Uterine artery embolization (Full Version)

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kalikshama -> Uterine artery embolization (2/16/2012 10:55:27 AM)

My GYN is recommending Uterine artery embolization because of the symptoms caused by my fibroids.

Menopause will shrink the fibroids but judging from my Mom, I am five years off and I don't know if I can deal with the monthly hemorrhaging and tiny bladder for another 5 years.

Last week, I had a pelvic MRI with contrast dye Wed and Fri the worst period of my life, so was kind of gearing up for surgery before I read this:

Significant adverse effects resulting from uterine artery embolization have been reported, serious adverse effects are approximately four times less frequent than for hysterectomy.[2]

Adverse effects that have been reported include death from embolism, or septicemia (the presence of pus-forming or other pathogenic organisms, or their toxins, in the blood or tissues) resulting in multiple organ failure.[3]

Infection from tissue death of fibroids, leading to endometritis (infection of the uterus) resulting in lengthy hospitalization for administration of intravenous antibiotics.[4]

Misembolization from microspheres or polyvinyl alcohol (PVA) particles flowing or drifting into organs or tissues where they were not intended to be, causing damage to other organs or other parts of the body.[5]

Ovarian damage resulting from embolic material migrating to the ovaries. Loss of ovarian function, infertility[6], and loss of orgasm.

Failure of embolization surgery- continued fibroid growth, regrowth within four months.

Menopause - iatrogenic, abnormal, cessation of menstruation and follicle stimulating hormones elevated to menopausal levels.[7]

Post-Embolization Syndrome (PES) - characterized by acute and/or chronic pain, temperatures of up to 102 degrees, malaise, nausea, vomiting and severe night sweats.

Foul vaginal odor coming from infected, necrotic tissue which remains inside the uterus. Hysterectomy due to infection, pain or failure of embolization.[8]

Severe, persistent pain, resulting in the need for morphine or synthetic narcotics.[9]

Hematoma, blood clot at the incision site. Vaginal discharge containing pus and blood, bleeding from incision site, bleeding from vagina, fibroid expulsion (fibroids pushing out through the vagina), unsuccessful fibroid expulsion (fibroids trapped in the cervix causing infection and requiring surgical removal), life threatening allergic reaction to the contrast material, and uterine adhesions.

If any of you have had a UAE, what was your experience?

I'm off to the gym and when I get back will write about the lifestyle approaches I've used to attempt to manage the fibroids, mostly derived for Dr. Christiane Northrup's "Women's Bodies, Women's Wisdom."



Aylee -> RE: Uterine artery embolization (2/16/2012 11:04:54 AM)

http://www.ncbi.nlm.nih.gov/pubmed/18331704

quote:

Data were available for 1108 women (649 UAE and 459 hysterectomy). Fewer complications were experienced by women in the UAE cohort compared to the hysterectomy cohort: hysterectomy n = 120 (26.1%), UAE n = 114 (17.6%), adjusted odds ratio 0.48 [95% confidence interval (CI) 0.26 to 0.89]. When only the severe/major complications were considered, this odds ratio was reduced to 0.25 (95% CI 0.13 to 0.48). Expected general side-effects of UAE occurred in 32.7% of the UAE cohort, of which 8.9% also experienced complications. Obesity and medical co-morbidity predisposed women to complications, whereas prophylactic antibiotics appeared to protect against both complications and the expected side-effects of UAE. More women in the hysterectomy cohort reported relief from fibroid symptoms (89% versus 80% UAE, p less than 0.0001) and feeling better (81% versus 74% UAE, p less than 0.0001), but only 70% (compared with 86% UAE, p = 0.007) would recommend their treatment to a friend. In the UAE cohort, 18.3% of the women went on to receive one or more further fibroid treatments including hysterectomy (11.2%). After adjusting for differential time of follow-up, the UAE women had up to a 23% (95% CI 19 to 27%) likelihood of requiring further treatment. The free-text data indicated that many women, in both cohorts, felt that their treatment had been a complete success. In the UAE cohort there were several areas where expectations were apparently high and outcome had not fulfilled their expectations. Disappointment was expressed mainly about continuation or return of symptoms or failure to become pregnant. Many continued to have remaining questions about their treatment. The economic analysis indicated that UAE is less expensive than hysterectomy even after further treatments for unresolved or recurrent symptoms are taken into account, with little difference in QALYs between the two treatments. Younger women are exposed to the risk of recurrent fibroids and subsequent additional procedures over a longer period and consequently UAE may no longer be cost-effective.


