They consist of swollen muscle fibers and connective tissue and are “fed” by the arteries of the uterus.

“They are the most common benign tumors of women and occur in 20-40% of women between the ages of 30 and 50,” as reported by Ms. Emmanuel Theodoropoulos, Michael Glynos and Nikolaos Plevris of the Fibroid Treatment Group of Metropolitan General, who then explain what we would like to know about their diagnosis and minimally invasive treatment with embolization:

The types of fibroids and their symptoms

Fibroids can develop in different parts of the uterus.

• The intramurally fibroids are the most common. Because they grow inside the muscular wall of the uterus, they give the impression that the size of the entire uterus is also increasing. They cause heavy bleeding during periods, pelvic pain, symptoms of pressure on the bladder or bowel, low back pain.
• The hypogonads Fibroids are the most common after intramural. Because they grow under the outer wall of the uterus, they cause less menstrual bleeding and more pelvic pain and symptoms of bladder or bowel pressure.
• The submucosa fibroids that develop under the inner wall of the uterus, usually cause heavy bleeding during the menstrual cycle.
• The petioles fibroids that grow inside or outside the uterus, but are attached to the uterus by a thin stalk. The symptoms caused by pedunculated fibroids are most often pressure and pain as their stalk can be pressed by surrounding organs or by the growing fibroid itself.

Usually a woman has more than one fibroids that can be of different sizes and develop in different areas of the uterus.

What are the most common symptoms?

Depending on the size, location and number of fibroids, the woman may experience:

• “Heavy” period also called Menorrhagia. Prolonged and profuse discharge of blood and clots from the uterus and vagina during menstruation can cause anemia
• Increased pain during period days
• Pain, pressure or discomfort in the pelvic area
• Pain in the lower back or legs
• Urinary frequency and difficulty urinating due to pressure on the bladder
• Constipation or bloating due to pressure on the bowel
• Abdominal swelling

How are fibroids diagnosed?

A gynecologist can diagnose fibroids during a routine gynecological exam. Additional tests that confirm the diagnosis are ultrasound and magnetic resonance imaging.

What treatments are there for fibroids?

The treatment of fibroids depends on the size, location and severity of the symptoms they cause. If they do not cause symptoms, the doctor will decide that there is no need for treatment. But if they provoke, then the woman has the following options:

• Medication: It includes medicines to control symptoms. Nonsteroidal anti-inflammatory drugs (NSAIDs), birth control pills, and hormone therapy (GnRHa) have been used to control symptoms.

• Surgical treatment: There are two types of surgery:

THE fibromyectomy removes fibroids leaving the uterus intact. Depending on the location and size of fibroids, it can be done through an incision in the pelvis (open surgery), or laparoscopically (through 3-4 holes in the lower abdomen) or through the vagina and cervix.

THE hysterectomy is the traditional surgery to remove the uterus and cervix. The fibroids are removed together with the uterus and the woman enters menopause, losing the ability to have children.

• Non-Surgical treatment – Embolization of fibroids

Fibroid embolization is a minimally invasive non-surgical method that preserves the integrity and functions of the uterus. It is performed by Interventional Radiologists, who are specially trained to use Radiology methods to guide very small catheters into the body’s vasculature and organs, treating many different conditions.

• The transvaginal cauterization of fibroids using radio frequencies (radiofrequency ablation) under ultrasound guidance is another therapeutic method that has developed significantly in recent decades. It has ideal results in small (<5cm) fibroids and in women who want to have children.

How is fibroid embolization done?

The embolization takes place in the Digital Angiography room, where the interventional radiologist can guide very small catheters, through the network of vessels, to the points he wants under continuous fluoroscopic control. The operation is usually performed with the woman awake and with the use of mild systemic analgesia.

1. A very small hole 1.5 mm long is made in the thigh area through which a small catheter enters the network of arteries
2. The catheter is guided through the network of arteries to the arteries that supply the uterus, while the interventional radiologist confirms the correct position of the catheter with the help of fluoroscopy (fluoroscopy is a radiological method that uses X-rays to visualize live on a monitor the system under consideration)
3. Very small pellets (like grains of sand) are injected through the catheter into the artery that supplies blood to the fibroids, cutting off the blood flow.
4. Most of the time the procedure is repeated from the opposite side of the uterus through the same skin hole and with the same catheter.

Once the blood flow to the fibroids is cut off, the bleeding stops. Over the next few weeks the fibroids shrink in size. Most women experience less pain and swelling and of course less bleeding.

The average woman’s return to work and normal daily activities is about one week. The main reason he doesn’t come back sooner is the “metabolic syndrome” whose symptoms resemble those of the flu (low-grade fever, malaise, diarrhea).

The gynecologist and the interventional radiologist are in close communication with the woman so that she can return to her normal activities as quickly and without problems.

More and more women nowadays are choosing to keep their uterus and avoid a long recovery from surgery by choosing embolization as a non-surgical, minimally invasive treatment technique for fibroids.

More information at inomiomata.gr.

Metropolitan General Fibroid Treatment Group:

Emmanuel TheodoropoulosInterventional Radiologist, Director of Interventional Radiology Metropolitan General

Michael GlynosInterventional Radiologist, Director of Interventional Radiology Metropolitan General

Nikolaos PleurisObstetrician-Gynaecologist, Director of the 1st Gynecological Clinic Metropolitan General

*Metropolitan General

At Metropolitan General has been created the “Fibroid Treatment Group” staffed by experienced Interventional Radiologists and Gynecologists. For each woman who addresses the group, a detailed history is taken, a clinical examination is performed, the necessary laboratory and imaging tests (Ultrasound, Magnetic Tomography) are reviewed. Minimally invasive or surgical treatments are then proposed based on modern guidelines and the latest literature, as well as the individualized approach of each woman (severity of symptoms and impact on quality of life, age, willingness to have children, size and location of fibroids, personal preferences ). The woman can also receive in writing the proposal of the Fibroid Group Council where they provide an opinion – in addition to the Interventional Radiologist and Gynecologist – and a specialist in gynecological issues, a Radiologist as well as an Oncologist and an Anesthesiologist.

The treatment proposal for each woman sets out the most appropriate treatment methods with the advantages and disadvantages of each, as well as the treatment plan and the return to her daily normal activities.

The extensive experience of Interventional Radiologists in the embolization operations of benign and malignant tumors, hemorrhages, aneurysms and malformations, combined with the latest generation Allura Philips Digital Angiograph of Metropolitan General, guarantee the best therapeutic result for fibroid embolization techniques.

On the other hand, the Gynecologists’ special experience in laparoscopic and robotic techniques, combined with the advanced Da Vinci XI Robotic System, offer surgical procedures with reduced recovery time and minimized risk of complications, allowing the woman to return to her daily life faster.