Uterine Artery Embolisation
Fibroid Treatment without Surgery
Fibroid treatment without surgery is done by specially trained doctors called interventional radiologists. Uterine fibroid embolisation was first performed in 1995, and since then more than 200,000 women have had the procedure performed, world-wide.
What is Uterine Fibroid Embolisation?
Fibroids are non-cancerous growths in the womb. They are common in fertile women and usually shrink after the menopause. The majority of fibroids do not cause any obvious symptoms.
Fibroids can cause symptoms depending on their size and location. Symptoms include heavy bleeding, pelvic pain, increased period pain, increasing need to pass urine (frequency) and may be associated with infertility.
Uterine Fibroid Embolisation (UFE), also known as Uterine Artery Embolisation (UAE), is a way to treat the symptoms of fibroids without having surgery. In this procedure, the blood flow to the fibroids is blocked so as to reduce the size of the fibroid and remove the symptoms. The uterus (or womb) is not removed.
UFE is performed in a special X-ray room of a hospital, which looks like an operating theatre. Radiology dye (contrast medium) is injected into the blood that shows up on live X-ray pictures. This allows the doctor to navigate to the artery supplying the womb and block it off.
How do I prepare for a Uterine Fibroid Embolisation?
UFE is a medical procedure and is performed in a hospital. You will usually be asked to come in fasting prior to the procedure. Blood tests may be requested to see if you have any kidney or blood related problems.
When you arrive at the hospital or day care facility you will be admitted as a patient and a drip or needle is inserted into your arm or the back of your hand. You will receive some antibiotics and pain killers.
Hospital stay is generally between 1-3 days so please bring in clothes etc for that duration.
A frequent concern from patients is that they are having their period at the time they are to undergo the procedure. UFE is performed from inside the blood vessels and it does not matter if you are having your period or where you are in your menstrual cycle. If you have a coil that will need to be removed prior to the procedure.
What happens during a Uterine Fibroid Embolisation?
UFE will be performed in a special X ray room of the hospital. This is a room like an operating theatre that is specifically set up for this type of procedure. There is also monitoring equipment, trained medical staff and medications to ensure the procedure is performed comfortably and safely.
You may be anxious, and the staff are well trained and expecting this. You may be offered an injection of sedative medication (usually through the drip) at this stage to make you feel a little drowsy and treat any feelings of anxiety.
The procedure begins with a needle and wire being placed into the artery, usually in the right groin. However, sometimes arteries in the left groin or arm are used. The overlying skin will have been injected with local anaesthetic to make it go numb. You do not have feeling inside the blood vessels, so you do not usually feel anything during the procedure. Once the wire is put into the artery a plastic tube known as a catheter is steered into the arteries supplying blood to the fibroids. Most commonly these are the right and left uterine arteries, but also occasionally the ovarian arteries or other arteries supply the fibroids.
Blood supply to the fibroid is stopped by injecting tiny particles of plastic known as polyvinyl alcohol (PVA). Once this has been completed, the catheter is removed from the groin and firm compression with the finger is applied to the tiny hole in the artery to stop the bleeding. The procedure is now finished and you will be taken back to the ward.
How long does a Uterine Fibroid Embolisation take?
UFE on average takes 60 minutes to perform. The procedure can sometimes take longer, depending on variation in the anatomy and the number of arteries that may need to be blocked.
Are there any after effects of a Uterine Fibroid Embolisation?
You usually do not feel anything during the procedure. However, there will be some effects experienced immediately after the procedure as well as for some time later.
It is common to get some degree of pelvic pain or cramping after the procedure as well as nausea (feeling sick) or vomiting. You may also have a slight fever. This is often called post embolisation syndrome and you will be given medications to lessen the chance of this happening or to lessen the feeling of nausea, often before and after the procedure. Post embolisation syndrome differs greatly between patients and if you do not get this it does not mean that the UFE did not work.
Approximately 1 out of 20 patients suffer a more severe post embolisation syndrome, which can be quite uncomfortable and requires a longer stay in hospital. If this happens, strong medications can be given to keep you comfortable. This does not mean there are problems with the procedure or that you are not going to get a good result.
What are the risks and possible complications?
All medical procedures carry a small risk of complications. Risks associated with UFE are usually less than with other procedures to treat uterine fibroids including uterine surgery.
Uncommon risks at the time of the UFE include damaging the artery in the groin and having an allergic reaction to any of the medications you are given, including the the radiology dye.
Damaging or blocking the blood supply to other parts of the body, other than the fibroid or uterus, is very rare.
Two weeks or more after the procedure you may develop a fever, sweats or increasing pelvic pain. This is uncommon (less than 1 in 50 women) but if this happens you should seek medical help straight away, as you may have an infection in the fibroid.
If your period does not come back after three months you need to contact your doctor, as there may be some damage to the ovary. This may lead to early menopause. However, this is also uncommon (less than 1 in 50 women) and can be more common if you are having the procedure at about the time you are going through menopause. This is also more common if the ovarian arteries had to be blocked during the procedure.
What are the benefits of a Uterine Fibroid Embolisation?
The major benefit of UFE is that it is an effective treatment for your fibroids sumptoms of pain, heavy periods, etc. It doesnot involve surgery and therefore there is no need to remove the uterus. It is regarded as effective and safe for short and long term treatment of symptomatic fibroids.
The effective treatment of symptoms is higher than uterus preserving surgery (myomectomy) with a lower adverse or side effect rate. UFE is not as effective as uterus removing surgery (hysterectomy) but has a lower complication rate. You can ask about these other treatments in order to decide, in consultation with the doctor, which procedure is best for you.
You need to be aware that there is a small treatment failure rate of 10-15%, usually requiring a repeat procedure or an alternative procedure.
When can I expect the results of my Uterine Fibroid Embolisation?
Blood flow to the fibroids reduces significantly after the procedure causing the fibroids to shrink. Blood supply to uterus from surrounding arteries prevents the uterus from dying while the fibroids decrease in size as they receive most of the blocking material. Fibroid shrinkage happens over the next few weeks after the procedure resulting in fibroid treatment without surgery. The benefit from UFE is usually seen within a few period cycles for heavy bleeding and pain related symptoms. It may take some months for the increased need to pass urine and pressure related symptoms to go away.
Useful websites and Further Information
British Society of Interventional Radiology
Why have a Fibroid Embolisation?
- NICE Approved
- MInimally Invasive ‘Pinhole’ Surgery
- Faster Recovery Times
- Lower Complication Rate than Open Surgery
- Lower Recurrence Rate than Myomectomy
- Keeps Fertility Options Open