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Category: Fibroids

uterine fibroids
21Oct

Uterine fibroids may directly or indirectly affect your married life, especially if you want to start a family. Get well versed with the treatment for fibroids

Uterine Fibroids and its consequences

Marriage is a social institution that officiates a relationship between a man and a woman. One of the greatest joys in life comes from the birth of a child. Becoming a parent changes a person on a whole and is an experience that matches none other. Surely, after marriage, almost every couple looks forward to appreciating this blessing. Unfortunately, issues regarding infertility have become more common now as people continue making unhealthy lifestyle choices. It is owing to advancement in science, that the causes are now better understood, and treatments/alternatives are also available. One of the conditions that may lead to female infertility is of uterine fibroids, however, successful pregnancy with fibroids is also not uncommon.

Uterine fibroids are one of the most common forms of tumors that develop in the reproductive system of women. These muscular growths are almost always benign and pose no serious threat. Fibroids in women are common in all age groups once girls reach puberty. Often, these benign masses go unnoticed owing to their asymptomatic nature. The asymptomatic uterine fibroids are of lesser concern than the ones that pose severe symptoms. Any aberration from characteristics of a normal menstrual cycle should alert a woman instantly. The signs and symptoms of uterine fibroids include heavy menstrual bleeding and extremely painful periods.

Adenomyosis is also another disease of the female reproductive system wherein a suffering individual faces heavy menstrual flow and painful periods. Since fibroids and adenomyosis have similar symptoms, adenomyosis is often wrongly diagnosed as fibroids. Fibroids vary in size and number and the symptoms are proportional to these variations. For example, multiple uterine fibroids are often so problematic that they may expand the uterus to a point that it touches the rib cage. Similarly, fibroids that are larger in size will cause more trouble, severe symptoms and will need immediate medical intervention.

The cause of fibroid in women is not known but it is certain that a few factors increase the risk of developing fibroid. These include maintaining an unhealthy lifestyle, hormonal imbalance, and being genetically predisposed to developing uterine fibroids. It is studied that uterine fibroids are more common in women over the age of 30 and teenager fibroid patients or fibroids in adolescents is a rare occurrence.

Treatment Options: Old vs New

Uterine fibroids that are symptomatic and larger than 10mm in size, may be treated surgically. In traditional gynecology, uterine fibroids causing complications are treated by hysterectomy, which is the removal of uterus. On the other hand, myomectomy may also be performed, wherein surgical intervention removes only the fibroids in the uterus.

Fibroid in unmarried girl or women who want to conceive may not want to go for uterus removal/hysterectomy. That said, myomectomy also adds to the misery with its high recurrence. Therefore, the best treatment for fibroids with high success rate is the non-surgical uterine artery embolization method, which may also be better known as 3-D precision guided treatment.

Dr Imtiaz Ahmad, an endovascular surgical specialist and interventional radiologist, is the pioneer of this treatment and has made this treatment available in Pakistan for the very first time since November of 2017.

3-D Precision Guided Endovascular Treatment

The 3-D precision guided treatment is an umbrella term that encompasses a handful of procedures, out of which uterine artery embolization alone, constitutes 60-70%. The entire procedure uses real time 3-Dimensional Fluoroscopy which is a type of X-ray that shows live imaging in 3- Dimensions. Live imaging helps in precisely locating the fibroids. The procedure begins with administering a local anesthesia in the form of “Cold Spray” applied to the skin of the groin area to numb it. Conscious sedation is achieved via IV in which the patient remains awake and relaxed. Avoiding any skin incisions or cuts, micro catheter is introduced through the femoral artery in the leg. The catheter is guided towards the uterine artery through which the blood to the uterus is supplied. Serial 3-Dimensional images are obtained followed by placement of specialized/engineered micro-catheters, if needed to complete the embolization.

In this way, the embolization procedure causes the blockage of blood flow to the fibroid(s) or adenomyosis. Additionally, Embolic agents are small micron sized particles that are passed through these catheters, these particles are engineered /programmed to block blood supply only to fibroids or adenomyosis while sparing the normal uterine walls. Another major component of the procedure comprises intra-arterial pain management done by intra-arterial infusion of carefully titrated medications directly into the fibroids/adenomyosis with super selective catheters selectively placed within the uterine fibroids or adenomyosis.

