Uterine Fibroids
Fibroids are the most common benign pelvic tumour in women. Fibroids account for 1 in 5 gynaecological out patient attendances and are a significant drain on health care resources. Estimated that 50 % of all women have fibroids but not all are symptomatic. Depending on their site and size, fibroids may present with heavy bleeding, pain, pressure symptoms (bladder and bowel) infertility and pregnancy complications (early and late miscarriage, premature delivery).
Historically, mainstay of treatment has been surgical when medical treatments fail. Hysterectomy and myomectomy are associated with significant hospital in patient stays together with a lengthy convalescent period and invariably have an adverse effect on fertility. During the last decade we have pioneered minimally invasive thermoablation treatment techniques for uterine fibroids in order to preserve fertility and minimise subsequent pregnancy complications.
The first generation studies utilised MR guided percutaneous laser technology to ablate the fibroids and we were able to demonstrate the safety and efficacy of this technique together with the added advantage that it could avoid lengthy hospital admissions. More recently, we have developed a completely non-invasive treatment – MR guided focussed ultrasound (MRgFUS) for uterine fibroids. St Mary’s is the only UK site (70 worldwide) to offer this treatment for uterine fibroids and we now have experience of more than 500 procedures. The availability of real time MR thermal imaging has revolutionised this field of translational research. We can now offer an effective thermoablation therapy that does not even breach the skin, is delivered in an outpatient setting with minimal sedation and the woman can return to work the next day. Significant improvement of symptoms as assessed with validated Quaility of Life questionnaires are achieved in 80% of cases.
We have now embarked on further studies to evaluate whether we can further improve th treatment response by using the Gonadotrophin releasing hormone agonist drugs pre and post MRgFUS treatment to reduce the size and vascularity of the fibroids and potentiate the thermoablation effect, thereby allowing us to offer this therapy to women with very large fibroid volumes who have hitherto been excluded from this successful treatment option.
