Archive for the ‘testosterone’ Tag
Have you recently experienced a major stress in your life, be it illness, job, death, children, etc? After this stress, have you felt as though you just cannot seem to get yourself together, or at least back to where you used to be? Are you usually tired when you wake up, but still “too wired” to fall asleep at night? Is it hard for you to relax or to get exercise? Do you find that you get sick more often and take a long time to get well? If so, then you, like many other Americans may be experiencing symptoms of Adrenal Fatigue.
Adrenal fatigue is not a new condition. People have been experiencing this condition for years. Although there is increasing physician awareness, many are not familiar with adrenal fatigue as a distinct syndrome. Because of this lack of knowledge, patients suffer because they are not properly diagnosed or treated.
Adrenal fatigue is a condition in which the adrenal glands function at a sub-optimal level when patients are at rest, under stress, or in response to consistent, intermittent, or sporadic demands. The adrenal glands are two small glands that sit over the kidneys and are responsible for secreting over 50 different hormones—including epinephrine, cortisol, progesterone, DHEA, estrogen, and testosterone. Over the past century, adrenal fatigue has been recognized as Non-Addison’s hypoadrenia, subclinical hypoadrenia, neurasthenia, adrenal neurasthenia, and adrenal apathy.
Generally patients who present with adrenal fatigue can often be heard saying, “After______, I was never the same.” The onset of adrenal fatigue often occurs because of financial pressures, infections, emotional stress, smoking, drugs, poor eating habits, sugar and white flour products, unemployment and several other stressors. After experiencing many of these events over a long period of time, the adrenal glands tend to produce less cortisol, the body’s master stress hormone. Cortisol’s main role in the body is to enable us to handle stress and maintain our immune systems. The adrenal gland’s struggle to meet the high demands of cortisol production eventually leads to adrenal fatigue.
Patients with adrenal fatigue have a distinct energy pattern. They are usually very fatigued in the morning, not really waking up until 10 AM, and will not usually feel fully awake until after a noon meal. They experience a diurnal lull in their cortisol (the stress hormone produced by the adrenal gland) and as a result, they feel low during the afternoon, generally around 2-4 PM. Patients generally begin to feel better after 6 PM; however, they are usually tired after 9 and in bed by 11 PM These patients find that they work best late at night or early in the morning.
Some key signs and symptoms of adrenal fatigue include salt cravings, increased blood sugar under stress, increased PMS, perimenopausal, or menopausal symptoms under stress, mild depression, lack of energy, decreased ability to handle stress, muscle weakness, absent mindedness, decreased sex drive, mild constipation alternating with diarrhea, as well as many others.
Although there no specific tests that will provide a true diagnosis of adrenal fatigue there are tests that may contribute to an assessment, such as a postural hypotension test, an AM cortisol test, or an ACTH stimulation test. It is customary for a physician to assess the adrenals together with thyroid tests to rule out insufficiency, which sometimes occurs in long-standing hypothyroidism.
A single determination of plasma cortisol or 24-hour urinary free cortisol excretion is not useful and may be misleading in diagnosing adrenal insufficiency. However, if the patient is severely stressed or in shock, a single depressed plasma cortisol determination is highly suggestive. An elevated plasma ACTH level in association with a low plasma cortisol level is diagnostic.
Treatment for adrenal fatigue is relatively simple. Lifestyle modifications can be initiated to treat this condition. Simple changes such as more laughter (increases the parasympathetic supply to the adrenals), small breaks to lie down, increased relaxation, regular meals, exercise (avoiding any highly competitive events), early bedtimes and sleeping until at least 9 AM whenever possible can all benefit those experiencing adrenal fatigue.
