HOW IS A UTERINE FIBROID EMBOLIZATION PERFORMED?
The physician makes a tiny nick in the skin either in the groin or the wrist (this will be discussed in further detail with you and your physician) and inserts a catheter into the artery. Using x-ray imaging, the physician guides the catheter to the uterine arteries feeding the fibroids. Once positioned, tiny embolic particles the size of grains of sand are injected into the uterine arteries. This blocks the blood flow to the fibroid tumors and causes them to shrink. As fibroids continue to shrink the symptoms resolve.
WHAT IS THE RECOVERY TIME?
Immediately after the procedure you will be monitored in the recovery room for 4 to 6 hours post procedure. Most patients experience pelvic cramping, which usually peaks during the first 2 – 6 hours after the procedure. At this point, the pain medication you received during the procedure will be wearing off and you will be given medication to continue to manage the pain. The pain you may experience is related to the lack of blood flow to the fibroids because the artery supplying the fibroid has been blocked. Some women report experiencing nausea as well.
After the first few hours, your symptoms can usually be managed at home. Because you have received sedating medications for the procedure and pain medication after the procedure, you will not be able to drive yourself home. When you leave, you will likely have only a small bandage over the nick in your groin or wrist.
The first 2 weeks
During your first full day at home, you should expect more, but milder, uterine cramping and fatigue. This will continue for the next 4-5 days. During the first week you should limit your physical activities, including work, to allow for a full recovery. By the second week of your recovery, you should be feeling more normal. Most women can return to regular activities in 8 – 14 days.
WHAT IS THE UFE EFFICACY?
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. The procedure is effective for multiple fibroids and large fibroids. Recurrence of treated fibroids is very rare. Short and mid-term data show UFE to be very effective with a very low rate of recurrence.
WHAT ARE THE EFFECTS ON FERTILITY?
There have been numerous reports of pregnancies following Uterine Fibroid Embolization, however, prospective studies are needed to determine the effects of UFE on the ability of a woman to have children. One study comparing the fertility of women who had UFE with those who had myomectomy showed similar numbers of successful pregnancies. However, other investigators have not yet confirmed this study.
Less than two percent of patients have entered menopause as a result of UFE. This is more likely to occur if the woman is in her mid-forties or older and is already nearing menopause
Treatment options associated with uterine fibroids.
If you and your healthcare provider determine that you have uterine fibroids, it is a good idea to discuss the various treatment options available for fibroids, including uterine fibroid embolization (UFE).
Non-invasive treatment options:
- Watchful Waiting
If your fibroids do not cause symptoms, there is no need to treat them. Your doctor can best manage your care and can continue to monitor your fibroids for growth.
- Hormone Treatment
Medications for fibroids target hormones that regulate a woman’s menstrual cycle and help treat symptoms such as heavy menstrual bleeding and pelvic pressure. They don’t eliminate fibroids, but may shrink them. The possible side effects of using these medications are similar to the symptoms experienced during and after menopause and include: weight gain, hot flashes, vaginal dryness, mood swings, changes in metabolism, and infertility. In most cases, once hormone therapy stops, fibroids tend to grow back and can reach their original size. This often occurs if hormone therapy is not accompanied by another treatment.
- High-Intensity Focused Ultrasound Surgery (HIFU or MRgFUS)
During the treatment, magnetic resonance images are used to help a doctor examine fibroids and surrounding organs in 3-D. High-intensity focused ultrasound waves are then used to heat an area of the fibroid, causing cell death. Pulses of ultrasound energy are also applied repeatedly to treat the fibroid. The procedure takes three to four hours. Patients report abdominal pain, cramping, and nausea throughout the procedure. A few days after the procedure, patients report feeling cramps as well as shoulder and back pain. Most women are able to return to work within one to two days following the surgery.
Less invasive treatment options:
- Uterine Fibroid Embolization (UFE)
The UFE procedure, also known as uterine artery embolization (UAE), begins with a tiny incision in the groin area or wrist. Using specialized X-ray equipment, an Interventional Radiologist (IR) passes a catheter (small tube) into the incision to the uterine artery and guides it near the location of the fibroid tumor. When the IR has reached the location of the fibroids, embolic material (small particles) is injected through the catheter and into the blood vessels feeding the fibroid, cutting off its supply of oxygenated blood. This shrinks the fibroid. The embolic material remains permanently in the blood vessels at the fibroid site. The catheter is then moved to the other side of the uterus, usually using the same incision. Once the IR has completed embolization of the uterine artery on both sides, the catheter is removed. The entire UFE treatment typically lasts less than one hour and is typically an outpatient procedure. Recovery typically takes less than one week.
