| Uterine Fibroid Embolization
What is Uterine Fibroid Embolization? Back to Top
Uterine
fibroid embolization (UFE) is a new way of treating fibroid tumors of
the uterus. Fibroid tumors, also known as myomas, are masses of fibrous
and muscle tissue in the uterine wall which are benign, but which may
cause heavy menstrual bleeding, pain in the pelvic region, or pressure
on the bladder or bowel. With angiographic methods similar to those
used in heart catheterization, a catheter is placed in each of the two
uterine arteries and small particles are injected to block the arterial
branches that supply blood to the fibroids. The fibroid tissue dies,
the masses shrink, and in most cases symptoms are relieved. Uterine
fibroid embolization, done under local anesthesia, is much less
invasive than open surgery done to remove uterine fibroids. The
procedure is performed by an experienced interventional radiologist, a
physician specially trained to perform uterine fibroid embolization and
similar procedures.
Uterine fibroid embolization was first used to limit blood loss
during surgical removal of fibroid tumors. It was found that after
embolization and while awaiting surgery, many patients no longer had
symptoms, and frequently the operation itself proved not to be
necessary. Today uterine fibroid embolization is used as a stand-alone
treatment for women who have symptom-producing uterine fibroids.
What are some common uses of the procedure? Back to Top
By
far the most common reason for embolizing the uterine arteries is to
treat symptoms caused by fibroid tumors. This is accomplished by
stopping the growth of fibroid tumors and attempting to shrink them.
Because the effects of uterine fibroid embolization (UFE) on fertility
are not yet known, the ideal candidate is a premenopausal woman with
symptoms from fibroid tumors who no longer wishes to become pregnant,
but wants to avoid having a hysterectomy (surgical removal of the
uterus). Uterine fibroid embolization may be an excellent alternative
for women who, for reasons of health or religion, do not want to
receive blood transfusions—as may be necessary if open surgery is
carried out. The procedure also benefits women who for any reason
cannot receive general anesthesia.
Embolization of the uterine arteries also may be used to halt severe
bleeding following childbirth or caused by malignant gynecological
tumors.
How should I prepare for the procedure? Back to Top
A woman
considering uterine fibroid embolization needs a gynecological work-up
to make sure that fibroid tumors are the actual cause of her symptoms.
Imaging of the uterus by magnetic resonance imaging (MRI) or
ultrasonography is performed to fully assess the size, number and
location of the fibroids. Occasionally your gynecologist may want to
take a direct look by performing laparoscopy. If bleeding is a major
symptom, a biopsy of the endometrium—the inner lining of the uterus—may
be done to rule out cancer.
What does the equipment look like? Back to Top
Several
different types of particles are available for uterine fibroid
embolization. These include polyvinyl alcohol (a material resembling
coarse sand), gelatin sponge (Gelfoam), and microspheres. All of these
types of embolization agents have been shown to be safe and effective
for uterine fibroid embolization. Regardless of the type of particles
used, they wedge in the uterine vessels, avoiding the risk that they
will travel to distant parts of the body.
How does the procedure work? Back to Top
By blocking blood
flow to the fibroids, uterine fibroid embolization in effect "starves"
them of the blood they need to grow. When deprived of blood, the tumor
masses die, and then develop into scar tissue and shrink in size. The
symptoms they previously caused become less bothersome or disappear
altogether. Multiple fibroids may be treated at the same session by
uterine fibroid embolization, and even very large ones can be
effectively treated by this procedure.
How is the procedure performed? Back to Top
Uterine fibroid
embolization is carried out in an angiography suite equipped with an
x-ray machine, where sterile conditions are maintained. Your heart
rate, blood pressure, electrocardiogram, breathing and blood oxygen
level will be monitored constantly during the procedure, which
typically takes 60 to 90 minutes.
After injecting a sedative to make you sleepy and a local anesthetic
to numb the skin at the groin, the interventional radiologist will make
a small nick in the skin less than a quarter-inch long and thread a
thin tube (catheter) into the femoral artery. Using x-ray guidance and
periodic injections of radiographic contrast material to map the blood
vessels, the catheter is threaded into the uterine arteries. Under
x-ray observation, the particles are injected until blood flow in the
uterine arteries is blocked. In most cases, both uterine arteries can
be treated through a single catheter insertion. After completing
uterine fibroid embolization, the site of skin puncture is cleaned and
bandaged.
What will I experience during the procedure? Back to Top
Most
patients having uterine fibroid embolization remain overnight in the
hospital for pain control and observation. Patients typically
experience pelvic cramps for several days after uterine fibroid
embolization, and possibly mild nausea and low-grade fever as well. The
cramps are most severe during the first 24 hours after the procedure
and improve rapidly over the next several days. While in the hospital,
the discomfort usually is well-controlled with a narcotic pump, which
dispenses intravenous pain medication. Oral pain medication will be
provided when you are discharged home the following day. Most patients
will recover from the effects of the procedure within one to two weeks
after uterine fibroid embolization and will be able to return to their
normal activities.
It usually takes two to three months for the fibroids to shrink
enough so that bulk-related symptoms such as pain and pressure improve.