A diet that would be conducive to treating adrenal fatigue includes one that combines unrefined carbohydrates (whole grains) with protein and oils (nuts and seeds) at most meals—olive, walnut, fiber, flax and high-quality fish oil. It is also important for patients to eat regular meals, chew food well, and eat by 10 AM and again for lunch. Patients should look to avoid any hydrogenated fats, caffeine, chocolate, white carbohydrates, and junk foods. Diets should have a heavy emphasis on vegetables. It may be of additional benefit that patients add salt to their diet, especially upon rising and at least a half-hour before their lowest energy point of the day. (Preferably, 1/8 to 1/2 teaspoonful of sea salt, Celtic salt, or sea salt w/kelp powder added to an 8 oz glass of water). In adrenal fatigue, one should not follow the USDA’s Food Guide Pyramid, as these patients tolerate fewer carbohydrates and need more protein.
The addition of nutritional supplements may also offer additional benefits to patients experiencing adrenal fatigue. They should consider the addition of:
- Vitamin C 2,000-4,000 mg/day Sustained Release
- Vitamin E w/mixed tocopherols 800 IU/day
- Vitamin B complex
- Niacin (125-150 mg/day) – as inositol hexaniacinate
- B-6 (150 mg/day)
- Pantothenic acid (1200-1500 mg/day)
- Magnesium citrate (400-1200 mg)
- Liquid trace minerals (zinc, manganese, selenium, chromium, molybdenum, copper, iodine)– calming effect
- If depression is present – Add SAM.e 200 mg bid; DL-Phenylalanine (DLPA) 500 mg bid
Some herbal remedies that have been noted as possible therapies include Licorice, Ashwagandha, Maca, Siberian Ginseng, Korean Ginseng. Note: Licorice can and, if taken over time, does have a propensity to elevate blood pressure. It should not be used in persons with a history of hypertension, renal failure, or who currently use digitalis preparations such as digoxin.
Under the supervision of a physician hormone supplementation with DHEA, Pregnenolone, and Progesterone may also offer some benefits. There are several glandular extracts on the market that contain adrenal, hypothalamus, pituitary, thyroid, and gonadal that are also often recommended.
Sometimes the initiation of hydrocortisone (Cortef®) may be necessary as a replacement hormone when cortisol is not being produced by the adrenals. While the initiation of corticosteroids, such as hydrocortisone may have quick and dramatic results, they can sometimes make the adrenals weaker rather than stronger. As a result, the initiation of hydrocortisone is usually a last resort. It is important to note that patients may have to undergo treatment for 6 months to 2 years.
While a cortisol measurement may be helpful to confirm any thoughts or ideas that a patient may have decreased adrenal function, typically blood cortisol levels would be tested along with blood levels of potassium, and sodium. If the pituitary gland is the cause of adrenal failure electrolyte levels are usually normal. Practitioners usually pay attention to extremely low cortisol levels, which generally diagnoses Addison’s disease—a condition in which the adrenal glands are completely depleted, also considered a medical emergency.
Natural Hormone Replacement Therapy (NHRT): If you are currently on or considering the use of Hormone Replacement Therapy (HRT) and you think individualized, natural HRT makes more sense than a “one-size-fits-all” approach, then you may want to look into naturally compounded, bio identical, plant-derived Hormone Replacement Therapy. Compounding is preparing medicines tailored to patients’ individual needs. Compounding is the preparation, mixing, assembling, packaging, or labeling of a drug as the result of a practitioner’s Prescription Drug Order based on the pharmacist-patient-prescriber relationship. Compounding offers patients their choice of drug, strength, dosage form, excipients, or lack of and can be decided on a case-by-case basis. This process allows for medical treatments that otherwise might not be possible.
With an individualized approach to hormone therapy, you can know exactly what your hormone levels are, compare the benefits vs. risks of all possible therapies, and choose the ideal replacement protocol to bring your hormones back to their proper balance. If your doctor is willing to prescribe conventional HRT, s/he should be more than willing to prescribe naturally compounded HRT.
Estradiol, the principal estrogen found in a woman’s body during the reproductive years, is produced by the ovaries. Estradiol is very effective for the symptomatic relief of hot flashes, genitourinary symptoms, osteoporosis prophylaxis, psychological well-being and reduction of coronary artery disease.
