Uterine artery/fibroid embolization (UAE/UFE) is a minimally invasive treatment for fibroid tumors of the uterus. Fibroid tumors are benign tumors that arise from the muscular wall of the uterus. It is extremely rare for them to turn cancerous. More commonly, the fibroids cause heavy menstrual bleeding which can result in anemia, pain during intercourse, pain in the pelvic region, enlarged abdomen, or pressure on the bladder which can result in frequent urination.
UFEs are performed by an Interventional Radiologist. An Interventional Radiologist is a physician who is trained to perform image guided minimally invasive procedures . Uterine artery embolization is performed while the patient is sedated but conscious. This procedure does not require general anesthesia. The Interventional Radiologist makes a tiny nick in the skin in the groin and inserts a catheter into the femoral artery. Using real time imaging, the physician guides the catheter through the body to the uterine arteries and then releases tiny particles, the size of grains of sand, into the arteries that supply blood to the fibroid tumor. This blocks the blood flow to the fibroid tumor and causes it to shrink and die.
Recovery time for fibroid embolization usually requires a hospital stay of one night. Medications are prescribed following the procedure to treat the cramping and the pain. Many women resume light activities in a few days and the majority of women are able to return to normal activities within 7-10 days. On average, 85-90 percent of women who have had the procedure experience significant or total relief of heavy bleeding, pain and/or bulk-related symptoms. Recurrence of treated fibroids is very rare. Data shows UAE to be very effective with a very low rate of recurrence.
Most fibroids don't cause symptoms; only 10-20 percent of women who have fibroids require treatment. Depending on size, location and number of fibroids, they may cause the following symptoms:
- Heavy, prolonged menstrual periods and unusual monthly bleeding, sometimes with clots. This can lead to anemia.
- Pelvic pain and pressure
- Pain in the back and legs
- Pain during sexual intercourse
- Bladder pressure leading to a frequent urge to urinate
- Pressure on the bowel, leading to constipation and bloating
- Abnormally enlarged abdomen
How should I prepare for UAE?
The Interventional Radiologist will determine if you are a candidate for UAE by imaging the uterus using MRI (magnetic resonance imaging) or ultrasound. These imaging studies help determine if the fibroid tumors are the cause of your symptoms and to fully assess the size, number and location of the fibroids. If you are bleeding heavily in between periods, a biopsy of the inner lining of the uterus may be performed to rule out cancer. Report any and all medications. Report any allergies to medications. Your physician may advise you to stop taking aspirin, anti-inflammatory drugs (NSAIDS) or a blood thinner for a specified period of time prior to your procedure. Inform your doctor about recent illnesses or other medical conditions. Women should always inform their physician or x-ray technologist if there is a possibility that they are pregnant.
Before the UAE
You may have some blood drawn to check your kidney function, clotting times or other tests that are necessary. You should not have anything to eat or drink after midnight the night before your procedure.
Day of UAE
Your doctor will tell you which medications you may take in the morning. You should plan to stay overnight in the hospital following your procedure.
After the UAE
Your pain will be controlled with a narcotic. You will experience pelvic cramps for several days after your UAE. You may also experience nausea and a low grade fever. The cramps are most severe during the first 24 hours after the procedure and will improve rapidly over the next several days. Once you return home, you will be given prescriptions for pain, nausea and an antibiotic. Afterward, it is common for menstrual bleeding to be much less during the first cycle and gradually change to a new level that is improved as compared to before the procedure. You may miss a cycle or even stop having periods altogether. Relief of bulk-related symptoms takes at least 2-3 weeks to several months as the fibroids shrink. By 6 months, the process is usually stabilized.
The benefits of having an Interventional Radiologist perform a uterine fibroid embolization:
- It is less invasive than surgery
- No surgical incision is needed
- Patients usually resume their activities within 3 weeks
- Blood loss is minimal
- 90% of women experience significant or complete resolution of their symptoms
- Follow up studies have shown it is rare for the treated fibroids to regrow or new fibroids to develop
Every medical procedure includes a level of risk. The risks involved with a uterine fibroid embolization are:
- Any procedure that involves placing a catheter inside a blood vessel can cause damage to the blood vessel
- Bruising or bleeding at the puncture site
- Infection at the puncture site
- The embolic agent can lodge in the wrong place and deprive normal tissue of its oxygen supply
- An allergic reaction to the dye which can be mild itching to affecting blood pressure and breathing
- 2-3% of women will pass pieces of fibroid tissue and may require a D&C
- Normal menstrual cycles resume in the majority of women but in 1-5% of women, menopause occurs after UAE
- It is important to note that the likelihood of requiring a hysterectomy is low, less than 1%