Uterine Fibroids

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Uterine Fibroids

September 06, 2012
12:00 p.m. – 1:00 p.m. (EST)

  • Kevin Stadtlander, MD

Cleveland_Clinic_Host: Welcome to our Online Health Chat "Uterine Fibroids" with Kevin Stadtlander, MD. We apologize for the late start; we were experiencing some technical difficulties.

Cleveland_Clinic_Host: We are thrilled to have him here today for this chat. Let’s begin with the questions.

Dr_Stadtlander: Hello, I look forward to answering you questions today!

LibbyS: I have a procedure scheduled in a month; will my fibroids totally disappear after the UFE surgery?

Dr_Stadtlander: Fibroids will shrink significantly over time, and may disappear, although this is not necessary for symptom relief. We usually get a follow-up MRI in 6 months to demonstrate amount of fibroid and overall uterus shrinkage.

gb1778: Why does an interventional radiologist do the UFE procedure rather than my GYN?

Dr_Stadtlander: An Interventional Radiologist (IR doctor) is a radiologist, a specialist in imaging, who has additional subspecialty training in minimally invasive image guided procedures such as UAE (Uterine Artery Embolization). We have training in arterial catheter placement to be able to deliver the particles in a safe manner, to allow for fibroid shrinkage, for additional information visit www.sirweb.org

claireE: Is there a difference between uterine FIBROID embolization and uterine ARTERY embolization? Thank you.

Dr_Stadtlander: These are the same procedure. In both cases we embolize the uterine arteries, thereby causing shrinkage of the uterine fibroids which receive their blood supply from those uterine arteries.

DIGGY: Can you remove pelvic tumors during a UFE?

Dr_Stadtlander: No, UFE is a minimally invasive procedure performed through a tiny pinhole nick in the groin (to place the catheter in the artery). There are no stitches, only a band-aid. We cause shrinkage of the fibroid but do not actually remove anything.

ColombianaP: What is the chance that I have fibroids but I don’t feel any pain? My mother had fibroids and she didn’t know until she was 72yo. I am 46, should I still have my gynecologists examine me for them???

Dr_Stadtlander: Yes, many women have fibroids and are, in fact, symptom free. While it is possible for your gynecologist to "screen" for fibroids with physical exam or ultrasound, we would not treat if you are asymptomatic.

Cleveland_Clinic_Host: For those now joining us, we are currently chatting with Kevin Stadtlander, who is taking your questions about Uterine Fibroids. To ask a question, type in the box below and then click 'Ask'

Patpat: What are the risk factors?

Dr_Stadtlander: It is difficult to pinpoint risk factors for uterine fibroids, which are benign tumors in the uterus. However, we do know that there is a genetic predisposition, and are 3 to 9 times as common in African-American women.

lvian_1: My gyn [gynecologist] said they couldn't do anything for Fibroid tumors…

Dr_Stadtlander: This is not the case. In its August 2008 guidelines practice bulletin, “Alternatives to Hysterectomy in the Management of Leiomyomas,” ACOG (American College of Obstetricians and Gynecologists) listed UFE among Level A treatment options, meaning that the minimally invasive treatment is considered safe and effective based on long- and short-term outcomes data. So, this is now a widely accepted procedure. And, of course, the gynecologist has treatment options as well.

xJanL: I am 62yrs and know I have uterine fibroids and gallstones following a sonogram but was told neither may cause me problems. Can you tell me what the symptoms would be should they become an issue and what the different symptoms between the two may be? Thx.

Dr_Stadtlander: We do not perform UAE (Uterine Artery Embolization) in post-menopausal women, even though fibroids may be present. In fact, the fibroids are more likely to be asymptomatic. As for gallstones, I recommend you speak with your physician, as comparing symptoms from the two entities would be very patient specific.

ValleyG: How soon after the procedure can I have sex again?

Dr_Stadtlander: Usually, it is ok in about a week, but I may recommend differently for any given patient's circumstances.

Cleveland_Clinic_Host: For those now joining us, we are currently chatting with Kevin Stadtlander, who is taking your questions about Uterine Fibroids. To ask a question, type in the box below and then click 'Ask'

msAleX: Does birth control have any effect on increasing the possibility of getting fibroids down the line? Tx!

Dr_Stadtlander: There is no definite consensus in medical literature or in practice, however no compelling evidence that points to fibroid growth later in life. In fact, often times women with fibroids are treated with oral contraceptives to help control/regulate menstrual period. However, some feel there may be a hormonal contribution to growth of fibroids that are already there. For a more specific answer, I would ask that you consult with your gynecologist.

Potcake_Tali: What is the probability of fibroids returning after they have been embolized doctor?