A hysterectomy may be more effective, but women are more likely to recommend UAE than a hysterectomy.



LafayetteLady -> RE: Uterine artery embolization (2/16/2012 12:33:11 PM)

Personally, I would go with a hysterectomy.  I think the recommendations Aylee found are likely based on so many women's obsession with their uterus defining them as a woman.

You have to remember while menopause tends to alleviate fibroids, menopause is not an overnight process.  You say based on your mother, you are five years off.  I assume that is from the start, so you have to add to that the time that your periods are all over the map as well.  I didn't look for any studies, but I'm willing to bet that with the fibroids, menopause is not going to be comparable to your mom's unless she also had fibroids.

I have uterine fibroids.  I started menopause very early and have been dealing with it for about 10 years.  While that isn't "standard" it isn't abnormal either.  It seems to finally be coming to an end, but I still wish I had a hysterectomy when things first went haywire.



Lucylastic -> RE: Uterine artery embolization (2/16/2012 12:39:34 PM)

Kali, my thoughts are with you hon, I had my tumour and cysts removed back in June, but already Im back to the monstrous flooding and pain. Ive already given the doc shit for not taking it out when he said he was going to. Not had an UAE but I just wanted to wish you the best of luck and some relief. I can truly empathise!



fucktoyprincess -> RE: Uterine artery embolization (2/16/2012 1:45:21 PM)

I don't have any knowledge about this to share, but just wanted to wish you well as you sort out the options.



kitkat105 -> RE: Uterine artery embolization (2/16/2012 4:29:58 PM)

I don't have personal experience with it, but I know some women in my workplace have gone for either embolization or hysterectomy. I think the women who went with hysterectomy are generally happier with their decision.

Best of luck either way.



kalikshama -> RE: Uterine artery embolization (2/16/2012 5:44:56 PM)

Thanks all!

Lucy, I remember your having surgery - what did they do and not do? What's causing this now?

quote:

I had my tumour and cysts removed back in June, but already Im back to the monstrous flooding and pain. Ive already given the doc shit for not taking it out when he said he was going to.



LadyHibiscus -> RE: Uterine artery embolization (2/16/2012 6:36:10 PM)

Kali, I would push for a hysterectomy. It's a sure solution.



kalikshama -> RE: Uterine artery embolization (2/17/2012 4:40:39 PM)

I'm considering Focused Ultrasound (FUS / ExAblate) which is noninvasive, but new, so probably not offered by the VA.

http://www.fibroids.net/fibroids.html

MRI-guided focused ultrasound surgery (FUS) is a noninvasive treatment option for uterine fibroids that preserves your uterus.

This procedure is performed inside a specially crafted MRI scanner that allows your doctors to visualize your anatomy, and then locate and destroy (ablate) fibroids inside your uterus without making an incision. Focused high-frequency, high-energy sound waves are used to target the proteins in fibroids, until they are denatured and cell death occurs, thus destroying the fibroids. Concurrent MRI allows precise targeting of tissue and monitoring of therapy by assessing the temperature of treated tissue. A single treatment session is done in an on- and off fashion, sometimes spanning several hours. The advantages of this procedure are a very low morbidity and a very rapid recovery, with return to normal activity in 1 day, but its long-term effectiveness is not yet known. Presently, the procedure is not recommended for women who desire future fertility. See a video about focused ultrasound treatment for fibroids.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3036536/

http://www.reuters.com/article/2009/01/28/idUS181078+28-Jan-2009+BW20090128



LafayetteLady -> RE: Uterine artery embolization (2/17/2012 5:02:24 PM)

I'm just curious...is there a reason you would opt for something experimental with unproven results as opposed to a hysterectomy that will definitively resolve the problem?



JstAnotherSub -> RE: Uterine artery embolization (2/17/2012 5:12:45 PM)

Good luck, whatever you do. This getting older aint for pussies.

My vagina, which I have loved and cared for, for nearly a half a century, has decided to quit self lubing, and it fucking hurts, but there is a cream for it. (hahahaha typing that made me crack up for some reason, the "there is a cream for it", I blame the porch).

Anyhow, since I still have a uterus, I have to take progesterone (I think that is it), I offered to lay back on the table and throw my legs up in the stirrups and let her have my uterus, but, she declined.