Because it is much more potent than estriol, it can be more effective for symptomatic relief than estriol. When Estradiol is replaced using a parenteral (sublingual, percutaneous, or transdermal) route, it is not subject to first pass metabolism by the liver, and therefore does no produce high levels of estrone. Using these routes of administration a woman can mimic the physiologic release of estradiol from the ovaries, thus receiving natural hormone replacement.
Estriol is the weakest of the three major estrogens. In fact it is 1000 times weaker in its effect on breast tissue. Estriol is the estrogen that is made in large quantities during pregnancy and has potential protective properties against the production of cancerous cells.
An important article in the 1966 Journal of the American Medical Association by H.M. Lemmon, M.D., reported a study showing that higher levels of estriol in the body correlate with remission of breast cancer. Dr. Lemmon demonstrated that women with breast cancer had reduced urinary excretion of estriol. He also observed that women without breast cancer have naturally higher estriol levels, compared with estrone and estradiol levels, than women with breast cancer. Vegetarian and Asian women have high levels of estriol, and these women are at much lower risk of breast cancer than are other women. Estriol’s anticancer effect is probably related to its anti-estrone properties-it blocks the stimulatory effect of estrone by occupying the estrogen receptor sites on the breast cells.
Estriol is the estrogen most beneficial to the vagina, cervix and vulva. In cases of vaginal dryness and atrophy, which predisposes a woman to vaginitis and cystitis, topical estriol is the most effective and safest estrogen to use. Because of this estriol is better than estradiol for the treatment of urinary tract infections.
None of the American drug products contain Estriol, so it is not available in most drug stores, although it has been used widely in Europe for over fifty years. Because estriol cannot be patented it does not hold much interest for the pharmaceutical industry. Its availability through compounding has caused its use to grow rapidly throughout the country.
Estrone is the estrogen most commonly found in increased amounts in post menopausal women. The body derives it from the hormones that are stored in body fat. Estrone does the same work that estradiol does, but it is considered weaker in its effects.
Biest is a combination of two estrogens: estriol and estradiol. It is most commonly found in a ratio of 80:20, estriol to estradiol. This combination allows for all of the protection of estriol while providing the cardiovascular and osteoporosis benefits along with the vasomotor symptom relief of estradiol.
Triest is a combination of three estrogens: estriol, estradiol and estrone. It is most commonly found in a ratio of 80:10:10, estriol, estradiol, and estrone. This combination is very popular and contains all of the three major circulating estrogens. It is slightly weaker in its effect when compared to biest. However, this can be compensated for by increasing the strength or by slightly changing the ratios.
Progesterone is produced by the ovaries and the adrenal glands in women and, in smaller amounts, in the testes and the adrenal glands in men. One of its most important functions is in the female reproductive cycle. Progesterone prepares the lining of the uterus for implantation of a fertilized egg, then helps to maintain it during pregnancy. If pregnancy does not occur it signals the uterus to shed this lining.
Progesterone also plays an important role in brain function and is often called the “feel good hormone” because of its mood enhancing and antidepressant effects. Optimum levels of progesterone can mean feelings of calm and well being, while low levels of progesterone can mean feelings of anxiety, irritability and even anger. Current research shows that progesterone may pay a role in the maintenance of the nervous system, the sense of touch, and motor function.
Pregnenolone is a superhormone that is key to keeping our brains functioning at peak capacity. Some scientists believe it is the most potent memory enhancer of all time. Perhaps what is even more amazing are the studies that demonstrate pregnenolone enhances our ability to perform on the job while heightening feelings of well-being. In other words, this superhormone appears to make us not only smarter but also happier.
Like the other steroid hormones pregnenolone is synthesized from cholesterol. In a complex series o steps, cholesterol is broken down into different steroid hormones as the body needs them. It is first synthesized into pregnenolone and used by the body in that form. What is not utilized undergoes a chemical change that “repackages” it into DHEA. DHEA in turns used by the body as DHEA and is also broken down into estrogen and testosterone. This chain of hormones is known as the “steroid pathway.” Because pregnenolone gives birth to the other hormones, it is sometimes referred to as the “parent hormone.”
