Sperling Medical Group

focused ultrasound for uterine fibroids

Types of Uterine Fibroids

Types of uterine fibroids. Click to enlarge

Uterine fibroids are benign (non-cancerous) growths that develop from the muscle tissue of the uterus. Although they develop during the childbearing years, not every woman has them. The cause of fibroids (also called myomas) is not fully understood, and may be connected to hormonal changes or genetic factors. Many women who do have fibroids never know about it unless a doctor discovers them during a pelvic exam. This is because they may not cause symptoms.
However, depending on the size, number and location of the fibroids, about 25% of women who have fibroids may experience any of the following symptoms:

  • Heavy or prolonged periods
  • Spotting between periods
  • Pain or pressure in the pelvic area
  • Urinary difficulties (frequency; trouble emptying the bladder)
  • Constipation
  • Backache or leg pains
  • Painful intercourse

It is always important to consult your doctor if you have abnormal bleeding, discharge or pain. Many conditions can cause these symptoms. If fibroids are the problem, and are producing intense or aggravated symptoms, there are several treatment options to discuss with your doctor. Many women choose a new noninvasive approach called MR guided Focused Ultrasound Surgery, or MRgFUS, as an alternative to more invasive surgical treatments. In most cases, MRgFUS can preserve the uterus.

What is MRgFUS for uterine fibroids?

MRI-guided Focused Ultrasound (MRgFUS) is an FDA-cleared, noninvasive treatment using magnetic resonance imaging (MRI) to guide focused sound waves that can eliminate fibroids. The technology is called the ExAblate® MRgFUS. Clinical studies have shown a range of symptom relief, with up to 88% of patients reporting improvement at 6 months, and 91% reporting significant improvement at 12 months.1

How is the procedure done?

The ExAblate® system is fully integrated into an MRI scanner. The entire treatment occurs inside the bore (tunnel) of the scanner. Special MRI software is used to plan the treatment, guide the focused ultrasound to its target, measure the temperature and monitor its effect so your doctor is assured that the correct area is completely treated. The device that delivers the focused ultrasound is located in the table on which the patient lies in a prone position (face down). The table slides in and out of the bore.

The patient is awake but medicated for relaxation and any discomfort. During treatment, the physician continually controls and monitors the treatment in real time.

Treatment occurs in a series of 15 second pulses of focused ultrasound called sonications. Sonications are aimed at the fibroids on a location-by-location basis. Each sonication pinpoints the area to be treated, where it creates a temperature of 85° C that destroys the fibroid tissue at each location. Sonications continue until the MRI shows that the treatment is complete.

This video shows how MRgFUS treats each targeted area:

Courtesy of INSIGHTEC

Benefits of MRgFUS for fibroids

  • Safe and effective outpatient alternative to surgery
  • Noninvasive – the focused ultrasound passes harmlessly through the outer skin and inner tissues
  • No cutting, no blood loss
  • Preserves the uterus, cervix and ovaries
  • Improves quality of life by reducing or eliminating symptoms
  • Quick recovery and return to normal activities

Risks of MRgFUS

No treatment is completely risk free. Side effects and risks have rarely been reported, but can include:

  • Discomfort or pain during treatment – report this immediately so medication can be adjusted
  • Immediate or lingering discomfort from having to lie still for a long period – this may be avoided by careful positioning before treatment starts
  • Damage to tissues near the targeted fibroid
  • Burns on the abdominal skin

Other considerations:

  • Less data on fertility and pregnancy after MRgFUS than other conventional fibroid treatments
  • Less long-term safety and efficacy data than other conventional fibroid treatments
  • Some fibroids may not be able to be treated
  • If symptoms return, further treatment may be necessary or may not be suitable for treatment

Discuss all possible side effects and risks with your doctor while considering MRgFUS for your treatment.

Am I a Good Candidate?

In general, the following conditions may exclude a woman from MRgFUS:

  • Any reason why a woman cannot have an MRI scan
  • Weight more than 250 pounds
  • Inability to lie prone (face down)
  • Surgical scar, clips or IUD in the path of the sonication
  • Gynecological abnormalities, conditions, infection, uterine cancer
  • Pregnant
  • Uterus larger than a 6-month pregnancy

All health concerns should be discussed with your doctor. Each woman must be examined and evaluated for the treatment, including undergoing an MRI to identify the size and location of fibroids.

What if I’m not a candidate for MRgFUS?

MRgFUS has been described as a wonderful treatment but it is not right for everyone. If MRgFUS is not an appropriate treatment, alternative treatments will be recommended. See the chart below for a brief summary of other uterine fibroid treatments.

Treatment Name Description

Surgical removal of the uterus.

  • Side effects include loss of fertility, potential post-operative infection, 4-6 week recovery
Abdominal myomectomy

Removal of fibroid(s) by an incision made in the abdomen to reach the uterus. Uterus remains intact.

  • Side effects include potential post-operative infection or bleeding, 2-4 week recovery, likely need for Caesarean birth for future pregnancy
Laparoscopic myomectomy

Removal of small fibroids through laparoscopy using 2-3 half-inch abdominal incisions. Uterus remains intact.

  • Side effects include potential post-operative infection or bleeding, 1-4 week recovery, likely need for Caesarean birth for future pregnancy
Hysteroscopic myomectomy

Removal of uterine fibroids by inserting a scope through the vagina and the cervix into the uterus so no abdominal incision is needed. Uterus remains intact.

  • Only appropriate for fibroids on the inner wall of the uterus that have not grown deeply into the muscle
  • Side effects are rare
Laparoscopic assisted vaginal myomectomy (LAVM)

Combines a vaginal incision with laparoscopic myomectomy. The uterus remains intact.

  • Fibroids must be small enough to be removed through the vagina
  • Side effects include risk of vaginal wall infection
Laparoscopic myomectomy with mini-laparotomy

Removal of slightly larger myomas than what laparoscopy can do alone, includes a 3” abdominal incision to access fibroids and repair the uterus.

  • Involves 1-2 day hospital stay with up to 2 week recovery
  • Side effects include possible risk of infection and future complications from internal scarring
Robot-assisted myomectomy or robotic myomectomy

Use of technologically advanced robotic device with high resolution visual guidance and “keyhole” abdominal incisions for less invasive fibroid surgery.

  • Fewer side effects and faster recovery than open myomectomy
  • Over 25% convert to open myomectomy during surgery due to fibroids too large to remove otherwise
MRI-guided focal laser ablation

Under MR guidance, a laser optic fiber is place into the fibroid and destroyed with heat

  • Side effects include risk of recurrence (regrowth of fibroids) and possible difficulty with getting pregnant
Uterine fibroid embolization

Minimally invasive procedure to block blood flow to fibroids, causing shrinkage

  • Side effects include possible pain, low-grade fever, nausea, and vomiting for up to 48 hours
  • longer term side effects are rare but can include infection and difficulty getting pregnant
Alternative treatments

Holistic treatments (herbal therapies, homeopathic treatments), oral treatments, hormone therapy

Surveillance No treatment, monitor for progression

Exablate at the Sperling Medical Group

At the Sperling Medical Group, our caring and expert staff offers Exablate MRgFUS guided by the most advanced MRI equipment. Treating uterine fibroids with Exablate MRgFUS has been shown to be safe and as effective as conventional treatments—if not more. Contact us to find out how we can help you.

Contact us for more information

1 Fischer K, McDannold N, Tempany C, Jolesz F, Fennessy F. Potential of minimally invasive procedures in the treatment of uterine fibroids: a focus on magnet resonance-guided focused ultrasound therapy. Int J Womens Health. 2015; 7:901-12.

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