Uterine Fibroid Embolization

Uterine fibroid embolization (UFE) is a new procedure for treating fibroids. Rather than physically removing the fibroid, this procedure blocks (or at least reduces) the blood flow to the fibroid. Fibroids may regrow in the years following the procedure. UFE preserves the uterus, but there are several unanswered questions about UFE’s long-term effects. For example, we do not know if it will have any negative effects on a woman's ability to have a child; because of this, UFE is only appropriate for women who wish to maintain their fertility who would otherwise require a hysterectomy.

The procedure is performed by a radiologist. Women are usually mildly sedated but not unconscious during the procedure.

A small incision (approx 5 mm) is made in the groin, and a tiny tube (catheter) is threaded into the nearby artery. The radiologist uses x-ray to guide the catheter through the artery to the uterus. Fibroids depend on the uterine arteries for nourishment, and literally suck up much of the blood supply from these vessels. When the tube reaches the artery that supplies blood to the uterus, a mixture of tiny plastic particles and x-ray dye is injected. This mixture flows into the fibroid(s), where the plastic beads pile up until they block the blood supply. The flow of particles is carefully monitored, by watching the flow of dye with x-ray equipment.

The procedure takes between 40 minutes and three hours. A woman is exposed to about the same amount of radiation as a person having a barium enema. This is not enough to cause symptoms or long-term side effects.

Afterwards

Because UFE restricts the blood flow to the uterus, it can cause severe cramping, which normally peaks in the first 24 hours after the procedure. Women usually stay in hospital overnight and receive pain medication intravenously. Anti-nausea medication may also be given if you are feeling nauseous. Most women return home on the second day and receive adequate pain control with oral medications. One to two weeks is usually required for a full recovery.

UFE successfully shrinks between 48 and 78 percent of fibroids. About 85 percent of women report that their symptoms improve as a result of the procedure. Five years after the procedure, 70 percent reported that their symptoms were still under control.

If a woman's fibroids are located adjacent to the lining of the uterus (endometrium), she may experience vaginal bleeding for a couple of weeks, and bits of fibroid tissue may be visible in the blood flow. Many women who have UFE have post-embolization syndrome, which consists of fever, extreme fatigue, pain, nausea and vomiting. One to five percent of women experience major complications. In some cases, women who develop an infection require a hysterectomy.

A number of participants in trials of UFE have become pregnant and given birth after the procedure. However, the number of women involved in these trials is too small to determine whether UFE influences fertility. Occasionally, women in their 40s experience menopause as a side effect of this procedure.

Advantages:

• appears to be successful at relieving symptoms in about 85 percent of cases
• preserves the uterus
• simple procedure
• does not require general anesthetic or incision
• quick recovery time

Disadvantages:

• 20 percent of women who have UFE later need another UFE or a hysterectomy
• within six years, fibroids return in 27% of women
• not recommended for women who wish to get pregnant
• possible to get a delayed infection within a year of the procedure
• long-term effects unknown
• not widely available