HHE Radiology and imaging supplement 2018 | Page 20

radiology and imaging
Radiological treatments
for uterine fibroids
Options for treating uterine fibroids have increased, including uterine artery embolisation and
MRI-focused high intensity ultrasound, but patient preference and tailored treatment still remain key
Vikram Talaulikar
MD MRCOG PhD
Ertan Saridogan
MD PhD FRCOG
Reproductive Medicine
Unit, University College
London Hospital NHS
Trust, London, UK
Uterine fibroids (also known as myomas or
leiomyomas) are benign tumours characterised
by the proliferation of uterine smooth muscle
cells and associated collagen matrix. They are
the most common benign tumours in women
of reproductive age. They are estimated to be
symptomatic in 50% of women who have them,
with the peak incidence of symptoms occurring
among women in their 30s and 40s. 1 Uterine
fibroids are thought to result from increased
mitotic activity within the myometrium under
the influence of female hormones; however,
what initiates the fibroid growth is not yet clear.
Symptoms from fibroids depend on size and
position of the fibroids. Symptoms include
bleeding disturbances (usually heavy and
prolonged periods, sometimes frequent and
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HHE 2018 | hospitalhealthcare.com
unpredictable bleeds), pressure symptoms
(bladder and bowel symptoms, bloating, chronic
pelvic pain and dyspareunia) and subfertility. 2
While bleeding disturbances are more suggestive
of submucosal or intramural fibroids which
distort the endometrial cavity, pressure symptoms
depend on the fibroid size and the extent to
which fibroids encroach on the surrounding
pelvic structures. The impact of fibroids on
fertility remains controversial but most clinicians
recommend surgical removal of fibroids
distorting the endometrial cavity to improve
chances of conception.
Asymptomatic women with small fibroids may
benefit from expectant management, especially
those approaching the menopause. Surgical
treatments such as hysterectomy and