Uterine Fibroid Embolization
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
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
- 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
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.
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 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.
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.