• What are fibroids?
• How are fibroids treated?
• What is uterine fibroid embolization?
• Will it work for me?
• Will I still be able to have children?
• Who is the best candidate for UFE?
• How do I know if I'm a candidate?
• What will I experience during and after the UFE?
• How can I make an appointment to discuss UFE further?

What are fibroids?

Fibroids, also known as myomas or leiomyomas, are benign (non-cancerous) tumors in the uterine wall, consisting of muscle tissue. Fibroids are frequently painful and can cause heavy menstrual bleeding, bleeding between periods, and pressure on the bladder and bowel. They are present in 25 to 50 percent of all women and cause symptoms in about half. Fibroids often increase in size over time, but regress after menopause.

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How are fibroids treated?

If the fibroids are not causing symptoms, they do not need treatment. Remember, this is a very common benign condition. Fibroids that are causing symptoms are treated in a number of ways, depending on their size, location, number, and the severity of the symptoms. For mild cases, over-the-counter pain relievers may be all that is necessary. More severe cases are treated with oral hormones (like birth control pills) or injected hormones. When those treatments are inadequate, the next step is usually surgery – either myomectomy (removing the fibroid but leaving the uterus in place) or hysterectomy. In the United States, approximately 200,000 hysterectomies are done every year for fibroid symptoms.

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What is uterine fibroid embolization?

Uterine fibroid embolization (UFE) is a new and non-surgical way of treating fibroids of the uterus. UFE is a specialized X-ray procedure, similar to that used for heart catheterization, in which a small tube (the size of a pencil point) is guided into the artery that supplies the fibroid and tiny beads are injected to block the flow of blood to the fibroid. When the blood supply is blocked, the fibroid loses its supply of oxygen and nutrients. This causes the fibroid to shrink, relieving the symptoms in most cases. The procedure itself is not painful and does not require general anesthesia. There is no real inscision, so there is no need for stitches afterward. In fact, there is no visible scarring at all.

UFE was originally developed as a means of decreasing blood loss during surgical treatments of fibroids. Quite unexpectedly, it was found that many patients treated with embolization, while waiting for fibroid surgery, became asymptomatic and the operation itself proved not to be necessary. Now UFE is used as a stand-alone treatment for symptomatic uterine fibroids. The procedure is done by a specialist called an interventional radiologist—a physician who, after medical school, has done an additional six years of training in this type of procedure.

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Will it work for me?

The answer to this question depends upon the severity of your symptoms and their cause. There are other conditions can mimic the symptoms of fibroids, so a thorough gynecological evaluation is critical. Imaging of the uterus with ultrasound or MRI is also very important. Once these evaluations have been completed, you should meet with an experienced interventional radiologist who can review your case and discuss the option of UFE. The final decision about treatment in your case will be developed through a discussion involving your gynecologist, your interventional radiologist, and you.

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Will I still be able to have children?

The issue of fertility after UFE has not been fully studied yet, though research is under way. There have been many successful pregnancies after UFE, including some in women who had previously had difficulty with getting pregnant. On the other hand, there have also been cases in which women have developed menstrual irregularity or a complete loss of menstruation after UFE. Such menstrual changes are more likely in women over the age of 45. In other words, we don’t know with complete certainly whether UFE is a good idea for women who want to get pregnant in the future. Therefore, women who would like to get pregnant, and who are candidates for myomectomy, should probably have that procedure instead of embolization.

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Who is the best candidate for UFE?

The ideal candidate is a symptomatic woman who is either post-menopausal or who is pre-menopausal but no longer wishes to become pregnant. UFE may also be an excellent alternative to surgery for women who, for reasons of health or religion, do not want to receive transfusions (which may be necessary if open surgery is performed). Incidentally, embolization of the uterine arteries can also be used to halt severe bleeding following childbirth or bleeding caused by malignant gynecological tumors.

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How do I know if I’m a candidate?

A woman wishing to be considered for a UFE should start by seeing her private gynecologist. If her symptoms are possibly being caused by fibroids, an MRI or ultrasound of the uterus should be performed to assess the size and number of the fibroids and to rule out other causes. Women with abnormal bleeding, especially if they are over 40, may require an endometrial biopsy. After other possible causes of the symptoms have been ruled out, the patient should be referred to an Interventional Radiologist trained in UFE. This doctor will review your case with you and make recommendations to your gynecologist.

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What will I experience during and after the UFE?

Before:
The UFE procedure is done in an area of the hospital called the angiography suite. You will lie on a small, movable table that has an X-ray machine below it and an X-ray camera over it. The doctor uses this camera to watch the catheter (the small tube) as he or she directs it into the artery supplying the fibroid. The catheter is inserted through a blood vessel in the thigh, near the groin crease. You cannot feel it in your body any more than you can feel the blood flowing through your vessels. Because UFE is not painful, it does not require general anesthesia. Instead, it is performed under conscious sedation, which means that the patient is drowsy but not sleeping. Most people do not remember anything after the procedure is over. UFE takes about 45 minutes.

After:
Although UFE is a minimally invasive procedure and is not painful, there is some discomfort during the recovery period. 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, but improve rapidly over the next several days. Typically, a women will spend one night in the hospital for pain management. While in the hospital, the discomfort usually is well controlled with a system called “patient-controlled analgesia,” or PCA. Using PCA, the patient controls her own medication with a trigger switch. Studies have shown that patients using PCA have better pain control with less medication than when medications are given by a nurse on a set schedule.

When you leave the hospital the following day, you will be provided with oral pain medication. Most patients will recover from the effects of the procedure within two weeks after UFE, and should be able to return to their normal activities within one week. It usually takes two to three months for the fibroids to shrink enough so that 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 within 10 days after uterine fibroid embolization, but occasionally patients take longer to recover fully.

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How can I make an appointment to discuss UFE further?

UFE is performed at Harborview Medical Center and the University of Washington Medical Center by the same group of physicians. If you are interested in being evaluated for this procedure, please call either UW Medical Center at 206-598-6209 or Harborview Medical Center at 206-731-6862.

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