Pregnenolone was studied extensively in the 1940s. It was shown to be beneficial in elevating mood, improving concentration, fighting mental fatigue, improving memory and relieving severe joint pain and fatigue in arthritis. Pregnenolone has vast therapeutic potential and is currently undergoing further studies in these areas.
Short for Dehydroepiandrosterone, DHEA is a steroid hormone distinguished from others by its unique chemical structure. DHEA is produced by the adrenal glands (located just above the kidneys) as well as by the brain and the skin, and is the most abundant steroid in the human body.
As newborns, we have an extremely high level of DHEA, but within a few days after birth, our DHEA level drops to nearly zero. Then between the ages of six and eight, we experience the even called “adrenarche” in which our adrenal glands begin to stir and gear up for puberty. At the same time our DHEA level begins to rise steadily and continues to rise until it peaks at around age twenty-five to thirty. From that point on in declines at a rate of about 2 percent a year, and we begin to feel the result of this decline in our mid-forties. By eighty our DHEA level is only fifteen percent of what it was when we were twenty-five. This drop in DHEA levels correlates dramatically with the signs and “symptoms” associated with aging.
DHEA is currently the focus of some of the most exciting medical research of this century. Researchers at distinguished medical centers all over the country are studying the properties and promise of DHEA. It is proving to be a potent protector against cancer. It protects against heart disease by lowering blood cholesterol and preventing blood clots. Studies also demonstrate that DHEA improves memory, strengthens the immune system, prevents bone loss, and may even protect us from diabetes and autoimmune disease. It has been shown to fight fatigue and depression; it enhances feelings of well-being and increases strength. DHEA alleviates symptoms of menopause, reduces body fat, and is even known to enhance libido.
Because DHEA is showing such tremendous promise in so many areas, and because of the limited amount of space provided here, we recommend further reading on the superstar of superhormones. An excellent resource for more information is the book “The Superhormone Promise” by W. Regelson, M.D., and Carol Colman.
Usually considered a male hormone or androgen, women also produce testosterone although in much smaller amounts than men do. Testosterone works differently in the bodies of men and women, but it plays a very important role in the overall health and well-being of both sexes. Often called the “hormone of desire” because of its powerful effect on libido, testosterone is also important in building strong muscles, bones, and ligaments as well as increasing energy and easing depression. Low levels of testosterone have been known to cause fatigue, irritability, depression, aches and pain in the joints, thin and dry skin, osteoporosis, weight loss, and the loss of muscle development.
As with all of the hormones, testosterone must be dosed properly to be effective without causing unwanted side effects. The dose in women is generally one-tenth that used in men. Because testosterone is not effective when it is taken orally it is usually prescribed as a topical gel, cream or as a sublingual tablet. Although testosterone was discovered more than sixty years ago, only very recently have we begun to fully understand and appreciate the power of testosterone.
HUMAN GROWTH HORMONE – HGH
HGH is one of many endocrine hormones, like estrogen, progesterone, testosterone, melatonin and DHEA, that all decline in production with age. While many of these hormones can be replaced to deter some of the effects of aging, HGH reaches far beyond the scope of any of these hormones. Not only does it prevent biological aging, but it acts to significantly reverse a broad range of the signs and symptoms associated with the aging process.
The decline of growth hormone with age is directly associated with many of the symptoms of aging, including wrinkling, gray hair, hair loss, decreased energy and sexual function, loss of muscle and increased body fat, cardiovascular disease, osteoporosis, and overall lower life expectancy.
The good news is that there is now clinical evidence which demonstrates that by replacing growth hormone we can dramatically reverse all of these symptoms. Although this may appear to be too good to be true, the more closely the scientific evidence is examined the more clear it becomes that everything that we associate with aging may be due totally or in part to the decline of HGH levels in our bodies.
