Tiny gel beads that shrink fibroids — and spare women’s fertility
AN ESTIMATED one in three women in the UK develops fibroids — non-cancerous growths in the womb. Rose Borges, 46, a student and mother-of-two from Southampton, underwent a new procedure to remove them without the need for major surgery, as she tells NATAS
LTHE PATIENT
ast spring, I noticed my stomach starting to protrude, as if I was constantly bloated. I couldn’t understand why, as my diet hadn’t changed, but I weighed myself and saw it creeping up (I’m 5ft 6in and normally weigh 10½ st). It would make me feel very self-conscious and I hid my body under baggy clothes.
after a couple of months, I went to see my GP, who told me I might have developed an intolerance to wheat or gluten, so I gave them up for a few weeks — but this didn’t help. I looked six months pregnant.
My energy levels also started dipping. I’m taking a course at university and found I’d struggle with the workload, as I’d be so tired by the afternoon.
taking my sons, Leon, 17, and Carlos, 14, to their football matches would wipe me out.
I went back to my GP, who referred me to hospital for an ultrasound scan, where I went three months later.
this showed I had fibroids — benign growths in the lining of my womb. What caused them was unclear, but they can cause both tiredness, as they lead to iron loss and anaemia when they bleed, and a bloated appearance.
I’d struggled to get pregnant with my two sons and tried for years to conceive each time. I’ve since been told this could have been due to the fibroids, as they change the shape of the uterus.
I was referred to a gynaecologist later that month. By then, my stomach had grown more and I weighed 12½ st.
I was told that the standard treatment for women my age was a hysterectomy but, although I’d already had children, I didn’t want to have a major operation. the gynaecologist then said colleagues at southampton University Hospital were starting a trial for a new, minimally-invasive treatment, so I asked to be referred.
I saw them a month later, where they explained that the procedure, called uterine fibroid embolisation, involved injecting tiny beads to block the blood supply to the fibroids, which kills them.
UsUaLLy,it’s done using plastic beads that stay in the body for life, but they were testing gel beads that are safely absorbed by the body after two months.
It sounded like a good option, so I asked to join the trial. I had the procedure in October, with a local anaesthetic applied to the groin.
the doctor inserted a catheter (a long, thin tube) — it wasn’t painful, just a tiny sting. then he injected the tiny gel beads. I could see everything he was doing on a screen, which was a bit strange, but he reassured me throughout.
the whole thing took around two hours and I stayed in hospital overnight. It hurt quite a bit that evening — I was told it was due to the fibroids dying — and I was given morphine, which helped.
I went home the next day, with painkillers. I had some cramping, not dissimilar to period pain, for a few days, and some bleeding, but it was manageable.
Over the next few weeks, I felt like a new woman. I was energised and my bloated belly went down — I’m back wearing my usual size 10-12 jeans.
I had an MRI scan in January, which showed that all of the fibroids had shrunk significantly. there was one — which was the largest, at 4cm wide, to start with — that I was warned would take longer to shrink completely, but they are all on track to disappear fully. I’ve been reassured that once they go, they won’t return.
I am extremely happy with the outcome — I have my confidence back and want to start dating. I hope this will become available to more women. THE SPECIALIST Dr NiGeL HaCKiNG is a consultant interventional radiologist at Southampton University Hospital. tHe exact cause of fibroids is unknown, but it is thought it may be genetic, or linked to the hormone oestrogen, as they shrink when these levels are low — for example, after menopause.
Fibroids can have a huge impact on a woman’s life. their periods can be heavy, as the fibroids enlarge the surface area of the uterus lining, making it bleed more when it sheds. In some cases, this can lead to fatigue and iron-deficiency anaemia.
they can also cause bloating, making some look pregnant, and can also lead to miscarriage and difficulty conceiving.
Fibroids can shrink by them-selves after the menopause, when oestrogen levels drop, but if they persist or occur in younger women, then surgery is needed to remove them.
a hysterectomy is the most effective option, but it involves major surgery and a long recovery of six weeks and renders the woman infertile, so those who want children are offered a myomectomy, where we remove the fibroids from the wall of the womb. again, this is major surgery, so it isn’t suitable for everyone.
More recently, we have offered uterine fibroid embolisation, which involves shrinking fibroids by blocking off their blood supply with plastic beads around half-a-millimetre in size. It completely avoids the need for open surgery.
Under local anaesthetic, beads are injected into the two arteries that supply the womb — by cutting off their blood supply, the fibroids die immediately.
the dead tissue is then slowly broken down by the body, which takes several months or years.
the plastic beads remain in the body for ever. While the plastic is non-toxic, there are concerns about long-term effects of plastics staying in the uterus — including a potential risk to fertility.
at University Hospital south-ampton, we are trialling a new way of blocking the blood supply to the fibroids — using tiny beads made of gelatin. the gel beads work in the same way as the plastic beads and kill the fibroid immediately, but are reabsorbed by the body within two months.
this removes any potential risk from the materials lingering in the body and, as they dissolve, the full blood supply to the uterus returns — I believe this will preserve function of the womb and remove potential risks to fertility.
If new fibroids form later, which is very unlikely, we can repeat the procedure.
the procedure is performed under local anaesthetic with the patient under an X-ray machine, which guides me throughout.
I first make a tiny puncture in the groin with a needle, then slide a catheter into the vessel and guide it to the arteries that supply the womb.
I inject the beads, suspended in saline, down the catheter and into each of the two arteries.
Once both arteries are blocked, I remove the catheter and press on the puncture in the skin for ten minutes to stop bleeding.
Patients stay in overnight. this is when the fibroids die, which can be painful, so we monitor the patient and give painkillers if needed.
Our ongoing trial evaluates what proportion of fibroids die at three months, using MRI scans.
Out of 22 on the trial, 12 have passed the three-month stage — they are all symptom-free and 100 per cent of fibroids have died.
studies comparing gel beads to plastic ones found them to be as good or better. We await full results of the trial to know more — these will be available in august.
THe procedure costs £2,400 to the NHS.