Saturday, February 16, 2008

Non-Invasive Fibroid Treatment Now Available at Duke, First in North Carolina

A new, noninvasive method for treating fibroids called MRI-guided focused ultrasound is available for the first time in North Carolina at Duke University Medical Center. It was approved by the FDA for treatment of uterine fibroids three years ago.

"Studies show focused ultrasound decreases the bleeding, pain and discomfort often associated with fibroids," explains Millie Behera, MD, Director of Duke's MRI Guided Focused Ultrasound Fibroid Treatment Program. "It's tailored to women who want to avoid the risks of surgery or scars, and who don't want to go through the recovery time associated with traditional therapies."
Up to 80 percent of all women have uterine fibroids, according to the National Uterine Fibroids Foundation. The non cancerous growths, which comprise muscle cells and other tissues, grow within and around the uterine wall. They can vary in size and numbers, and may cause no problems. When they do, however, the symptoms can include heavy menstrual bleeding, cramping, abdominal pressure, painful sex and lower back pain. Fibroids can also affect fertility.
Choosing the right treatment depends on the woman, and her fibroids.

Women who are still in their childbearing years primarily undergo a surgical procedure called myomectomy which leaves the uterus intact and only removes the fibroids.

Women who are done having children have more options. Hysterectomy, which removes the uterus and fibroids, is often considered the only cure, but it is also the most invasive. A newer, minimally invasive method -- uterine artery embolization – involves the injection of radiologic particles in an attempt to starve the fibroids by cutting off their blood supply.

All these procedures carry some risk of complications including bleeding and infection. They also require hospitalization, and up to six weeks to recover. For myomectomy and embolization, the fibroid recurrence rate can be up to 25-30 percent, Dr. Behera says.

Because MRI-guided focused ultrasound is noninvasive, many of those risks are no longer factors in treatment.

During the procedure, doctors use magnetic resonance imagery to aim high-intensity ultrasound beams which pass harmlessly through the skin and shrink the fibroid tissue. "The MRI is giving real-time feedback to make sure the surrounding tissues are safe throughout the procedure," says Dr. Behera. "Because the beams are focused at the center of the fibroid, it doesn't affect the uterine lining, the uterine wall or the ovaries."

Afterward, women simply get up and walk away. Two-year follow up studies show there's only a 10-20 percent chance that additional treatments will be needed.

Right now, candidates for MRI-focused ultrasound are women who have less than six fibroids, are in good health and have completed their childbearing years. However, studies will begin shortly at Duke's Center for Fibroid Biology and Therapy to determine whether young women who want to have children can one day be treated too. "Our study will look at how this fibroid treatment affects chances of pregnancy. "It may be that treating fibroids without surgery improves fertility down the line," Dr. Behera says.

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