Until recently, the only way to increase HGH levels in the body, was to use injectable HGH. These injections are very effective, although they are costly and difficult to use. Now, there are natural substances that have been well documented to increase growth hormone by stimulating the bodyís own production of HGH. According to researchers, these cutting edge natural secretagogues may have the ability to more closely mimic the bodyís youthful GH secretion patterns.
These natural substances which stimulate the body’s own production of HGH are known as secretagogues. They can be introduced into the body in two ways: orally or transdermally (topically applied to the skin).
The oral secretagogues are very popular and have shown to be very effective. They include such products as Pro-HGH®, Rejuvamin®, Rejuvamax® and Medi-Tropin®. Though effective, all of these except Medi-Tropin® are available without a prescription. Achieving consistent results with the oral products can be difficult due to changes in absorption from the stomach and the necessity for the stomach to be empty for four hours prior to use.
Trans-D Tropin ®
Trans-D Tropin ®, a transdermal product that is now available by prescription only, provides a very efficient delivery system and an ease of administration that leads to better patient compliance and consistent results. Trans-D Tropin ® is a natural complex which mimics growth hormone releasing hormone(GHRH). The transdermal delivery system allows frequent dosing, up to four times daily, which more closely resembles the body’s own natural response. Imitating this natural response results in an effective and superior release of the body’s own growth hormone.
Saliva Test for Hormones
Adequate levels and an appropriate balance of the steroid hormones (estradiol, progesterone, testosterone, DHEA, cortisol) are necessary for maintaining optimal health and well being in both females and males. This family of steroid hormones supports a wide range of essential physiological functions, including blood lipid balance, bone mineral density, fertility, sexuality, a general sense of well being, as well as certain aspects of brain functioning. The saliva test measures levels of specific hormones that are produced in the body, consumed as foods, dietary supplements or medication. Saliva yields a direct measure of “free hormone ” level and is comparable to that measured by blood. Also, timing of the test can be precisely controlled and levels can be determined at optimum times. Saliva testing provides a means to establish whether or not your hormone levels are within the expected normal range and it is simple and non-invasive. It is appropriate to monitor and titrate doses to minimize side effects and risks without compromising the benefits of replacement therapy.
PyriLinks-D (urine sample)
* must be ordered by a physician
Medical insurance may pay for testing
Uterine fibroids are the most common pelvic tumors in women, occurring in approximately 30% of women over the age of 35. Although fibroids are benign (non-cancerous), they may produce a wide variety of symptoms including excessive bleeding leading to iron deficiency anemia, pain and pressure sensations, and even obstruction of the bowel or urinary tract. Women with fibroids often complain of painful intercourse, and the presence of fibroids may result in pregnancy loss. Each year, approximately 200,000 hysterectomies are performed in the United States for uterine fibroids. Despite this large number of operations, the vast majority of women with symptomatic fibroids are “silent sufferers.”
Until recently, the only effective treatments for fibroids were hormonal therapy and surgery. Because fibroids grow in response to the female hormone estrogen, anti-estrogen hormones such as progesterone can shrink fibroids and may result in dramatic improvement in symptoms. However, these hormones have many untoward side effects including menopausal symptoms and osteoporosis (softening of the bone). Consequently, hormonal therapy can only be used for a short time and, unfortunately, once it is discontinued, symptoms usually return. Therefore, hormonal therapy is most useful in shrinking fibroids prior to surgery.
There are two general types of surgery available for fibroids, hysterectomy and myomectomy. Hysterectomy is the complete removal of the uterus with or without removal of the ovaries. In some cases hysterectomy can be performed through the vagina, avoiding an incision through the abdominal wall. However, with large fibroids, an abdominal hysterectomy (that is, a hysterectomy through an abdominal wall incision) is often necessary. Abdominal hysterectomy is a major surgical procedure requiring general anesthesia, approximately 6 days of hospitalization, and at least 6 weeks of recuperation. Obviously, pregnancy is no longer possible following a hysterectomy.
