If you suffer from heavy or prolonged menstrual bleeding (periods), pelvic pain and pressure, a frequent urge to pee, and low energy due to anemia, you may have uterine fibroids.
Uterine fibroids are the most common noncancerous tumors in women of childbearing age. Fibroids can grow in the muscles and fibers of the uterus (womb).
“It’s estimated that 70% of women will develop fibroids by age 50,” said Colleen Foos, MD, an OBGYN with Banner Health.
Many are not usually serious and simply require monitoring, also known as “watchful waiting.” However, if your fibroids grow, they can cause complications and pain.
Treatment of uterine fibroids
Hysterectomy (the complete surgical removal of the uterus) or myomectomy (the surgical removal of fibroids) used to be traditional surgical options for fibroid treatment. Today, there are several medical and minimally invasive treatment options depending on the severity of the fibroids.
Treatments can range from medications like oral contraceptives and IUDs to pills or injections to reduce the size of fibroids or control bleeding. If you do not desire a future pregnancy, there are two minimally invasive procedures, the Acessa procedure and uterine artery embolization, also known as uterine fibroid embolization (UFE).
If you are exploring alternatives to a hysterectomy or myomectomy, you may have heard about the Acessa and UFE procedures. Both are performed by specially trained medical providers as outpatient procedures, involve short recoveries and are highly effective at shrinking fibroids to reduce pain and other symptoms.
Here’s what you should know about both procedures and how to make an informed decision.
What is the Acessa procedure?
Acessa is an outpatient procedure that uses a technology called radiofrequency thermal ablation (RFA) to heat and destroy fibroid tissue. The surgical procedure is performed laparoscopically (with small incisions in the abdomen and under general anesthesia) by a gynecologist.
“With Acessa, the radiofrequency current is directed only to the fibroid tissue, not to the surrounding tissue or the ovaries,” Dr. Foos said. “It enables most people to keep their uterus while obtaining significant relief from their symptoms.”
Recovery and results
After Acessa, most people go home the same day after the procedure. They can return to work and normal activities within a week.
Your potential timeline to experience complete symptom relief may vary, but 90% of patients notice their symptoms improve. It can also significantly decrease heavy bleeding.
“Generally, you can expect a 77% reduction in the volume of fibroids after one year,” Dr. Foos said. “With the rate of needing another surgery being about 12% three years after Acessa. There is also a 30% chance fibroids may reoccur in the future.”
Due to the nature of the procedure, rare but serious risks and side effects can include blood clotting, blood loss, skin burns, mild inter-operative bleeding and post-procedure discomfort (cramping, pelvic pain).
What is uterine fibroid embolization (UFE)?
UFE is performed by an interventional radiologist in a radiology unit with local anesthesia—meaning you are awake throughout the procedure. Interventional radiologists are trained in techniques that use imaging guidance to provide precise therapy in a minimally invasive way.
During UFE, the radiologist finds the blood vessels supplying blood to the fibroids and injects tiny synthetic particles, or beads, to cut off blood supply to the fibroid.
“This causes the tissue to gradually die over a period of several weeks, which causes relief of symptoms,” Dr. Foos said. “The fibroids will get smaller but may not go away completely.”
Recovery and results
After UFE, many people feel immediate relief and can return to a normal activity level within one to two weeks.
“Studies have shown that approximately 70% of people have no heavy periods, and 80% have less pain after UFE,” Dr. Foos said. “Like with Acessa, fibroids can grow back, with 19% to 38% of patients needing additional treatment two to five years after UFE.”
There is also a minor risk post-op. The dying tissue can cause pain and fever (known as post-ablation syndrome). This is usually managed with over-the-counter pain medications.
“In rare cases, it may require a hospital stay,” Dr. Foos said. “If the plastic material used to embolize the uterine arteries migrates to the ovaries, there is a risk it can cause ovarian failure and early menopause.”
Which should I consider, UFE or Acessa?
Anyone with uterine fibroids who has no desire for a future pregnancy can have UFE or Acessa. However, the Acessa procedure is not recommended for people with metal in their pelvis or hips.
“It’s important to talk to your provider and consider your treatment goals,” Dr. Foos said. “Is a future pregnancy desired? Do you want lighter bleeding or no bleeding altogether? The amount of pelvic pain or how fast you want to return to work are also factors.”
Many options are available to those with uterine fibroids – from medications and minimally-invasive procedures like Acessa and UFE to surgical procedures like a hysterectomy.
Need help treating uterine fibroids?
Schedule an appointment with a gynecologist near you.