How will my physician tell if I have fibroids?
During your gynecological examination, your doctor will check the size of your uterus. If it feels enlarged, your doctor may order an abdominal or transvaginal ultrasound or a magnetic resonance (MR) imaging session, which can confirm the presence, location and size of fibroids. After identifying the size and location of your fibroids, and possibly after other diagnostic tests, your doctor may be able to rule out other conditions, advise you of your options and recommend a course of treatment for fibroids.
What types of fibroids can be treated with the ExAblate?
Your physician will determine if your fibroids are suitable for treatment. ExAblate can be used for submucosal, subserosal, and intramural uterine fibroids. These are terms that are used to describe the location of the fibroid within the uterus. More than one fibroid can be treated. Fibroids that are pedunculated (hanging from a stalk), in close proximity to sensitive organs (such as bowel or bladder), or in a location inaccessible by the focused ultrasound may be untreatable.
What is the treatment like?
The entire procedure takes place with you lying in an MR scanner. The doctor will first take some MR images of your pelvic area to locate your uterus and your fibroid(s). Then, he will use these images to develop a treatment plan. When the treatment begins, a small beam of focused ultrasound is directed at the target for approximately 15 seconds and heats the tissue. MR images are taken during each heating cycle provide an image of the target tissue and the degree of heating. The system then moves to the next treatment point, and the process is repeated about once every 90 seconds until the entire volume has been treated. Typically, 30-100 individual pulses are delivered over a 3-hour period to complete a treatment. After the treatment, more MR images are taken to determine how successful the treatment was.
What will I be required to do during the treatment?
In order to have a successful treatment, it will be very important that you lie very still during the procedure. The doctor will give you some sedatives and pain medication to help you relax. The doctor also will talk with you throughout the procedure to see how you are feeling. You will be able to talk to the doctor and tell him or her if something is bothering you.
How long will the treatment last?
You will lie on the patient table inside an MRI for 3-4 hours depending on the size of your fibroid(s).
What will I feel during the treatment?
Women have reported feeling a warming sensation on their skin or inside the pelvic region. You may feel a ‘pinch’ or something like a brief menstrual cramp when the energy is being delivered. During the treatment, the doctor will advise you of sensations that are normal and instruct you to stop the treatment if you experience sensations that are not normal, using a button that you will hold in your hand.
What happens to me after the treatment?
The ExAblate treatment is performed as an outpatient procedure that takes 3-4 hours. Following the treatment you will rest for additional 1-2 hours.
Based on how you are feeling, you will receive discharge instructions from your doctor regarding medications you may need to take to keep you comfortable. Usually, over-the-counter pain relief medication is all that is required. You may experience some cramping, similar to menstrual period cramping; or shoulder or back pain that lasts a few days after the procedure from lying in the treatment position.
Most women are able to return to work and normal activity within 1-2 days.
Who provides my post-procedural care / what will I need to do after the treatment?
It is important that you and your doctor discuss who will handle your follow-up care, phone calls and/or office visits, after the procedure. You should also know who to contact in case of an emergency after your procedure. This is especially important if you are experiencing fever, pelvic pain, or foul-smelling vaginal discharge after the procedure that increases over time and lasts more than 24 hours.
How soon will I start to feel better?
Depending on initial symptoms, most patients find relief in their fibroid-related symptoms within 3 months, as shown by a clinical study conducted by InSightec.
Is ExAblate suitable if I plan a pregnancy?
A growing body of clinical data suggest strong benefits for the ExAblate treatment over the alternatives for women who desire future pregnancies.
These benefits include less risk for adhesions, no clear indication for C-section, normal weight of the new born baby.
My gynaecologist told me it is “experimental” treatment. Is that true?
Over 10,000 women worldwide have been treated with ExAblate with great success. Today the regulatory bodies have eliminated all the barriers that in previous years prevented the treatment of the entire fibroid. The treatment is approved by the FDA and the Israeli ministry of health. Recently the general sick fund in Israel has decided to fund the treatment for its patients. 100 peer reviewed papers have concluded the safety and efficacy of the treatment. Many gynaecologists are not up to date with the new literature. We advise you to come and meet our expert gynaecologists to discuss these concerns.
Is the treatment funded by the sick fund and private insurers?
The treatment is fully funded to the general sick fund customers. Many private insurers are also covering the treatment to their customers.
What should I tell my doctor about my health before this treatment?
Before you undergo ExAblate treatment you should discuss:
- Your personal health history, including any allergies you may have
- Your families health history
- Any recent illnesses
- Medicines, include both prescription, over the counter and herbal medicines or dietary supplements
- Recent activities, including travel
- Your level of normal physical activity
- Previous MR or CT imaging studies
What are my other treatment alternatives?
Your physician would be the best person to discuss treatment alternatives with you. Other available treatments are:
- Watchful waiting
- Abdominal myomectomy
- Laparoscopic or hysteroscopic myomectomy
- Uterine artery embolization
- Hormone Therapy
Could my fibroids come back after the treatment?
Although this treatment may be successful in destroying the fibroids causing painful symptoms, at a later time, more fibroids may grow, become symptomatic and require additional treatment. This is true for all fibroid treatments, except hysterectomy where the entire uterus is removed. In the clinical trial, 21% of the subjects had alternative surgical treatment for their fibroids within 1 year of the treatment with ExAblate.
Are there any risks to the treatment?
As with any medical procedure, there are risks involved in the ExAblate treatment. The vast data collected suggests that the ExAblate treatment is much safer than the alternatives.
How many patients have been treated so far?
Over 10,000 patients have been treated around the world .