Myomectomy is an alternative surgical procedure for the treatment of fibroids. The object of myomectomy is to remove only the fibroid while leaving the uterus intact and preserving reproductive potential. Depending on the location and size of the fibroid, myomectomy may require an abdominal incision or may be done through a laparoscope (a telescope-like instrument inserted through an abdominal wall puncture) or a hysteroscope (a telescope-like instrument inserted through the vagina). With larger fibroids, attempted myomectomy frequently results in hysterectomy due to uncontrollable bleeding in these highly vascular tumors. Even when successful, myomectomy offers only temporary improvement in about one-third of patients because smaller untreated fibroids continue to grow.
Frequently Asked Questions About Fibroids
Q: After menopause, how does estrogen/progesterone therapy affect the growth of uterine fibroids?
A: In a menopausal woman who chooses not to take hormonal replacement therapy, existing fibroids usually shrink because the body is producing less estrogen. New fibroids are unlikely.
Q: How common are fibroids?
A: Up to 40% of women past the age of 40 have fibroids and about 75% of women will never be aware of their existence unless they cause a problem.
Q: Do fibroids move to another part of your body?
A: Fibroids typically grow attached directly to the inside or outside wall of the uterus.
Q: I recently had very excessive vaginal bleeding from fibroids, which required a myomectomy and blood transfusions. Could this happen again?
A: In some cases, fibroids can return, even after a myomectomy. It is important that you have annual examinations with your physician (or sooner, if symptoms return). Bleeding can again cause anemia and should not go unchecked.
Q: I am 46 and have a uterine fibroid tumor that has been shown to be 6 inches in size as measured by a hysteroscopy and ultrasonography. My OB/GYN has recommended a hysterectomy. I do not intend to have children. Should I consider myomectomy or uterine artery embolization alternatives?
A: Your physician may be recommending a hysterectomy due to your history, the size, location, and/or your specific anatomy, etc. S/he may feel this is the best recommendation for your situation. As you are also aware, there can be other options and it would be to your benefit and mental ease to discuss this with your doctor or health care practitioner. If you feel that you want to pursue discussing the other options more thoroughly, you can always seek a second opinion. Second opinions reinforce or offer alternatives, depending on your specific situation.
Q: I have fibroids. My OB/GYN has suggested a treatment of Lupron. Do you have any information?
A: Lupron is a synthetic form of a natural hormone (LH-RH). LH-RH stimulates the production of testosterone in men and estrogens in women. However, when the synthetic LH-RH is given, it actually stops natural production of hormones. As a result, in women who are premenopausal, menstruation will stop. Essentially, it induces temporary menopause. That is the reason why it works for endometriosis and fibroids. That also explains why it works for advanced prostatic cancer-by stopping the hormone production, the tumor growth also stops.
Q: I have fibroids. My doctor put me on a low estrogen pill to regulate me. I’m still having irregular periods, feeling bloated, and bowel problems.
A: Fibroids can cause irregular bleeding, pain, and a swollen abdomen (bloated). The size and type of fibroid(s) can also be varied, as the hormone fluctuations in your body take place. Your physician probably prescribed the low estrogen to help regulate your hormone balances We recommend that you return to your physician and discuss your continued symptoms and further evaluate if your symptoms are related to the same fibroid(s) or any other underlying causes. Further testing may be warranted.
Q: Does natural progesterone have any effect on fibroids?
A: Natural progesterone may be used when a woman’s primary symptom is bleeding. This helps to prevent the endometrial lining of the uterus from building up too much. This may be an option when women are unable to modify their diets or when their symptoms aren’t alleviated by dietary changes (low-fat, high-fiber, even vegetarian). A low-fat, high complex carbohydrate diet may halt the growth of fibroids and in some cases, result in their disappearance.
Q: What’s the difference between a cyst and a fibroid?
A: A fibroid is a solid tumor containing mostly smooth muscle bound together by fibrous tissue commonly found within and around the uterus. A cyst is a fluid-filled pouch located on or in an ovary. Both are usually benign.
