Uterine fibroid embolization (UFE) is a minimally invasive procedure used to treat fibroid tumors of the uterus which can cause heavy menstrual bleeding, pain, and pressure on the bladder or bowel. It uses a form of real-time x-ray called fluoroscopy to guide the delivery of embolic agents to the uterus and fibroids. These agents block the arteries that provide blood to the fibroids and cause them to shrink. Studies have shown that nearly 90 % of women who undergo UFE experience significant or complete resolution of their fibroid-related symptoms.
The question of whether uterine fibroid embolization impacts fertility has not yet been answered, although a number of healthy pregnancies have been documented in women who have had the procedure. Because of this uncertainty, physicians may recommend that a woman who wishes to have more children consider surgical removal of the individual tumors rather than undergo uterine fibroid embolization. If this is not possible, then UFE may still be the best option.
Your doctor will likely first evaluate your condition using diagnostic imaging, MRI or Ultrasound. If you are bleeding heavily in between periods, a biopsy of the endometrium(the inner lining of the uterus) may be performed if recommended by your gynecologist to rule out cancer.
You may be advised to stop taking aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), or blood thinners several days prior to your procedure. You also may be told not to eat or drink anything after midnight before your procedure.
In the radiology procedure room, you’ll have an intravenous (IV) line placed in one of your veins to give you fluids, anesthetics, antibiotics and pain medications.
Typically you’ll receive a type of anesthesia that reduces pain and helps you relax, but leaves you awake (conscious sedation).The procedure involves inserting a catheter through the groin, maneuvering it through the uterine artery using Fluoroscopy, which converts x-rays into video images, to watch and guide progress of the procedure, and then injecting the embolic agent into the arteries that supply blood to the uterus and fibroids which will block these arteries and cause the fibroids to die and begin to shrink which will result in the uterus full recovery.
In the recovery room, your care team monitors your condition and gives you medication to control any nausea and pain.
- You must lie flat for several hours to prevent pooling of the blood (hematoma) at the femoral artery site or femoral artery.
- Pain. The primary side effect of uterine artery embolization is pain, which may be a reaction to stopping blood flow to the fibroids and a temporary drop in blood flow to normal uterine tissue. Pain usually peaks during the first 24 hours. To manage the pain, you receive pain medication.
- Observation. Post-embolization syndrome — characterized by low-grade fever, pain, fatigue, nausea and vomiting — is frequent after uterine artery embolization.
Post-embolization syndrome symptoms peak about 48 hours after the procedure and usually resolve on their own within a week. Ongoing symptoms that don’t gradually improve should be evaluated for more-serious conditions, such as an infection.
- Uterine fibroid embolization, done under local anesthesia and conscious sedation which is much less invasive than any other open surgery like myomectomy and hysterectomy.
- Only a small nick in the skin that does not have to be stitched is needed.
- Patients ordinarily can resume their usual activities much earlier than if they had surgery to treat their fibroids.
- Recovery time is much shorter, with virtually no blood loss comparing to open surgery.
- Follow-up studies have shown that nearly 90 percent of women who have their fibroids treated by UFE experience either significant or complete resolution of their fibroid-related symptoms. On average, fibroids will shrink to half their original volume. More importantly, they soften after embolization and no longer exert pressure on the adjacent pelvic organs.
- Follow-up studies over several years have shown that it is rare for treated fibroids to regrow or for new fibroids to develop after UFE. This is because all fibroids present in the uterus, even early-stage nodules that may be too small to see on imaging exams, are treated during the procedure.
- UFE is a more permanent solution than the option of hormonal therapy, because when hormonal treatment is stopped the fibroid tumors usually grow back. Regrowth also has been a problem with laser treatment of uterine fibroids.
- Any procedure that involves placement of a catheter inside a blood vessel carries certain risks, Such as damage to the blood vessel, bruising or bleeding at the puncture site, and infection. However precaution is taken to mitigate these risks.
- When performed by an experienced interventional radiologist, the chance of any of these events occurring during uterine fibroid embolization is less than one percent.
- Any procedure where the skin is penetrated carries a risk of infection. The chance of infection requiring antibiotic treatment appears to be less than one in 1,000.
- There is always a chance that an embolic agent can lodge in the wrong place and deprive normal tissue of its oxygen supply.
- An occasional patient may have an allergic reaction to the x-ray contrast material used during uterine fibroid embolization. These episodes range from mild itching to severe reactions that can affect a woman’s breathing or blood pressure. Women undergoing UFE are carefully monitored by a physician and a nurse during the procedure, so that any allergic reaction can be detected immediately and addressed.
- Approximately 2-3 % of women will pass small pieces of fibroid tissue after uterine fibroid embolization. This occurs when fibroids located inside the uterine cavity detach after embolization. Women with this problem may require a procedure called D & C (dilatation and curettage) to be certain that all the material is removed to prevent bleeding or infection from developing.
- In the majority of women who undergo uterine fibroid embolization, normal menstrual cycles resume after the procedure. However, in approximately 1-5 % of women, menopause occurs after uterine fibroid embolization. This appears to occur more commonly in women who are older than 45 years.
- Although the goal of uterine fibroid embolization is to cure fibroid-related symptoms without surgery, some women may eventually need to have a hysterectomy because of infection or persistent symptoms. The likelihood of requiring hysterectomy after uterine fibroid embolization depends on how much time elapses until menopause. The younger the patient, the greater the tendency to develop new fibroids or recurrent symptoms.
- Women are exposed to x-rays during UFE, but exposure levels usually are well below those where adverse effects on the patient or future childbearing would be a concern.
- It is not possible to predict whether the uterine wall is in any way weakened by UFE. Therefore, the current recommendation is to use contraception for six months after the procedure and to undergo a Cesarean section during delivery rather than to risk rupture of the wall of the uterus from the intense muscular contractions that occur during labor.
- Because the effect of uterine fibroid embolization on fertility is not fully understood, UFE is typically offered to women who no longer wish to become pregnant or who want or need to avoid having a hysterectomy.
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