Fucking doctors.



MariaB -> RE: Uterine artery embolization (2/18/2012 11:33:12 AM)

Why is your doctor not offering you a myomectomy? You have fibroids not cancer. A fibroid or fibroids are removable without amputating your uterus or shutting it down.
Before considering a hysterectomy, make sure the consent to operate is given by a well informed you. So many women just say, oh chop it out, its a nuisance and I don't need it anymore. Doctors tell women that having their womb removed is inconsequential. It’s a fantasy dished out to women every second of every day.
Are you aware that the uterus is a hormone responsive sex organ and that removal of it impacts every cell in a woman’s body and increases her risk of heart disease three times that of women with a uterus. Are you aware that when the uterus stops working or is removed, the ovaries normally shut down within 2 years?

Please watch this before making any decisions http://www.hersfoundation.org/anatomy/



LadyHibiscus -> RE: Uterine artery embolization (2/18/2012 1:12:35 PM)

"Amputating" the uterus? Isn't that a little dramatic? Sometimes (No, not ALWAYS) it really is the right decision.



MariaB -> RE: Uterine artery embolization (2/18/2012 1:30:00 PM)


quote:

ORIGINAL: LadyHibiscus

"Amputating" the uterus? Isn't that a little dramatic? Sometimes (No, not ALWAYS) it really is the right decision.


No I don't think amputation is a harsh word at all. A hysterectomy is dramatic, not the word amputation. If I had cancer of the uterus then I wouldn't hesitate to have my uterus removed. I had alternative treatment for fibroids and ovarian cysts. My gynecologist was quick to say, 'lets whip out the troublesome beast' but knowing and understanding how important my uterus and ovaries are and knowing that I didn't have cancer, I insisted on the alternatives. The alternatives worked for me.



LadyHibiscus -> RE: Uterine artery embolization (2/18/2012 1:31:29 PM)

I used alternative treatments myself, and they worked for me, too.



AttitudyJudy -> RE: Uterine artery embolization (2/18/2012 3:07:50 PM)

I'm lucky enough to have a healthy uterus....so far....but I would be inclined to exhaust any conservative and alternative approaches before having a hysterectomy. It's not a "Me Woman, Me Keep Uterus" thing, it's just not really wanting to have ANY organs removed surgically unless I absolutely have to.



LafayetteLady -> RE: Uterine artery embolization (2/19/2012 4:57:25 PM)

Which is totally understandable, and I am all for trying the alternative treatments.  However, when they continuously fail for a person (I know they work for many), it is time to start considering it.

When it is a young woman of child bearing age, trying every alternative treatment available that will leave the uterus and overies intact, and hopefully functional for bearing children is the best thing to do.  When you are talking about a woman who is past child bearing, is suffering terrible pain, it is totally inappropriate to expect them to wait five years or more until menopause and hope that solves the problem.  After menopause, the uterus and ovaries are not important and don't serve any function.



kalikshama -> RE: Uterine artery embolization (2/20/2012 5:11:59 AM)

quote:

When you are talking about a woman who is past child bearing, is suffering terrible pain, it is totally inappropriate to expect them to wait five years or more until menopause and hope that solves the problem.


Are you referring to me? I have barely noticeable pain that isn't worth mentioning. You may be thinking of Lucy.

quote:

After menopause, the uterus and ovaries are not important and don't serve any function.


The Hysterectomy Epidemic: Where's the Outrage?

...An expert panel looked into the issue in 2000 as part of the Women’s Health and Hysterectomy Project, conducted by a branch of the U.S. Department of Health and Human Services. The panel developed its own criteria for when hysterectomy was appropriate and also considered criteria set by the American Congress of Obstetricians and Gynecologists (ACOG). Their findings: 70 percent of the hysterectomies were recommended inappropriately according to their criteria, and 76 percent didn’t meet the criteria of the ACOG.

Using the 70 percent estimate, a staggering 420,000 women every year might be able to avoid a hysterectomy. And since half these women usually lose their ovaries, 210,000 could avoid the additional threat to their health that is the consequence of that loss. (Of the 210,000 whose ovaries are conserved, somewhere between 15 and 30 percent lose ovarian function anyway.)