- Endometrial Ablation
This procedure destroys the endometrium (the lining of the uterus) with the goal of reducing menstrual flow. In some women, menstrual flow may completely stop. No incisions are needed for endometrial ablation, as a physician inserts a slender tool through the cervix. The tools used for this procedure vary depending on the method used. Some types of endometrial ablation use extreme cold, while others depend on heated fluids, microwave energy, or high-energy radio frequencies. This procedure can only be used to treat submucosal fibroids that are less than one inch in diameter.
Surgical treatments options:
- Surgical myomectomy treatments
A myomectomy is the surgical removal of fibroids in the uterus. This treatment is recommended for women who want to become pregnant. There are different types of myomectomy procedures, including:
- Hysteroscopic Myomectomy
In this procedure a long, thin scope with a camera and light is passed through the vagina and cervix into the uterus. No incision is needed. Submucosal or intracavitary fibroids can be resected or removed using a wire loop or similar device. Patients are usually sent home following the procedure. The hospital stay is generally under two hours, and recovery time is one or two days. Usually only small fibroids accessible through the cavity can be treated this way.
- Laparoscopic Myomectomy
The laparoscope is a slender telescope inserted through the navel (belly button) to view the pelvic and abdominal organs. Two or three half-inch incisions are made below the pubic hairline and instruments are passed through these incisions to perform the surgery. Next, a small scissors-like instrument is used to open the thin covering of the uterus, where the fibroid is found and removed. After the fibroid is removed from the uterus, it is brought out of the abdominal cavity. This is done by cutting the fibroid into small pieces. The pieces are then removed through one of the incisions. Most women are able to leave the hospital the same day as surgery. For more extensive surgery, a one-day stay may be required. Patients can usually walk on the day of surgery, drive in about a week, and return to normal activity within two weeks.
- Robotic-assisted Myomectomy
During this procedure, a surgeon sits at a special console with hand and foot controls that move robotic arms during the operation. With the assistance of the robot, the surgeon injects medication into the fibroids to decrease overall bleeding and makes an incision in the uterus. The surgeon then removes the fibroid(s) from the surrounding uterine tissue. Once the fibroid has been removed, the surgeon cuts the fibroid into smaller pieces inside the abdomen, and removes the fibroid pieces through the incision. Patients typically go home the same day of the procedure and most patients resume normal activities within two weeks.
- Abdominal Myomectomy
The operation begins with a surgeon entering the pelvic cavity through one or two incisions. Depending on the size and location of the fibroid, a vertical or horizontal incision is made. For large fibroids or fibroids that are located in a ligament between the uterus and pelvic wall, a vertical incision is required. The incision is made from the middle of the abdomen that extends below the navel (belly button). In other cases, a horizontal bikini-line incision is made that runs about an inch above the pubic bone. The procedure usually requires a hospital stay of two to three days. Recovery takes four to six weeks.
- Surgical hysterectomy treatments
A hysterectomy is a surgical operation to removal all or part of the uterus. There are different types of hysterectomy procedures, including:
- Vaginal Hysterectomy
This procedure is most often used in cases of uterine prolapse, or when vaginal repairs are necessary for related conditions. During a vaginal hysterectomy, the surgeon detaches the uterus from the ovaries, fallopian tubes, and upper vagina, as well as from the blood vessels and connective tissue that support it. The uterus is then removed through the vaginal opening. If a patient’s uterus is enlarged, a vaginal hysterectomy may not be possible.
- Laparoscope-assisted Vaginal Hysterectomy (LAVH)
LAVH uses a laparoscope (a thin, flexible tube containing a video camera) to guide the removal of the uterus and/or fallopian tubes and ovaries through the vagina. During LAVH, several small incisions are made in the abdominal wall through which slender metal tubes known as “trocars” are inserted to provide passage for a laparoscope and other microsurgical tools. Next, the uterus is detached from other structures in the pelvis using the laparoscopic tools. The fallopian tubes and ovaries are also detached from their ligaments and blood supply. The organs and tissue are then removed through an incision made in the vagina. LAVH typically requires a one to three day hospital stay. Complete recovery time is usually four weeks.
