Explainer | Fibroid surgery alternative to relieve period pain, Hifu treatment – also used to slow skin ageing – is non-invasive and leaves no scars
More than 170 million women suffer from uterine fibroids, growths that vary in size, shape and location but which often cause excessive bleeding and pain
A doctor describes how Hifu technology used to beat facial wrinkles is put to use to shrink fibroids – an alternative to hysterectomies or hormone treatment
The condition causes excessive bleeding, crippling period pain, difficulties in pregnancy – and is one of the main reasons women have hysterectomies. It is uterine fibroids, and 171 million women in the world have the problem.
According to Johns Hopkins Medicine in the US state of Maryland, up to 80 per cent of women will develop fibroids in their womb, or uterus, sometime during their childbearing years.
They are especially common in women between the ages of 40 and 50. While most fibroids are benign, the symptoms they trigger are often debilitating.
US journalist Tanika Gray Valbrun set up non-profit organisation The White Dress Project to rally support for, and promote awareness of the impact that uterine fibroids have on, women who suffer from them.
US journalist Tanika Gray Valbrun set up non-profit organisation The White Dress Project. Photo: Instagram/@wecanwearwhite
Most women who suffer from fibroids do not like to wear white because of the heavy bleeding related to the condition. The “white dress” is an emblem of hope and strength for sufferers, and a reminder that a cure will be found.
What effects do fibroids have on sufferers?
On The White Dress Project website, one woman talks about how her fibroid grew to the size of a grapefruit, causing pelvic pain, bloating, frequent urination and heavy periods.
A story from another woman, Katy, is even worse: her periods were so heavy that she bled through her clothes. She wore maternity leggings daily because jeans caused her too much pain, and bled most days of the month.
Katy ended up getting a hysterectomy – in which her entire womb was surgically removed – at 35 and, while she is now infertile, she is glad that she is living an almost pain-free life.
Fibroids vary in their size, shape and location. They can show up in the uterus, uterine wall or on its surface.
They can also attach to the uterus by a stalk- or stem-like structure.
Treatments may vary according to their size, shape and location.
What treatments are available?
Having a hysterectomy is seen as the last resort and only considered when the fibroids’ position makes their surgical removal impossible. There are also many hormonal treatments, either taken orally or via a T-shaped device inserted into the womb.
There are some reasons to shy away from hormonal treatments, which can trigger negative side effects such as mood swings and depression. Oral tablets that simply aim to reduce the bleeding are available, but are better suited to patients who have milder symptoms.
There is a solution for those who suffer from heavy symptoms but do not want hormonal treatment or a hysterectomy: high-intensity focused ultrasound (Hifu) ablation therapy. This non-invasive solution requires no surgery or anaesthesia, and does not cause bleeding for the patient.
Lisa Chan is a Hong Kong doctor with a special interest in aesthetic medicine. Photo: Lisa Chan
What is Hifu?
If the name sounds familiar, it is because Hifu has been regarded in recent years as a non-invasive procedure for skin lifting and tightening.
Hong Kong doctor Lisa Chan, who has a special interest in aesthetic medicine, explains: “Hifu uses an ultrasound transducer, similar to the ones used for diagnostic imaging, but with much higher energy.
“Hifu protects the skin surface, precisely penetrates and treats beyond the dermis and foundation layers, where structural weakening starts.”
When used for skin lifting and tightening, the transducer focuses sound waves to generate heat at targeted points. This creates “wounds” and cellular friction, which triggers healing and stimulates new collagen formation.
“When Hifu is being applied,” Chan adds, “it helps sagging skin tighten itself and become more firm.”
How can Hifu treat fibroids?
Dr Zara Chan, a Hong Kong specialist in gynaecology and obstetrics, elaborates on the application of Hifu to uterine fibroids. “It’s been around for at least a decade and is a very well researched and peer-reviewed procedure.”
The ultrasound technology is the same as that used on pregnant women to produce sonogram images of their unborn babies and to help diagnose diseases such as cancer. “It’s just a higher intensity,” she adds.
Dr Zara Chan is a Hong Kong specialist in gynaecology and obstetrics. Photo: Zara Chan
Those undergoing Hifu treatment for fibroids usually have a shorter stay in hospital than those undergoing fibroid surgery – in Hong Kong, it is likely to be an outpatient procedure – but it is not without risks, says Zara Chan.
“There is a chance the patient might get burns – this is uncommon but the probability exists. There is also a risk of pain. Hifu shrinks the fibroid by causing apoptosis [cell death] of uterine smooth muscle.
“The high-energy ultrasound waves cause the temperature of their target to increase. The high temperature can cause the fibroid cells and surrounding blood vessels to contract. This is why there is pain.
“But the pain or discomfort, if any, will be gone within a couple of weeks.”
Hifu’s limitations in fibroid treatment
Hifu is not suitable for all types of uterine fibroid. “There [are] very defined patient selection criteria,” says Zara Chan.
Those who have larger fibroids report greater satisfaction with their results “as the shrinkage will be more apparent, as opposed to smaller fibroids where the difference is harder to notice”, she says.
The fibroids’ location, too, plays a big part in determining the effectiveness of Hifu ablation therapy. “If [a fibroid] is far back or down low in the pelvic area or near the cervix, it will be slightly more difficult. [Larger] patients with a thick abdominal wall may also have difficulties,” Zara Chan says.
The patient’s symptoms and the nature of a fibroid also play a part in the selection of patients for the treatment.
“If the patient has a 1cm [0.4 inch] fibroid in their uterine cavity, with constant vaginal bleeding and very heavy periods, then Hifu may not address the symptoms as they will still have a fibroid with marginal shrinkage where the bleeding will still continue,” the doctor adds.
Since Hifu ablation shrinks fibroids instead of completely removing them, there is also a risk they will come back.
“If the patient is in their 20s, then there is a higher chance of recurrence since they have more active years of hormonal activity. A patient in their 40s and closer to menopause will have less chance of recurrence,” Zara Chan says.
“The studies done on Hifu ablation for fibroids have [shown it is] proven to be safe … with higher patient satisfaction since it’s non-invasive and mostly performed in outpatient clinics,” she adds.
While Hifu is not a one-size-fits-all solution, it is a safe option for those who want to explore other options short of surgery, especially if doctors have recommended a hysterectomy.