Q: Is a golf-ball sized fibroid considered large or small?
A: It could depend on the location of the fibroid and whether it is causing symptoms. Fibroids can be either much smaller or much larger.
Q: How are large fibroids surgically removed?
A: How fibroids are removed varies, depending on size, location and preference of the surgeon. The recovery period varies, depending on some of above variables.
Q: How reasonable is it to resist having a hysterectomy due to large fibroids?
A: Because fibroids tend to shrink after menopause, it depends on how close you are to menopause and also how severe your symptoms are. Also there is a relatively new technique that cuts off the blood supply to fibroids and causes them to shrink.
Q: If I wait until menopause, what are the chances my fibroids will shrink?
A: Even if fibroids do not shrink (and they often do) after menopause, at least they should stop growing.
Q: What is the most common symptom of fibroids?
A: Often the first indication is an increase of the amount of menstrual flow, including blood clots. Discomfort or pain may also accompany fibroids.
Q: How fast do fibroids grow?
A: Fibroids usually grow very slowly, however they grow more rapidly during pregnancy, or when taking oral contraceptives.
Uterine Artery Embolization
Embolization (embolotherapy) is a procedure used to block blood vessels from the inside. Embolotherapy is performed by Interventional Radiologists, physicians who specialize in the treatment of a variety of diseases using catheters (tiny tubes) and medical imaging techniques. For nearly thirty years, embolotherapy has been used as a means of stopping uncontrollable bleeding from the uterus due to cancer, blood vessel malformations, trauma, and complications of pregnancy. In the early 1990’s, investigators in France began using embolotherapy of the uterine arteries to prevent excessive bleeding in women about to undergo myomectomy for uterine fibroids. A surprising and wholly unexpected result of these uterine artery embolization procedures was that many of the patients had such significant improvement in their symptoms that surgery was postponed. Over the course of months it became clear that the improvement noted in these women was not only significant, it was durable. Consequently, a pilot study was begun to evaluate the long-term results of uterine artery embolization for the primary treatment of fibroids.
In the initial pilot study, 85% of women undergoing uterine artery embolization experienced significant improvement or complete resolution of symptoms. In 75% of cases the size of the uterus decreased by 20-80% within 3 months, and these results remained stable with an average follow-up of more than 18 months (11 to 38 months). In a second study from UCLA, 77% of patients reported “significant improvement” or “complete resolution” of their dominant fibroid symptom at 2 to 9 months follow-up. In this group, 2-month follow-up revealed an average 40% (22-61%) reduction in uterine volume with the dominant (largest) fibroid decreased by an average of 58% in 55% of the patients studied. In one-third of the patients the fibroids were no longer visible by ultrasound.
On the basis of these studies, uterine artery embolization programs for the non-surgical treatment of fibroids have been established at several academic medical centers in the United States. The experience gained at these centers will optimize treatment protocols and provide in-depth answers to questions regarding the durability of symptomatic relief and preservation of reproductive function.
The Uterine Artery Embolization Procedure
The uterine artery embolization procedure is performed by an Interventional Radiologist in the radiology department of the hospital. Although patients are awake for the procedure, they are sedated and often have no recollection of events during the embolization. The procedure itself consists of introduction of a tiny tube (catheter) into an artery in either the left arm or the groin under a local anesthetic. Except for the injection of the local anesthetic, there is little or no discomfort associated with the catheter insertion. Once in the artery the catheter is manipulated into the uterine arteries and angiography is performed. Patients may experience a mild sensation of warmth during the angiogram. When the catheter is positioned well within the uterine artery, tiny pellets of a material called PVA are injected. (Note: the chemical name for PVA is polyvinyl alcohol, but it is neither vinyl as in flooring nor alcohol as in alcoholic beverages. It is merely an organic [i.e., carbon-based] synthetic compound with properties that make it a useful embolic agent.) The PVA is carried by the flow of blood into the uterus and all of the fibroids present. The particles eventually impact in the very small arteries and produce blockage. Deprived of their blood supply, the abnormal cells in the fibroids die and are slowly removed by the body. Meanwhile, the body restores circulation to the normal tissue by both the in-growth of new arteries and the removal of a portion of the PVA from some of the existing vessels.