- Robotic-assisted Laparoscopic Hysterectomy
During a robotic-assisted laparoscopic hysterectomy, a surgeon controls the movements of robotic arms from a computer station in the operating room. Three or four small incisions are made near the belly button. Gas may be pumped into the belly to distend it and give the surgeon a better view and more room to work. The laparoscope is inserted the abdomen, while other surgical instruments are inserted through the other incisions. The uterus will be cut into small pieces that can be removed through the small incisions. Depending on the reasons for a patient’s hysterectomy, the entire uterus may be removed or just the part above the cervix. The fallopian tubes and ovaries attached to the uterus may also be removed. Most people stay in the hospital for a few days. Complete recovery may take anywhere from a few weeks to a few months.
- Abdominal Hysterectomy
The uterus is removed through the abdomen via a surgical incision about six to eight inches long. The incision can be made either vertically, from the navel down to the pubic bone, or horizontally, along the top of the pubic hairline. The tissues connecting the uterus to blood vessels and other structures in the pelvis are then carefully cut away. The uterus is removed, along with any other structures such as the ovaries, fallopian tubes, and cervix, depending on each patient’s situation. Abdominal hysterectomy usually requires a hospital stay of one to two days, but it could be longer. The recovery period is usually about six to eight weeks.
Look beyond hysterectomy and discover UFE.
A highly effective, minimally invasive procedure, UFE typically takes less than an hour to perform. Clinically proven to reduce the major symptoms of uterine fibroids, UFE has become one of the most successful alternatives to hysterectomy procedures.
Interested in learning all about the procedure? Click the play button below to watch the video, then ask your doctor if UFE is the right treatment for you.
UFE is a safe treatment option and like other minimally invasive procedures has significant advantages over conventional open surgery. That’s why 90% of all women were “satisfied” or “very satisfied” at final follow-up after UFE.1
A number of benefits.
- Preservation of the uterus
- Decrease in heavy menstrual bleeding from symptomatic fibroids
- Decrease in urinary dysfunction
- Decrease in pelvic pain and/or pressure
- Virtually no blood loss
- Typically performed as an outpatient procedure
- Offers a shorter hospital stay and a faster return to work when compared to having a hysterectomy2
- Safe procedure that involves minimal risk and fewer complications after 30 days when compared to having a hysterectomy2
- Overall, significant improvement in patient’s physical and emotional well-being
- Covered by most insurance companies
- Lohle, P. et al. Long term outcome of uterine artery embolization for symptomatic uterine leiomyomas. JVIR 2008; 19:319-326
2.Spies J et al. Outcome of uterine embolization and hysterectomy for leiomyomas: results of a multicenter study. American Journal of Obstetrics & Gynecology 2004;191: 22-31.
Understand the risks.
Although UFE complications are rare, any medical procedure carries some degree of risk. Despite the low risk factor, it is important to understand the potential complications associated with UFE. These include:
- Embolization of non-target organs (bowel, bladder, nerves, and buttock)
- Sexual dysfunction related to non-target embolization (cervicovaginal branch)
- Transient amenorrhea (absence of period)
- Common short-term allergic reaction/rash
- Vaginal discharge/infection
- Possible fibroid passage (transcervical passage of fibroid; can cause discharge, cramps, and possible urinary retention)
- Post-embolization syndrome (post-procedure pain, fever, tiredness, and elevated white blood cell count)
- Premature menopause
The effects of UFE on the ability to become pregnant and carry a fetus to term, and on the development of the fetus, have not been determined. As with any medical procedure, discuss all risks and complications with your physician.
FIND OUT IF YOU ARE A CANDIDATE
Is uterine fibroid embolization (UFE) right for me?
You may be a candidate for UFE if:
- You are experiencing symptoms associated with uterine fibroids
- You want to retain your uterus and are looking for alternatives to hysterectomy
- You do not want surgery
- You are a non-surgical candidate due to a preexisting conditions such as obesity, bleeding disorders, or anemia
- You are not pregnant and are not planning on having any more children
UFE and Fertility.
When researching and reviewing alternatives to hysterectomy procedures and the other fibroid treatment options available, it is important to understand how different treatments can affect you and your lifestyle. If you decide to pursue UFE treatment, becoming pregnant in the future can be difficult.
