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Uterine Fibroid Emolization

Uterine fibroids are noncancerous (benign) growths that develop in the muscular wall of the uterus. Some can be as small as a pea, while others can be as large as a cantaloupe. About 20 to 80 percent of women develop fibroids by the time they reach age 50. Fibroids are most common in women in their 40s and early 50s. Not all women with fibroids have symptoms. Women who do have symptoms often find fibroids hard to live with. Some have pain and heavy menstrual bleeding. Fibroids also can put pressure on the bladder, causing frequent urination, or the rectum, causing rectal pressure. Should the fibroids get very large, they can cause the abdomen (stomach area) to enlarge, making a woman look pregnant.

There are several factors that can increase a woman's risk of developing fibroids:

  • Age - Fibroids become more common as women age, especially during their 30s and 40s and on through menopause. After menopause, fibroids usually shrink.
  • Family history - Having a family member with fibroids increases your risk. If a woman's mother had fibroids, her risk of having them is about three times higher than average.
  • Ethnic origin - African-American women are more likely to develop fibroids than Caucasian women.
  • Obesity - Women who are overweight are at higher risk for fibroids. For very heavy women, the risk is two to three times greater than average.
  • Eating habits - Eating a lot of red meat (e.g., beef) and ham is linked to a higher risk of fibroids. Eating plenty of green vegetables seems to protect women from developing fibroids.

While fibroids do not always cause symptoms, their size and location can lead to problems for some women, including:

  • Heavy, prolonged menstrual periods and unusual monthly bleeding, sometimes with clots
  • Anemia
  • Pelvic pain, pressure or heaviness
  • Pain in the back or legs
  • Pain during sexual intercourse
  • Bladder pressure leading to a constant urge to urinate
  • Pressure on the bowel, leading to constipation, bloating and an abnormally enlarged abdomen

Fibroids typically improve after menopause when the level of estrogen decreases dramatically. However, menopausal women who are taking supplemental estrogen may not experience relief of symptoms.

Screening and Diagnosis

Uterine fibroids often can be detected during a pelvic examination. Ultrasound may also be performed. In some cases, a flexible scope may be inserted through the vagina into the uterus to view inside (a "hysteroscopy"). This procedure is well tolerated using a local anesthetic.

Treatment

The decision as to whether or not Uterine Fibroid Embolization (UFE) is an appropriate treatment will be made after referral to the Interventional Radiologist by the patient’s primary care physician, gynecologist or self-referral. A consultation and thorough explanation of the risks and benefits of the procedure will be made between the patient and Interventional Radiologist, utilizing pre-procedure diagnostic tools, including pelvic ultrasound and/or CT/MRI studies.

The procedure is done with angiography assistance in the Interventional Radiology department using intravenous medication to make our patients “sleepy and relaxed”. A catheter is placed through the femoral artery in the groin area and is passed into the artery that supplies blood flow to the uterus and the uterine fibroid. The Interventional Radiologist will inject small particles (made of a gelatin-based material) that will move into the arteries that supply the fibroid. The particles stop the blood flow to the fibroid and over time will cause it to shrink in size. The advantages to UFE include:

  • The usual one-overnight stay versus three to seven days after surgery
  • No significant blood loss
  • No surgical incision
  • Return to normal activities about one week post-procedure versus 6-8 weeks after surgery.

Post procedure

After the procedure is completed, patients are transferred to a holding room for approximately 1 hour. Most patients will experience moderate pelvic pain and cramping. There also may be nausea and possible fever. The pain and nausea will be controlled with intravenous medications, and a pump (PCA) that allows self-administration of the medications. After the initial period of bed rest, usually 4-6 hours, patients are allowed to get out of bed. Most symptoms improve by the next morning.

After discharge home

After discharge, most patients will have periodic moderate to severe cramping for a few days. Pain medication will be prescribed to control these symptoms. Most women feel better within a few days. Patients are asked to take it easy for a few days, with no heavy lifting. Two weeks of pelvic rest and off work for a few days are also recommended.

Outcomes

On average about 80-85 percent of women have almost total or total relief of pain and other symptoms caused by uterine fibroids. Up to 1 percent of women have injury to the uterus from the procedure, possible resulting in the necessity of a hysterectomy. Some women experience menopause after the procedure. Results about getting pregnant after the procedure is inconclusive.