I would argue that what’s partly responsible for this epidemic of unnecessary surgery is the sexist attitude that the uterus and ovaries are strictly reproductive organs, essentially useless after child bearing. In fact, they are sex organs, and removing them brings about sudden, and irreversible changes to their sex lives and puts them at greater risk for heart disease and heart attack, early death, dementia, osteoporosis and incontinence, with the degree of added risk depending on a woman’s age at the time of surgery. These risks come as a surprise to most women because most gynecologists continue to offer hysterectomy as the routine, standard, unremarkable cure for problems such as fibroids (non-cancerous tumors), heavy menstrual bleeding and endometriosis. It is shocking that this continues after decades of research and development of alternative procedures, including one of the oldest, removal of the fibroids only.

...The ovaries of post-menopausal women continue to deliver small amounts of hormones that are essential to a woman’s health, including testosterone. Testosterone maintains a woman’s sex drive and bone strength and gives her energy. How many marriages founder because women who’ve lost their ovaries suddenly lose interest in sex? The question has not been adequately studied.

Making matters worse is the horror show of symptoms caused by the “surgical menopause” that is induced by oophorectomy (or by hysterectomy, in the cases in which it causes ovaries to fail). The list includes severe hot flashes, sleeplessness, irritability, depression and even suicidal impulses. And in the long run, surgical menopause channels women into continuing and costly treatment for these symptoms—all avoidable by leaving women in their natural state.



kalikshama -> RE: Uterine artery embolization (2/20/2012 5:24:36 AM)

quote:

I'm just curious...is there a reason you would opt for something experimental with unproven results as opposed to a hysterectomy that will definitively resolve the problem?


FUS is non-invasive.

While a hysterectomy would resolve the fibroid problem, it is likely to bring about a host of new ones. I prefer Dr. Christiane Northrup on the subject but since I can't copy and paste from her books, here's wiki:

Hysterectomy has like any other surgery certain risks and side effects.

Mortality and surgical risks

Short term mortality (within 40 days of surgery) is usually reported in the range of 1-6 cases per 1000 when performed for benign causes. Risks for surgical complications are presence of fibroids, younger age (vascular pelvis with higher bleeding risk and larger uterus), dysfunctional uterine bleeding and parity.[26]

The mortality rate is several times higher when performed in patients that are pregnant, have cancer or other complications.[27]

Long term effect on all case mortality is relatively small. Women under the age of 45 years have a significantly increased long term mortality that is believed to be caused by the hormonal side effects of hysterectomy and prophylactic oophorectomy.[28]

Approximately 35% of women after hysterectomy undergo another related surgery within 2 years.

Ureteral injury is not uncommon and can range from 2.2% to 3% depending on whether the modality is abdominal, laparoscopic, or vaginal. The injury usually occurs in the distal ureter close to the infundibulopelvic ligament or as a ureter crosses below the uterine artery, often from blind clamping and ligature placement to control hemorrhage.[29]

Convalescence

Hospital stay is 3 to 5 days or more for the abdominal procedure and between 2 to 3 days for vaginal or laparoscopically assisted vaginal procedures.

Time for full recovery is very long and independent on the procedure that was used. Depending on the definition of "full recovery" 6 to 12 months have been reported. Serious limitations in everyday activities are expected for a minimum of 4 months.

Unintended oophorectomy and premature ovarian failure

Removal of one or both ovaries is performed in a substantial number of hysterectomies that were intended to be ovariesparing.[30]

The average onset age of menopause in those who underwent hysterectomy is 3.7 years earlier than average even when the ovaries are preserved.[31] This has been suggested to be due to the disruption of blood supply to the ovaries after a hysterectomy or due to missing endocrine feedback of the uterus. The function of the remaining ovaries is significantly affected in about 40% women, some of them even require hormone replacement treatment. Surprisingly, a similar and only slightly weaker effect has been also observed for endometrial ablation which is often considered as an alternative to hysterectomy.

Substantial number of women develop benign ovarian cysts after hysterectomy.[32]

Premature menopause and its effects

Estrogen levels fall sharply when the ovaries are removed, removing the protective effects of estrogen on the cardiovascular and skeletal systems. This condition is often referred to as "surgical menopause", although it is substantially different from a naturally occurring menopausal state; the former is a sudden hormonal shock to the body that causes rapid onset of menopausal symptoms such as hot flashes, while the latter is a gradually occurring decrease of hormonal levels over a period of years with uterus intact and ovaries able to produce hormones even after the cessation of menstrual periods.