The patient is ensured more comfort via fluoroscopic guided nerve block which is effective for at least 18-20 hours post procedure. Post embolization syndrome which is an expected sequelae after any embolization procedure is dealt with there and then by infusion of specific medications directly into the fibroids/adenomyosis. All in all, the procedure takes around 45-60 minutes and has a high success rate amongst patients of all age groups. It is often difficult to relocate the access site since no incisions are made during the procedure. The patients are usually discharged only a few hours after the treatment in outpatient settings or are kept overnight under observation with a 23-hour admission.  As part of post-procedural practice, the patient can expect a follow-up for a few months, especially if the procedure was also aimed at reversing infertility.

bidding goodbye to fibroids and adenomyosis
15Sep

It is a blessing and a huge honor for Dr Imtiaz Ahmad  and his team to offer a “totally” non surgical definitive treatment for Adenomyosis; offered first time in Pakistan since Nov 2017.

A brief outlook on Fibroids and Adenomyosis

Fibroids and adenomyosis often occur together, but are distinct in their characteristics. The fibroid is a benign tumor that can grow in different layers of the uterus while in Adenomyosis, the uterine inner lining itself grows into the myometrium (The outer layer of the uterus which is muscular). Intersecting symptoms of adenomyosis and fibroids include menorrhagia accompanied by pains and cramps, abdominal and lower back pain and abdominal swelling. However, while uterine fibroids are commonly asymptomatic, adenomyosis comprises excruciating and crippling painful cramps and may also accompany more chronic prolonged symptoms such as heavy bleeding and blood clots especially if fibroids coexist with adenomyosis. It is substantial to ensure that the two are not misdiagnosed, since an inaccurate treatment may prove more detrimental for the patient. Ultrasound imaging is sufficient to diagnose fibroids but to rule out adenomyosis, an MRI is advised. Once the specialist is able to differentiate between fibroids and adenomyosis, he has a clear picture regarding the treatment approach to be taken. At present, the most advanced method available under the non-surgical treatment for fibroids and adenomyosis is the 3-dimensional endovascular treatment. 3-D endovascular treatment for fibroids in Pakistan has been introduced by Dr Imtiaz Ahmad, an endovascular Surgical Specialist, and an Interventional Radiologist, who is well experienced in this field and has bagged thousands of success stories so far.

Uterus

Treatment for Fibroids and Adenomyosis

Surgical interventions for the treatment of fibroids and adenomyosis have, time and again, proven to be invasive and are slowly becoming obsolete for that reason. Hysterectomy (removal of the uterus) or myomectomy (removal of fibroids) are the two most common traditional surgical approaches taken towards fibroids and  adenomyomectomy for adenomyosis treatment. Surgical treatments also include endometrial ablation, wherein the inner lining (endometrium) is destroyed using either heat, cold, electricity, or microwaves. Women undergoing surgical procedures to sort their miseries regarding fibroids and adenomyosis must also give up on the idea of conceiving in most cases or be mentally prepared for recurrence. On the contrary, an innovative approach under the umbrella of endovascular procedures has recently gained accolades as being a noninvasive treatment, ensuring that the uterine wall is not damaged, while still being able to get rid of fibroids and adenomyosis completely. More specifically, the best treatment for fibroids and adenomyosis available is known as Uterine Artery embolization, which is a 3-D endovascular treatment that aims at selectively targeting fibroids and adenomyosis.

Fibroids

3-D Precision Guided Endovascular Treatment

Endovascular treatment using 3-dimensional imaging to locate the arteries supplying blood precisely to fibroids or adenomyosis ensures an accurate treatment. The entire procedure does not only comprise the uterine artery embolization but also, a complete set of steps to increase patient compliance and comfort. These include post embolization syndrome management, superior hypogastric nerve plexus block and intra-arterial pain management. Before the endovascular treatment is performed, a complete health analysis is done to assess the medical fitness status of the patient. Once the procedure is finished, you should also expect a thorough follow-up for up to 1 year, depending on the case. In cases where the goal is to achieve pregnancy, fertility status is also kept in check. In short, the treatment in itself is incomplete if the follow-up is not diligently done and as advised.