While UFE is an effective treatment for uterine fibroids, there is no conclusive data or scientific results that establish the impact of UFE on fertility and pregnancy. The effects that UFE has on the ability to become pregnant, the development of the fetus, and the ability to carry the fetus to term have not been determined.
It is extremely important to tell your doctor if you intend or are considering becoming pregnant after fibroid treatment.
If you are not planning on becoming pregnant after UFE treatment, be sure you continue to use a reliable form of birth control to prevent pregnancy. If you have additional concerns about UFE and fertility, find a UFE specialist near you to discuss your specific situation, and determine which treatment option is best for you.
HOW ARE UTERINE FIBROIDS DIAGNOSED?
Fibroids are usually diagnosed during a gynecologic physical exam. Your physician will perform a pelvic exam to feel if your uterus has increased in size. Presence of fibroids is more commonly confirmed by ultrasound. Fibroids may also be confirmed using magnetic resonance imaging (MRI) and computer tomography (CT scan). Adequate treatment depends on the size and localization of fibroids, as well as severity of the symptoms.
WHAT ARE THE TYPICAL SYMPTOMS?
- Prolonged, heavy menstruation often accompanied by clots, and bleeding in between monthly cycles. The excessive bleeding may result in anemia.
- Pelvic pain.
- Pressure or pelvic heaviness.
- Back or leg pain.
- Pain during intercourse.
- Pressure on the bladder and a frequent need to urinate.
- Pressure on the intestines, constipation and abdominal distention.
- Abnormal increase in the size of the abdomen.
WHO ARE THE MOST PRONE WOMEN TO HAVE UTERINE FIBROIDS?
Uterine fibroids are very common AND may be small enough not cause symptoms. However, in general, 20% to 40% of women over 35 years old have fibroids of a significant size. Afro-American women have a greater risk (50%) for fibroids of significant size.
WHAT ARE FIBROIDS?
Fibroids, also known as uterine fibroids, leiomyomas, or myomas, are benign (non-cancerous) tumors that grow within the muscle tissue of the uterus.
WHO IS AT RISK?
Since uterine fibroids are the most common tumors within the female reproductive system, all women are at a potential risk of developing them. The majority of uterine fibroids are diagnosed in women between the ages of 35 and 54. However, fibroids can occur in women younger than 35.
WHAT DOES THE RESEARCH SAY?
- Studies demonstrate the prevalence of fibroids in 20-40% of women older than 35 years of age.1
- Evidence suggests that African-American women are three times more likely to develop uterine fibroids2-4 than other women, with an earlier age of onset.5
- Most clinicians believe fibroids shrink when a woman goes through menopause.
COMMON SYMPTOMS ASSOCIATED WITH UTERINE FIBROIDS
- Excessive Menstrual Bleeding
Heavy menstrual bleeding is one of the most common symptoms associated with uterine fibroid tumors. It is the most prevalent symptom for two of the four types of uterine fibroid tumors: intramural and submucosal. Over time, excessive menstrual bleeding can lead to fatigue and anemia, which is a result of low red blood cell count. If left untreated, excessive menstrual bleeding can eventually lead to the need for blood transfusions.
- Pelvic Pain and Pressure
As fibroids grow, they can put additional pressure on the surrounding organs, which can be extremely painful. The growth of the fibroids can cause consistent lower abdominal pain, as well as swelling which is sometimes mistaken for as weight gain or pregnancy. If you are experiencing pelvic pain or pressure or any other type of uterine fibroid symptoms, a full gynecological exam should be done immediately to determine the cause.
- Urinary Incontinence or Frequent Urination
One of the organs commonly affected during the growth of fibroid tumors is the bladder. As added pressure is applied to this organ, the risk of urinary incontinence (loss of bladder control) occurs, as well as frequent urination.
- Other Symptoms
Other common symptoms include anemia, pain in the back of the legs, pain during sexual intercourse, constipation, and an enlarged abdomen.
If you are experiencing signs and symptoms of uterine fibroids, and are finding it difficult to perform your daily activities and maintain your way of life, contact your primary care physician or OB-GYN immediately.
TYPES OF FIBROIDS
- There are four primary types of fibroids.
