this may put additional stress on other ligaments supporting the pelvis.

Another potential side effect of hysterectomy involves the small intestines herniating downwards near the top of the vagina because the structural support provided by the uterus is gone. This condition is known as enterocele.

For hysterectomy, recovery can take up to 5-6 weeks. Hysterectomy should only be considered as a last resort when all other treatments for uterine fibroids have been tried and proven to be ineffective.

For women diagnosed with uterine fibroids who are experiencing severe symptoms, speaking with their  GP or gynaecologist about these options is the best route in finding the right treatment for them.