Uterine Fibroids

Uterine fibroids are benign tumors that attach themselves to the uterine wall. Uterine fibroids may vary in size from microscopic fibroids to fibroids that occupy the entire uterine cavity. Uterine fibroids may appear as one or many. They often grow and enlarge over time and extend beyond the uterine cavity.

Symptoms of uterine fibroids are painful menstrual cycles and pelvic cramps. There may be abdominal fulness and increased urine frequency. In some women, there may not be apparent symptoms to indicate uterine fibroids. Women suffering from uterine fibroids may notice backache and leg pain. There is heavy menstrual bleeding. The symptoms depend on the location of the uterine fibroids.

Fibroids have been associated with changing levels of estrogen hormones. With menopause, uterine fibroids shrink on account of the reduced levels of estrogen. A doctor will conduct a pelvic examination to detect fibroids in the uterus. Ultrasound helps in better visualization of the uterine cavity. Hysterosalpingography involves use of dye to observe the uterine cavity and fallopian tubes.

Most often uterine fibroids are left untreated. If the fibroids are growing too rapidly or causing abnormal bleeding, then suitable treatment will need to be adopted. In some cases, uterine fibroids affect fertility. Treatment for uterine fibroids depends on the age of the woman and severity of symptoms. Surgical options to treat uterine fibroids involve myomectomy (removal of fibroids leaving uterus intact). A hysterectomy is performed in post-menopausal women. Uterine artery embolization (UAE)involves using imaging techniques to locate and block the blood vessels that feed the fibroids. Sometimes medication is prescribed to lower estrogen levels. But they have disturbing side-effects.

Interventional Radiology

A sub-specialty of radiology, Interventional radiology - IR has contributed significantly to medical developments in recent years. Patients are diagnosed and treated using minimally invasive imaging techniques such as X-ray, MRI and ultrasound for guidance. In addition to diagnosis, new treatment options are offered by techniques in Interventional radiology (also known as Surgical Radiology)- patients are treated with lesser risk and shorter hospital stays.

The advantage of IR procedures is that they can be used in almost every organ system - be it abdomen, central nervous system, chest, heart and vascular, musculoskeletal, genito-urinary and other organs and soft tissues.

Interventional Radiologists

Patient evaluation and management are provided by Interventional radiologists, who are doctors trained in radiology and in minimally invasive procedures, skilled in interpreting X rays, ultrasounds and CT and other imaging techniques. While surgery was the only available option for a number of conditions a few years back, these days the expertise of Interventional radiologists with imaging technique enables them to guide small catheters, that are only a few millimeters in diameter and guide wires through blood vessels or other organ pathways to treat many conditions. Diseases and conditions are diagnosed and treated percutaneously with minimally invasive procedures.

Benefits and uses of Interventional radiology

This is an imaging technique using cutting-edge equipment for accurate diagnosis and treatment, a minimally invasive procedure through a small nick in the skin, minimizing the patient's discomfort and recovery time. These days, there is hardly any area in hospital medicine where IR has not impacted patient management.

These procedures require only local anesthesia, and short stays at the hospital. Sick patients who are unfit to undergo surgery can also undergo these techniques. Recovery post IR procedure is less painful than when the patient undergoes surgical procedures.

These image guided medical procedures use CT, MRI, fluoroscopy and ultrasound to view targeted areas. This makes the vessels clearly visible under imaging. A thin catheter is used to deliver the contrast material into a particular blood vessel and shows the inside of the vessel allowing the radiologist to locate blockages. Some examples of interventional radiology procedures include:

• Angiography or Angioplasty
  
• Stent placement
  
• Control bleeding with Embolization
  
• Tumor embolization
  
• Vertebroplasty and Kyphoplasty
  
• Needle biopsies for different organs including lungs and thyroid gland
  
• Tumor ablation
  
• Breast biopsy by stereotactic or ultrasound techniques
  
• Uterine artery embolization
  
• Feeding tube placement
  
• Venous access catheter placement

Using Interventional radiology

By minimizing the physical trauma to the patient, non-surgical interventions also reduce infection rates and recovery time and shorten hospital stays.

• Blood vessel disease such as narrowing of arteries leading to restricted flow of blood
  
• Expanded arteries at risk of rupture and bleeding
  
• Bleeding or hemorrhage which is the most common vascular emergency treated by IR.
  
• Blood clots in the lung
  
• Dilated veins or varicose veins that most commonly occur in the legs but can occur in the pelvis and scrotum and can be treated by blocking the vein by heat treatment or using embolization techniques.
  
• Tumor therapies in liver intended to shrink or destroy them in their primary site.
  
• Kidney and other tumors by destructive therapies
  
• Uterine fibroids which cause heavy menstrual bleeding and pain caused by benign tumors called fibroids
  
• Kidney stones that can cause pain
  
• Infection and blockage in the kidney and gall stones, one of the most common upper abdominal disorders.

Menorrhagia

Menorrhagia refers to excessive loss of blood during menstruation. Many pre-menopausal women experience menorrhagia as a response to erratic hormonal activity. The endometrium may develop in excess due to hormonal imbalance and lead to heavy menstrual bleeding. Uterine polyps can lead to cases of menorrhagia. Polyps occur due to excessive hormone production or consumption.

Uterine fibroids or tumors can trigger off heavier than normal menstrual bleeding or prolonged menstrual bleeding. Women suffering from pelvic Inflammatory disease, thyroid problems and liver or kidney disease are also likely to notice excessive bleeding. In rare cases, menorrhagia is caused due to deficiency of vitamin K. Women who use IUD for birth control are likely to face excessive menstrual bleeding. Cancers of the female reproductive organs such as cervix cancer, ovarian cancer and uterine cancer cause excessive bleeding.

Tranexamic acid tablets are often prescribed to reduce excessive blood loss during menstruation. It is taken at the beginning of the period and does not stop menstrual bleeding. Tranexamic acid is not a contraceptive. It works on helping the blood in the uterus to clot. Often it is combined with an NSAID. Possible side effects include indigestion, diarrhea, headache and back pain. If the patient has a history of blood clots, tranexamic acid might not be advised.

Endometrial sampling is taken to check for cause of menorrhagia. Hysteroscopy and vaginal ultrasound aids in clinical diagnosis. Once the cause for excessive bleeding is identified, treatment is undertaken accordingly. Thyroid malfunction is treated with medication or birth control pills. Hysterectomy is performed for women who suffer prolonged heavy menstrual bleeding.