The most common type of fibroids, intramural fibroid tumors, typically develop within the uterine wall and expand from there. When an intramural fibroid tumor expands, it tends to make the uterus feel larger than normal, which can sometimes be mistaken for pregnancy or weight gain. This type of fibroid tumor can also cause “bulk symptoms” which include excessive menstrual bleeding that may cause prolonged menstrual cycles and clot passing, and pelvic pain that is caused by the additional pressure placed on surrounding organs by the growth of the fibroid.
Subserosal fibroids typically develop on the outer uterine wall. This type of fibroid tumor can continue to grow outward and increase in size. The growth of a subserosal fibroid tumor will put additional pressure on the surrounding organs, causing pelvic pain and pressure, and tend not to interfere with a women’s typical menstrual flow. Depending on the severity of the location of the fibroids, other complications may accompany pain and pressure such as bloating, indigestion, constipation, and frequent urination.
These fibroids develop under the lining of the uterine cavity. Large submucosal fibroid tumors may increase the size of the uterus cavity and can block the fallopian tubes, which can cause complications with fertility. Associated symptoms with submucosal fibroids include very heavy, excessive menstrual bleeding and prolonged menstruation. These symptoms can also cause the passing of clots and frequent soiling accidents. Untreated, prolonged or excessive bleeding can cause more complicated problems such as anemia and/or fatigue, which could potentially lead to a future need for blood transfusions.
This type of uterine fibroid occurs when a fibroid tumor grows on a stalk, resulting in pedunculated submucosal or subserosal fibroids. These fibroids can grow into the uterus and/or outside of the uterine wall. Symptoms associated with pedunculated fibroid tumors include pain and pressure as the fibroid may sometimes twist on the stalk.
A woman may have one or all of these types of fibroids. Some fibroid tumors don’t produce any symptoms at all, while others can be severely symptomatic. It is common for a woman to have multiple fibroid tumors and it may be difficult to understand which fibroid is causing specific symptoms.
Don’t suffer in silence with fibroids. Instead, reclaim your life! Learn as much as you can about uterine fibroids and treatment options, work together with your family and healthcare team to make the best of your care, and take control of your life.
QUESTIONS FOR YOUR DOCTOR
Questions to get the conversation started.
If you decide to make an appointment with your OB-GYN to discuss whether you might be a candidate for UFE, please view the list of questions provided below. The questions will help you to better understand the fibroid treatment options available to you.
Questions about fibroid treatments:
- How do you typically treat symptomatic fibroids? What are the risks and benefits of each of these treatments?
- What are surgical and less invasive options for treating my uterine fibroids? What are the advantages, risks, and benefits of each of these treatments?
- Have all of the necessary diagnostic tests been performed? Trans-vaginal ultrasound or
MRI? Endometrial biopsy? Blood tests? Why or why not?
- If I want to retain my uterus, what alternatives to hysterectomy are available?
Questions about more invasive surgical options:
- Do I need to have surgery? Will my ovaries be removed? If so, why? Will my cervix be removed? If so, why?
- What are the risks associated with surgery?
- Will I experience earlier menopause? Can the symptoms of menopause be treated?
- What are the risks and benefits of treatment(s) for the symptoms of menopause?
- What are the limitations of surgery?
- Will surgery cure my uterine fibroid tumors?
Questions about UFE:
- Do you refer patients for UFE? If not, why?
- How many patients have you referred for UFE and how many have chosen UFE to treat their fibroids?
- Will you refer me to an Interventional Radiologist for a consultation?
Questions for your Interventional Radiologist (IR):
- How would you coordinate my care with my OB-GYN?
- How often is the procedure successful in treating uterine fibroids?
- Are your patients happy with the procedure?
- How often do complications occur? What are typical complications?
- How will I feel during and after the UFE procedure?
- What is the length of the procedure? What is the normal recovery time?
- How long should I expect to stay in the hospital?
- How long should I expect to be away from work?
- What kind of follow-up care is typical and who manages it?
- What typically happens to the fibroids after the blood supply is cut off? Will the fibroids be expelled vaginally or will the procedure simply result in my fibroids shrinking?
- Will my fibroids, or the symptoms of my fibroids, come back?
- Will I still get my periods after having UFE and what will they be like?
- Will my insurance cover UFE?
- Can you help me determine if I am a candidate for UFE and when can we schedule the procedure?
HEAR FROM PATIENTS
In her words.
Read powerful stories of women who chose UFE over other fibroid treatment options.
Find out important information regarding uterine fibroid embolization (UFE).