When only the uterus is removed there is a three times greater risk of cardiovascular disease. If the ovaries are removed the risk is seven times greater. Several studies have found that osteoporosis (decrease in bone density) and increased risk of bone fractures are associated with hysterectomies.[33][34][35][36][37][38] This has been attributed to the modulatory effect of estrogen on calcium metabolism and the drop in serum estrogen levels after menopause can cause excessive loss of calcium leading to bone wasting.

Hysterectomies have also been linked with higher rates of heart disease and weakened bones. Those who have undergone a hysterectomy with both ovaries removed typically have reduced testosterone levels as compared to those left intact.[30] Reduced levels of testosterone in women is predictive of height loss, which may occur as a result of reduced bone density,[39] while increased testosterone levels in women are associated with a greater sense of sexual desire.[40]

Oophorectomy before the age of 45 is associated with a fivefold mortality from neurologic and mental disorders.[41]

Urinary incontinence and vaginal prolapse

Urinary incontinence and vaginal prolapse are well known adverse effects that develop with high frequency a very long time after the surgery. Typically, those complications develop 10–20 years after the surgery.[42] For this reason exact numbers are not known, and risk factors are poorly understood. It is also unknown if the choice of surgical technique has any effect. It has been assessed that the risk for urinary incontinence is approximately doubled within 20 years after hysterectomy. One long term study found a 2.4 fold increased risk for surgery to correct urinary stress incontinence following hysterectomy [43][44]

The risk for vaginal prolapse depends on factors such as number of vaginal deliveries, the difficulty of those deliveries, and the type of labor.[45] Overall incidence is approximately doubled after hysterectomy.[46]

Effects on social life and sexuality

Some women find their natural lubrication during sexual arousal is also reduced or eliminated. Those who experience uterine orgasm will not experience it if the uterus is removed. The vagina is shortened and made into a closed pocket and there is a loss of support to the bladder and bowel.[specify]

Other rare problems

Hysterectomy may cause an increased risk of the relatively rare renal cell carcinoma. Hormonal effects or injury of the ureter were considered as possible explanations.[47][48]

Removal of the uterus without removing the ovaries can produce a situation that on rare occasions can result in ectopic pregnancy due to an undetected fertilization that had yet to descend into the uterus before surgery. Two cases have been identified and profiled in an issue of the Blackwell Journal of Obstetrics and Gynecology; over 20 other cases have been discussed in additional medical literature.[



kalikshama -> RE: Uterine artery embolization (2/20/2012 5:30:47 AM)

quote:

"Amputating" the uterus? Isn't that a little dramatic? Sometimes (No, not ALWAYS) it really is the right decision.


I'm in the "castration" camp.

From the same article I quoted above:

The Hysterectomy Epidemic: Where's the Outrage?

...Women react with horror to clitoridectomies because of the savagery of the cutting and because they know it means a life-long loss of pleasure. But so do hysterectomies. Many, although not all women, feel their orgasms in their uteruses. When that organ is gone, they will never enjoy that intensity of feeling again. I know because I did enjoy such orgasms, a whole-body rush with my uterus rhythmically contracting. I now realize with regret that I could have avoided that loss with surgery to simply remove the tumors. My female gynecologist led me to believe there was no alternative. I was in my early 40’s; the average age of women undergoing hysterectomy is 42.

Can you imagine men reacting calmly to loss of feeling in their sex organs? What would they do after they learn that the loss could have been avoided? Or how about suggesting to a man that because he’s had all his children, he might as well have his testicles removed to avoid the slim chance of testicular cancer? Do you think doctors would dare make that suggestion? Yet women I’ve interviewed say their doctors use fear of rare ovarian cancer to justify removal of healthy ovaries. Lacking good information about the actual risks, they often consent.

...It’s time for hysterectomy to become a feminist issue. It’s time to ask ourselves why we give up our sex organs so easily. Why are we willing to wear 5-inch heels, to bleach, shave, starve, decorate, lift, implant, glue and lace ourselves into sexy versions of ourselves—while we meekly give up sexual pleasure? And then shut up about the consequences to our health?

It’s time we had compassion for the women who have yet to face this potentially unnecessary pain. Our sexuality is diminished, our health endangered by hysterectomy and ooophorectomy. It’s time to call these operations by their rightful name—castration—and to say no, this will not continue.



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