Focus on Uterine Fibroids

Researchers Offer New Tools and Techniques to Treat Women's Health Issue.

The most common benign tumors of a woman's uterus, fibroids are tumors of the smooth muscle in the uterine wall. They can cause excessive menstrual bleeding, pelvic pain and frequent urination.

According to the Mayo Clinic, MRI-guided focused ultrasound surgery (FUS), a noninvasive treatment for uterine fibroids, preserves the uterus, requires no incision and is done on an outpatient basis. It is performed while a patient is inside an MRI scanner with a high-energy ultrasound transducer.

In uterine artery embolization, small particles are injected into the arteries supplying the uterus, stopping blood flow to fibroids. This technique can shrink fibroids and relieve the symptoms they cause.

In myolysis. a laparoscopic procedure, radiofrequency energy, an electric current or laser destroys the fibroids and reduces the blood vessels feeding them. A procedure called cryomyolysis freezes fibroids.

In a myomectomy, the surgeon removes the fibroids, leaving the uterus in place. If there are few fibroids, a laparoscopic or robotic procedure uses slender instruments inserted through small incisions in the abdomen. Hysteroscopic myomectomy may be used if the fibroids are contained inside the uterus. Endometrial ablation, a treatment performed with a specialized instrument inserted into the uterus, uses heat, microwave energy, hot water or electric current to destroy the lining of the uterus.

Hysterectomy, the removal of the uterus, remains the only proven permanent solution for uterine fibroids. This major surgery ends the ability to bear children. Patients who also have their ovaries removed may want to take hormone replacement therapy to avoid heart and blood vessel diseases and certain metabolic conditions.

Morcellation, breaking fibroids into smaller pieces, may increase the risk of spreading cancer. The risk can be reduced by evaluating risk factors before surgery, morcellating the fibroid in a bag or expanding an incision to avoid morcellation. Dr. Payman Banooni, a Beverly Hills obstetrician-gynecologist, believes morcellators are good options in young patients, while the other methods could work in older patients. The Food and Drug Administration (FDA) advises against morcellation for most women.

Medications for uterine fibroids target symptoms such as heavy menstrual bleeding and pelvic pressure. While they do not eliminate fibroids, they may shrink them. Gonadotropin-releasing hormone (Gn-RH) agonists block the production of estrogen and progesterone. A progestin-releasing intrauterine device (IUD) can relieve heavy bleeding caused by fibroids. Tranexamic acid (Lysteda), a nonhormonal medication, can ease heavy menstrual periods. Nonsteroidal anti-inflammatory drugs (NSAIDs) may relieve pain related to fibroids.

The Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) performs research on uterine fibroids. Researchers supported through the Fertility and Infertility (FI) Branch found that treatment with vitamin D reduced the size of uterine fibroids without compromising fertility. FI researchers have also discovered a form of gene therapy that affects estrogen receptors and was effective, safe and not damaging to fertility. The FI researchers are studying the role of diet in the high incidence of fibroids in African American women, concluding that high dairy intake reduces the risk of fibroids.

NICHD researchers in the Unit on Reproductive Endocrinology and Infertility, in the Division of Intramural Research Program in Reproductive & Adult Endocrinology, determined that cells within the uterine fibroid tumors produce a disordered and excessive extracellular matrix (ECM), a complex structural framework that surrounds and supports the body's cells. Mechanical signaling, a way of cell communication and activation, was changed in the cells within the fibroid.

Researchers in the Unit on Reproductive Endocrinology & Infertility examined the relationship of mechanical signaling to fibroid cells and completed a collaborative clinical trial of MRI-guided high-frequency ultrasound (HIFU) for the non-surgical treatment of uterine fibroids. This pilot study determined that HIFU is a highly accurate method for targeting uterine fibroids.

Scientists found that treatment of fibroid cells with the drug liarozole decreased the function of important fibrosis genes. When administered at pharmacologic concentrations, liarozole decreased the ability of fibroid cells to multiply and decreased genes involved in creating the fibrosis involved in symptoms.

Researchers in the Biostatistics and Bioinformatics Branch, within the Division of Intramural Population Health Research (DIPHR), are developing statistical models to study associations between hormone levels, menstrual cycle characteristics and reproductive outcomes, including fertility, miscarriage, uterine fibroids and cardiovascular disease. Investigators in the Unit on Reproductive Endocrinology and Infertility are collaborating to create a Uterine Fibroid Tissue Bank.

The International Congress on Uterine Fibroids brings together researchers working in the fields of medicine, epidemiology, basic research and therapeutics to exchange scientific information about fibroids. Topics include treatment options, epidemiology, mechanisms of fibroid development and growth, environmental influences, hormonal therapies and genetic characteristics.

To learn more about our clinical research opportunities please visit us at http://unitedclinicalresearch.com/  or simply fill out the form below and one of our researchers will contact you.

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