Immediately following the embolization procedure the catheter is removed and pressure is applied to the entry site for about 15 minutes to stop any bleeding. Almost all patients experience crampy abdominal pain following the procedure. Consequently, we provide patients with on-demand pain medicine through a device called a PCA (patient controlled analgesia) pump. Many studies have demonstrated that patients experience far less pain, yet actually use far less pain medication when this device is used. Patients are admitted to the hospital overnight and can usually be discharged home the morning following the procedure. Most patients can return to work within a few days. At the current time, we ask patients to return for an ultrasound examination two weeks and two to three months after the procedure to assess results. The patient will also be asked to complete a short mail-in questionnaire one year after embolization. Additional follow-up may be requested in the future
Frequently Asked Questions About Uterine Artery Embolization
Q: What are the risks associated with uterine artery embolization?
A: The potential risks of the procedure include bleeding from the catheter entry site, infection, adverse reactions to medications or contrast media, blood vessel injury, inadvertent embolization of other tissues. The risk of a significant complication is less than 0.5%.
Q: Does uterine artery embolization result in significant clinical improvement?
A: In all studies to date, embolization has resulted in significant improvement or resolution of symptoms in more than 75% of patients treated. With improvements in technique, it is anticipated that perhaps 90% of women treated will have substantial improvement in symptoms.
Q: What impact does uterine artery embolization have on reproductive function?
A: Most studies published thus far have focused on women who did not desire pregnancy. However, pregnancies have occurred and been carried to term following uterine artery embolization for fibroids. Small studies of women who underwent uterine artery embolization to control bleeding complications of labor and delivery have shown the return of normal menses within a few months in all cases and all women desiring subsequent pregnancy conceived and were successful in carrying to term. Since the presence of fibroids already has a negative impact on pregnancy, determining the impact specific to embolization will be difficult and will require a very large number of patients.
Q: Does uterine artery embolization preclude other potential treatments?
A: In the setting of uterine fibroids, this procedure began as a preoperative measure to control bleeding during myomectomy. Preoperative embolization is commonly used in a variety of settings because it makes surgery easier and safer. Since the only other definitive treatment for fibroids is surgical at this time, the only impact embolization would have on such treatment is complementary.
Q: Is uterine artery embolization cost-effective compared with conventional therapy?
A: The overall procedure cost is significantly less than abdominal hysterectomy and moderately less than hysteroscopic and laparoscopic myomectomy. When one takes into account the potential economic losses during a 6-week recovery from abdominal hysterectomy, the cost differential becomes astronomical.
Q: Are results obtained with uterine artery embolization durable?
A: Published reports have shown stable results with follow-up of more than 3 years in a few cases. For women approaching menopause, the results may well be permanent since estrogen production is declining and estrogen is required for fibroid growth. There is insufficient data at this time to predict the long-term durability in younger patients because estrogen secretion will continue for many years and, theoretically, may stimulate the formation of new fibroids. It may be several years before sufficient data is compiled to assess long-term results in younger patients. On the other hand, if fibroids do recur after several years, it should be possible to treat them with repeat embolization.
Q: Where can I find more information about uterine artery embolization?
A: You should first discuss this procedure with your primary care physician or gynecologist. Unfortunately, many physicians are unaware of this alternative treatment for fibroids despite the fact that this procedure has now been used to treat well over a thousand patients in the United States. For specific information on this procedure you should contact an Interventional Radiologist in your locale. For Kansas, Missouri, Arkansas, Oklahoma and adjacent areas of neighboring states you may find a local Interventional Radiologist in the MIRS Physician Listings. Additional information and Interventional Radiologists in other locales can be found at the Society of Cardiovascular and Interventional Radiology (SCVIR) site on the World Wide Web.