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What Are Uterine Fibroids?

Uterine fibroids (UF), also known as uterine leiomyomata, are the most common non-cancerous tumors in women of childbearing age. The tumors arise from muscle cells and other tissues within the wall of the uterus. Fibroids can occur as individual tumors, or as clusters of tumors of varying sizes.

Subserosal fibroids
These fibroids develop in the outer portion of the uterus and continue to grow outward.

Intramural fibroids
The most common type of fibroid. These develop within the uterine wall and expand making the uterus feel larger than normal (which may cause "bulk symptoms").

Submucosal fibroids
These fibroids develop just under the lining of the uterine cavity. These are the fibroids that have the most effect on heavy menstrual bleeding and the ones that can cause problems with infertility and miscarriage.

Pedunculated Fibroids
Fibroids that grow on a small stalk that connects them to the inner or outer wall of the uterus.

Until today, treatment for symptomatic uterine fibroids was noninvasive and provided only short-term symptom relief or required some form of invasive surgery. As a result many patients suffer with symptoms, taking a wait-and-see approach.

In MONTH 2004 the FDA approved ExAblate® 2000, which uses Magnetic Resonance guided Focused Ultrasound for noninvasive treatment of uterine fibroids, offering patients an important new treatment option.

Who Gets Uterine Fibroids?

According to the U.S. National Institutes of Health, at least 25 percent of women suffer from uterine fibroids. As many as 77 percent of women may actually have the condition, but may be unaware of it because they exhibit few or no symptoms.

Although the cause of UF is still unknown, several factors have been found to increase or decrease the risk of developing them:

• African-American women have a three to five ti-mes greater risk for developing UF than Caucasian women.
• Women who are obese or overweight have a slightly higher risk for developing UF than women of normal weight.
• Women who have given birth have a lower risk of developing UF than women who have not.

What are the symptoms of Uterine Fibroids?

Symptoms of UF include:

• Heavy bleeding or painful periods
• Bleeding between periods
• Feeling "full" in the lower abdomen
• Frequent urination (resulting from a fibroid pressing on the bladder)
• Pain during sex
• Lower back pain

How Are Uterine Fibroids Treated?

The choice of treatment depends on several factors including degree and frequency of symptoms, fertility considerations, fibroid size, patient age and a patient's willingness to undergo invasive procedures. Upon detection of UF, if symptoms are not severe, women are often counseled to take a watchful waiting approach to see if symptoms worsen. Pain medication (over the counter or by prescription) may be sufficient to treat intermittent pain or mild symptoms. For women with more severe symptoms, the goal of therapy has been to remove or reduce the size of the tumor(s).

Treatment options for symptomatic UF include:

• Hormonal therapy: Use of gonadotropin-releasing hormone agonists (GnRH) or anti-hormonal agents, such as mifepristone, to slow or stop the growth of fibroids by blocking production of the hormones that regulate menstruation. This treatment provides temporary relief of symptoms, but fibroids grow back once therapy is stopped.
• Hysterectomy: Surgical removal of the uterus, usually used when a woman's fibroids are large or cause heavy bleeding. Hysterectomy is the most common surgical procedure for UF and more than 200,000 women in the US undergo hysterectomy each year as a treatment for the disease. Hysterectomy requires a three to four day hospital stay and a recovery time of approximately six to eight weeks.
• Myomectomy: Surgical excision of the tumor, leaving the healthy areas of the uterus in place. This procedure may preserve a woman's ability to have children. Myomectomy requires a hospital stay of several days and a recovery time of two to four weeks.
• Uterine artery embolization (UAE): Blocking the blood vessels that supply the tumor by injecting small particles into the arteries feeding the uterus. Fibroids are deprived of oxygen and nutrients, causing them to shrink and die. UAE often requires a day of hospitalization and a week of recovery time.
• Magnetic Resonance guided Focused Ultrasound: Non-invasive treatment of the tumor using Magnetic Resonance guided Focused Ultrasound. The patient lies inside the MRI scanner and highly focused ultrasound waves are directed into the body. At the focal point, the ultrasound waves raise the temperature of the tissue, leading to its destruction. ExAblate is an outpatient procedure and has minimal recovery time, with patients typically returning to their normal daily activities within one to two days.

Societal cost of UF

The direct costs alone associated with hysterectomy and myomectomy are estimated at more than $1 billion annually and could be as high as $3 billion. These costs do not take into account additional expenses incurred because women may not be able to fulfill home duties or loss of salary -- or the negative psychological impact of UF treatments on patients.

UFs result in more inpatient hospital days than AIDS, breast cancer, dementia, cirrhosis, prostate cancer or epilepsy. Women lose 5-10 million work-days annually because of fibroids. In addition, many women have their activities limited, and their quality of life suffers.

Because it is performed on an outpatient basis, the ExAblate procedure has the potential to be a more cost-effective therapy compared with current invasive treatment strategies.