By: Jean Johnson for Fibroids1“My periods were astoundingly heavy and pressure on my bladder made me feel like I had to go all the time,” Cece Clark told Health magazine. But after Clark tried ultrasound treatment for her fibroids, Health said in its July/August 2006 issue, “everything changed.”
“The pressure lessened right away,” Clark reported. “It was such a physical and emotional relief.”
Why Ultrasound?
Symptomatic fibroids can cause the distressing problems of heavy bleeding, pelvic pressure, and pain. Fibroids are also the condition behind 160,000 women in the United States resorting to hysterectomies annually.
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The following criteria were used by the Mayo Clinic research team to evaluate women as candidates for MRI-guided focused ultrasound:
Score above 20 on a validated symptom severity scale
Free of other pelvic pathology requiring surgical intervention
Have a dominant fibroid(s) greater than 3 cm in diameter
Be premenopausal
Indicated they have completed childbearing |
Because hysterectomies are costly in terms of both dollars and emotional health, over the past decade researchers have worked to develop a range of less invasive treatments for the common problem of fibroids. They have had success with hormonal therapy, myomectomy, and uterine artery embolization. Now those on the forefront are in the relatively early stages of exploring MRI (magnetic resonance imaging) -guided focused ultrasound. Backgrounder
The Mayo Clinic was first to offer MRI-guided focused ultrasound treatment in July 2002 as part of a multi-institutional research effort. Since then, the Mayo Clinic has performed more than 100 focused ultrasound treatments for uterine fibroids. Results from these early trials led to the U.S. Food and Drug Administration (FDA) approving ultrasound as a fibroid treatment in October 2004.
The cost of MRI-guided focused ultrasound – writes lead author of Mayo Clinic research, Gina K. Hesley, M.D., in the July 2006 issue of the Mayo Clinic Protocol – “is typically one half the cost of hysterectomy and one third that of uterine artery embolization.” That said, Hesley notes that since the procedure is relatively new, “supporting documentation and letters of appeal often are required to obtain insurance approval.”
How Ultrasound Works
Ultrasound is conducted with the patient positioned in an MRI chamber feet-first. Because this treatment uses heat to decrease fibroid masses, care must be taken to avoid burning the skin and internal areas of the body proximate to the uterine fibroids.
Prior to treatment, all hair is shaved from the umbilicus to the pubic bone. A urinary catheter is placed along with an I.V. line through which sedative medication is administered. In some cases where the bowel loops in such a way that it could be damaged – and positioning the patient does not get it out of the way – the colon is filled with water to keep it positioned safely.
The ultrasound treatment itself typically lasts three to four hours and is non-invasive. Short bursts of heat are delivered to the fibroids. Mayo Clinic researchers’ experience is that “one hour after the last dose of sedative, most patients report mild to no discomfort. Patients occasionally require over-the-counter medication for pain relief (e.g., acetaminophen, 500 mg every four to six hours, or equivalent) on the day after the procedure, and do not require hospitalization. Most patients return to work the next day.”
Effectiveness and Potential Complications
The Mayo Clinic’s Hesley and her team concluded that ultrasound “is a promising new non-invasive treatment option for women with symptomatic uterine fibroids.”
She added that at the Mayo Clinic, ultrasound gave over half of those patients in the trial either complete or symptomatic relief from both heavy bleeding and pelvic pressure.
Hesley also states that “complications and adverse effects resulting from MRI-guided focused ultrasound treatment are uncommon. However, it is important to be aware of potential complications such as skin burns, nerve damage, and deep venous thrombosis.”
Finally Hesley et al. provide a word on fertility and the appropriateness of ultrasound for women who have not had all the children they desire. “Although MRI-guided focused ultrasound has not yet been approved for women who want to preserve their fertility, a recent article described a successful pregnancy after MRI-guided focused ultrasound treatment of focal adenomyosis.”
In sum, even though ultrasound is currently not recommended for women who wish to have children, it may be in the future and Hesley thinks this aspect of the treatment needs further study.