Dr_Stadtlander: Fibroids don't necessarily "return" if successfully treated the first time around. Success rates are around 90-95% for symptom relief. Very rarely, there are alternative blood supplies to fibroids which could result in "incomplete" fibroid treatment and may therefore need a 2nd treatment. New fibroids could form, however I rarely see this in my practice as a reason for women to return.

enu1: In 2004 I had my tubes tied; can I still have the procedure done? I need it...

Dr_Stadtlander: Yes

Cleveland_Clinic_Host: We have already received some great questions! Dr. Stadtlander is being as thorough as possible in his answers. Thank you in advance for your patience. We will get through as many questions as possible.

Cora: What are the particles used to block and kill the blood supply to the fibroids? Can they travel through the body and affect you negatively?

Dr_Stadtlander: The microsphere particles are tiny beads made of an acrylic co-polymer (trisacryl) which is then cross-linked with gelatin, FDA approved for UFE procedure. These are around 500-700 microns in size, approximately 1/64 of an inch. We constantly visualize the particles going into the area of fibroids so that it is exceedingly rare to have them go to other parts of the body and cause harm.

Cleveland_Clinic_Host: We have approximately 15 minutes left in the chat. We received a large amount of questions and we will continue to answer as many as possible. We apologize if we did not get to your question. If you have additional questions after the chat, please use our contact link clevelandclinic.org/webcontact to submit your questions.

amanda: Hello Doctor! I have very heavy periods is that going to go away after the procedure?!?

Dr_Stadtlander: Yes, assuming you have heavy bleeding AND were diagnosed with fibroids on ultrasound or MRI. Then I can say with a 90-95% confidence that bleeding symptoms should improve. It also helps to know how large and how many fibroids, and this gets discussed in the one-on-one consultation I have with patients to determine procedure eligibility.

romanPhilly: My wife currently takes the medical Lupron, she is scheduled for the UFE procedure in 3 weeks. Will that affect her, should be take her off of it?

Dr_Stadtlander: Depending on the Lupron dose, the answer is yes, we usually avoid for a certain time period prior to UFE. Please review with your IR doc to make sure this will not be a problem.

CathyP2012: I have a fibroid the size of an orange! Is there a size limit to what you will perform surgery on?

Dr_Stadtlander: No absolute size limit. Each case is personalized at time of the consultation and review of that patient's imaging, which usually includes MRI. Of course, if we determine that you may benefit from a different procedure that your gynecologist could perform, we will certainly recommend that for you.

Nanomira: My gynecologist is advising against me even considering having the UFE procedure done, what can I do for a second opinion??

Dr_Stadtlander: You can always contact an Interventional Radiologist (IR) in your area and go for a consultation. Check out www.sirweb.org for a listing of doctors. Remember, you are always in charge of your own medical treatment, especially when it comes to an elective procedure such as UFE.

JDMiller: Do/can fibroids go away on their own?

Dr_Stadtlander: Yes, fibroids can shrink in size after menopause. However, we perform UAE (Uterine Artery Embolization) in younger women who are symptomatic and do not want to wait that long.

Cleveland_Clinic_Host: We are getting ready to close for today. A large number of questions were received and we apologize if we did not get to your question. We will try to answer as many questions as possible in these last few minutes. If you have additional questions, please go to clevelandclinic.org/health/livepersonchat to chat online with a health educator.

deedrasmom: are uterine fibroids cancerous?

Dr_Stadtlander: Uterine fibroids are benign (non-cancerous). When we treat with UFE, we are treating the symptoms, such as bleeding and bulk/pressure symptoms.

Anisha_Patel: Is there a long recovery time after an UFE procedure? Any pain

Dr_Stadtlander: Yes, there can be some pelvic pain after procedure. We keep patients overnight after procedure to manage any discomfort or pain, and then discharge home with oral pain meds if needed. Most patients tolerate procedure very well and have a full recovery within a few days, a week at most.

Cleveland_Clinic_Host: I'm sorry to say that our time with Kevin Stadtlander, MD is now over. Thank you again, Dr. Stadtlander, for taking the time to answer our questions today about Uterine Fibroids. To make an appointment with Dr. Stadtlander, or any other specialist at Cleveland Clinic Florida, please call 954.689.5123 or 877.463.2010. You can also visit us online at vanity clevelandclinicflorida.org.

Cleveland_Clinic_Host: If you would like to view the entire transcript of this chat after the event, it will be available on the Cleveland Clinic Florida website. If you have logged in during the middle of this chat and want to view what has already been discussed, click on the transcript button on this page.

Dr_Stadtlander: Thank you everyone, I hope I was able answer your questions to your satisfaction!