The 3-D precision-guided endovascular treatment uses live imaging to accurately locate the blood vessels supplying blood to the fibroids or adenomyosis. The imaging also helps assess the number of arteries involved and their sizes. The goal is to block the blood supply to these growths using miniature but programmed and specially engineered permanent devices. To begin, mild conscious sedation is achieved. Following, microcatheters are introduced in the patient’s body through the femoral/radial artery in the leg or wrist. This is achieved without causing any pain as a result of topical cold spray anaesthesia followed by local anaesthesia. Once the blood vessels are located, the FDA approved medical particles are then administered through the catheter. These embolic agents are small micron-sized particles that are engineered /programmed to block the blood supply to only fibroids or adenomyosis while sparing the normal uterine wall. Medical particles/Drugs used in the endovascular treatment are highly specific and are only issued to registered practitioners in America. In this way, embolization is successfully achieved.

The uterine artery embolization constitutes a major portion of the 3-D guided endovascular and may constitute approximately 60-70% of the entire treatment, through this technique management of the  post embolization syndrome is also done. Specific medications are administered at the exact location of the fibroid or adenomyosis, using microcatheters, to avoid post embolization syndrome, which may prolong the recovery time if not addressed at the right moment. Moreover, intra-arterial pain management is also attempted, medications at the specific location are administered so that the extent of pain felt by the patient is reduced by many folds. Finally, to further reduce the pain, the nerves to the pelvis are relaxed using a fluoroscopic guided superior hypo gastric nerve block approach. The analgesic effect is maintained for up to 20 hours.

To conclude, this new treatment for fibroids without surgery, also targeting adenomyosis, has become the talk of the town, and it is with great pride that the best treatment for fibroids and adenomyosis was introduced in Pakistan by Dr Imtiaz Ahmad, which is now helping thousands of patients since November, 2017.

fibroids treatment & details
7Jul

Introduction to Fibroids

Fibroids, also medically termed as leiomyomas, are non-cancerous abnormal growth in the uterine wall. Their structure comprises smooth muscle cells of the myometrium and fibroblasts, which partake in the synthesis of the extracellular matrix. They have been reported in women of all age groups post-puberty and pose a specific set of clinical presentations that help diagnose them.

These benign masses of tissue may vary in size and number, however, those that cause symptoms and require fibroid treatment, have been reported to be of, or greater than 10 mm. As the size of the fibroid increases, the composition does, too. Smaller fibroids have a greater blood supply and smooth muscle cells than in larger fibroids. The location of the fibroids classifies them into three major types including subserosal fibroid that grows outside the uterus, intramural fibroid which grows in the wall of the uterus, and submucosal fibroid which grows inside the uterus.

Fibroids may directly attach to the uterus or by a peduncle, commonly known as a stalk. While fibroids are the most recurrent cause of uterus removal(hysterectomy), alternative treatment options such as fibroid embolization may be employed for women who do not prefer surgical interventions.

Fibroid symptoms- How do you know if you have Fibroids?

Even though fibroids are noninvasive and well-circumscribed, they have high morbidity. Fibroids can be diagnosed by a simple pelvic ultrasound and are usually found during one of those unrelated trips to the sonologist. They are often left undiagnosed if they are small and show no symptoms that may alert an individual. Such fibroids also require no treatment. Women often reach out for treatment because of painful symptoms including heavy menstrual bleeding with sharp pains which may lead to anemia, backaches, pelvic and bladder pressure, constipation, and frequent urination. An eventual consequence of fibroids is reproductive dysfunction and obstetric complications. Fibroid symptoms in women vary based on their size, number, and location.

fibroid symptoms

Fibroid Causes- What are the risk factors?

While fibroids are a common occurrence in women in their reproductive age, those approaching their menopausal age are more likely to develop the disease. It is reported that about 25% of women beyond 30 years of age are at a risk of developing fibroids and by 50 years, the risk rises to an alarming 70%. Risk factors for developing the disease commensurate with fibroid causes and may include early menstruation, obesity, high blood pressure, caffeine, alcohol, age, and genetic factors. Interestingly, the disease is more common in African American women due to a higher prevalence of pelvic infections and genetic inheritance in their population.