It is common for heavy bleeding to improve during the first menstrual
cycle following the procedure.
Most women are able to return to work one to two weeks after uterine
fibroid embolization, but occasionally patients take longer to recover
fully.
Who interprets the results and how do I get them? Back to Top
The
interventional radiologist who performs your procedure will interpret
the results and will work with your gynecologist or primary care
physician to ensure proper follow-up care.
What are the benefits vs. risks? Back to Top
Benefits
- Minimally invasive: Uterine fibroid embolization (UFE) is
less invasive than either open surgery to remove fibroid tumors or
surgically removing the uterus itself. Patients ordinarily can resume
their usual activities weeks earlier than if they had a hysterectomy.
Blood loss during uterine fibroid embolization is minimal, the recovery
time is much shorter than for hysterectomy, and general anesthesia is
not required.
- Relief of symptoms: Follow-up studies
have shown that approximately 85 percent of women who have their
fibroids treated by uterine fibroid embolization experience either
significant reduction or complete resolution of their fibroid-related
symptoms. This is true for women with heavy bleeding and for those with
bulk-related symptoms such as pelvic pain or pressure. Overall,
fibroids will shrink to half their original size six months after
uterine fibroid embolization.
- Durable effect:
Follow-up studies lasting several years have shown that it is rare for
treated fibroids to regrow or for new fibroids to develop after uterine
fibroid embolization. This is because all fibroids present in the
uterus, even small early-stage masses that may be too small to see on
imaging studies, are treated during the procedure. UFE is a more
permanent solution than another option, hormone therapy, because when
hormonal treatment is stopped the fibroid tumors usually grow back.
Regrowth also has been a problem with laser treatment of uterine
fibroids.
Risks
- Catheter-related risks: Any procedure that involves
placement of a catheter inside a blood vessel, including uterine
fibroid embolization, carries certain risks. These risks include damage
to the blood vessel, bruising or bleeding at the puncture site, and
infection. When performed by an experienced interventional radiologist,
the chance of any of these events occurring during uterine fibroid
embolization is less than 1 percent.
- Allergy to
x-ray contrast material: An occasional patient may have an allergic
reaction to the x-ray contrast material used during uterine fibroid
embolization. These episodes range from mild itching to severe
reactions that can affect a woman's breathing or blood pressure. Women
undergoing uterine fibroid embolization are carefully monitored by a
physician and a nurse during the procedure, so that any allergic
reactions can be detected immediately and reversed.
- Passage
of fibroid tissue: From 2 percent to 3 percent of women may pass small
pieces of fibroid tissue after uterine fibroid embolization. This
occurs when fibroid tissue located near the lining of the uterus dies
and partially detaches. Women with this problem may require a procedure
called D & C (dilatation and curettage) to be certain that all the
material is removed so that bleeding and infection will not develop.
- Early
onset menopause: In the majority of women undergoing uterine fibroid
embolization, normal menstrual cycles resume after the procedure.
However, in approximately 1 percent to 5 percent of women, menopause
occurs shortly after uterine fibroid embolization. This appears to
occur more commonly in women who are older than 45 years when they have
the procedure.
Need for hysterectomy: Although the goal of uterine
fibroid embolization is to cure fibroid-related symptoms without
surgery, some women may eventually need to have a hysterectomy because
of infection or persistent symptoms. The likelihood of requiring
hysterectomy after uterine fibroid embolization is low—less than 1
percent.
- X-ray exposure: Women are exposed to
x-rays during uterine fibroid embolization, but exposure levels usually
are well below those where adverse effects on the patient or future
children would be a concern.
- Future fertility: The
question of whether uterine fibroid embolization reduces fertility has
not yet been answered, though a number of healthy pregnancies have been
documented in women having the procedure. Because of this uncertainty,
physicians may recommend that a woman with symptom-producing fibroids
who wishes to have more children consider surgical removal of the
individual tumors rather than uterine fibroid embolization. A majority
of women who have uterine fibroid embolization are no longer interested
in childbearing. In some women, however, fibroid tumors are the cause
of infertility and the best treatment may be to embolize them. For each
individual it is difficult to predict whether the uterine wall will be
weakened enough by uterine fibroid embolization to pose a problem
during delivery of an infant. It may well be worthwhile to do an
ultrasound study in a pregnant woman who has had the procedure so as to
assess the state of the uterus.
What are the limitations of Uterine Fibroid Embolization? Back to Top
Uterine
fibroid embolization (UFE) should not be done in women who have no
symptoms from their fibroid tumors; when cancer is a possibility; or
when there is inflammation or infection in the pelvis. Uterine fibroid
embolization also should be avoided in pregnant women and when the
kidneys are not working properly—a condition known as renal
insufficiency. A woman who is very allergic to contrast material
containing iodine should receive another treatment option.
At present, it remains difficult for women in some parts of the
country to learn about uterine fibroid embolization or make
arrangements to have the procedure. Not all gynecologists are familiar
with this relatively new method of treating uterine fibroids and rely
instead on the conventional approach—surgery. Back to Top |