While a definitive cause is yet to be understood, generally, high levels of estrogen and genetics are considered as the most common reasons for fibroid development. Additionally, women who have reached a childbearing age but do not get pregnant continually experience high levels of estrogen as part of their normal cycle, however, this has been associated with an increased risk of developing fibroids.

On the contrary, various studies have concluded a lesser incidence of fibroids in women who take oral contraceptives, attributing it to aberration in hormone levels. The same rationale is frequently used in the observation of the post-menopausal regression in fibroids.

Fibroid treatment- Is there a solution?

Surgical procedures employed as a treatment for fibroids have now become rather obsolete. Hysterectomy or uterus removal is still practiced but not recommended and is the only definitive treatment for fibroids in traditional gynecology. Myomectomy includes removal of fibroids via surgical intervention, however, there are several reports that conclude the recurrence of fibroids after myomectomy. Non-surgical treatments have been rendered as the best treatment for fibroids and have gained greater patient compliance. They are also reported to have a 90-95% success rate in the context of recurrence. These alternative to surgery methods most commonly include, uterine fibroid embolization, magnetic resonance imaging guide high intensity focused ultrasound (MR-HIFU) and laparoscopic occlusion.

Dr Imtiaz is one of the pioneers in introducing 3-D precision guided treatment of fibroids and is proud to have the largest database of successfully treated fibroid and adenomyosis patients.

 

Fibroid Causes

3-D precision guided treatment – Best Treatment for fibroids

Uterine Fibroid embolization, also known as, uterine artery embolization constitutes up to 70-80% of the 3-D precision guided treatment besides 6-7 other procedures bundled in a single category of “3-D precision guided treatment”. The entire procedure uses real time 3-Dimensional Fluoroscopy which is a type of X-ray that shows live imaging in 3- Dimensions and begins with administering a local anesthetic in the form of “Cold Spray” applied to the skin of the groin area to numb it. Followed by injection of more local anesthetic into the skin and soft tissues overlying the right groin.An IV sedative is also administered which is moderate enough to achieve conscious sedation in which person remains awake and relaxed. Using an extremely miniaturized  technique and without any skin incision the right femoral artery is accessed and a special selective catheter is introduced through the femoral artery in the leg.The catheter is guided towards the uterine artery through which the blood to the uterus is supplied. Serial 3-Dimensional images are obtained followed by placement of specialized/engineered Micro-catheters are introduced if needed to complete the embolization procedure, leading to blockage of blood flow to the fibroids or adenomyosis.

Embolic agents are small micron sized particles that are then passed through these  catheters, these particle are engineered /programmed to block blood supply to fibroids or adenomyosis only sparing the normal uterine walls. Another major component of the procedure comprises intra arterial pain management done by intra arterial infusion of carefully titrated medications directly into the fibroids/adenomyosis with super selective catheters selectively placed within the uterine fibroids or adenomyosis.

Patient is ensured more comfort and is achieved via fluoroscopic guided nerve block which is effective for at least 18-20 hours post procedure. Post embolization syndrome which is an expected sequelae after any embolization procedure is dealt with there and then by infusion of specific medications directly into the fibroids/adenomyosis. The entire procedure takes around 45-60 minutes and has a high success rate amongst patients of all age groups. It is often difficult to relocate the access site since no incisions are made during the procedure. The patients are usually discharged only a few hours after the treatment in outpatient settings, or are kept overnight as under observation (23 hour admission).

Fibroid prevention- What could you have done differently?

Most causes of fibroids are linked with the overall lifestyle a woman maintains. Healthy eating, sleeping, and living habits can prevent not only fibroids but other lethal diseases, too. It is important to understand that while one woman might be more predisposed to developing fibroids, lifestyle changes can positively impact the process. Smoking cigarettes, doing drugs or alcohol consumption are injurious to health and must be stopped immediately. Additionally, eating fresh green vegetables and fruits that contain flavonoids may help in overcoming the severity of fibroid symptoms. Obesity and fibroids develop a symbiotic relationship, benefiting each other to a point where both problems peak.