Uterine Fibroid Embolization
Uterine fibroids are noncancerous (benign) tumors that develop in the womb (uterus), a female reproductive organ. Uterine fibroid embolization (UFE) is a minimally-invasive, non-surgical procedure used to treat symptomatic uterine fibroids. This safe, simple FDA-approved procedure — an alternative to surgery — reduces the bleeding, pain and other symptoms of uterine fibroids in 90% of women who undergo the treatment. Read a patient testimonial about this procedure. There’s also an article on UFE that appeared in MD News written by interventional radiologist Peter Stratil, MD.
We work closely with your OB/GYN and other providers to determine that this procedure is the right therapy option for you.
- Symptoms of uterine fibroids
- How are fibroids diagnosed?
- Fibroid treatment options
- Benefits of the uterine fibroid embolization procedure
- About the procedure
- Video interview — about uterine fibroid embolization
- Risks of uterine fibroid embolization
- Conditions to advise us about
- Insurance coverage
- Consultation and procedure locations
- Preparation guidelines
- What to expect during the procedure
- Recovering from your procedure
- Consults. Referrals. Scheduling. Appointments.
Some 20 to 40 percent of women over age 35 have uterine fibroids large enough to cause heavy and prolonged menstrual periods, according to the Society of Interventional Radiology (SIR). SIR reports that of the 600,000-plus women in the U.S. that are diagnosed with uterine fibroids each year, more than 30 percent undergo hysterectomies. Recent research reveals many of those women could have been treated by much less invasive means, thus preserving the uterus. Due to the prevalence of this condition, it is essential for all women to understand their treatment options.
Since most fibroids cause no symptoms, they may be discovered when a woman has a routine pelvic exam. For those who do experience symptoms, these may include:
- Heavy, prolonged monthly periods or excessive bleeding. Sometimes, you may see clots.
- Fatigue due to anemia, a condition in which you have a low red blood cell count
- Back and leg pain
- Pelvic pain and pressure
- Pain during intercourse
- Constipation or bloating
- Urinary incontinence and frequency
- Abnormally enlarged abdomen
Fibroids are usually suspected after physical examination. They can be confirmed using non-invasive imaging techniques such as ultrasound and-or MRI. Most patients are imaged using ultrasound initially but a pelvic MRI is required in all patients being evaluated as potential candidates for uterine fibroid embolization (UFE), An MRI provides solid information concerning the size, number, location and blood supply to the fibroids.
1. Medical treatment – such as birth control pills, which can often decrease heavy bleeding, and hormone treatments, which can cause menopause-like side effects. Symptoms usually return when medical treatment stops.
2. Surgical Treatment – such as hysterectomy (removal of the uterus) and myomectomy (removal of just the fibroids). These options are generally effective, but do require anesthesia, lengthy recovery types and a higher complication rate than uterine fibroid embolization. Some women are no candidates for myomectomy due to the size, number or location of the fibroids.
3. Uterine Fibroid Embolization (UFE) - preserves the uterus, has greatly reduced recovery time, and considered a minimally invasive option for treatment with excellent outcomes.
Uterine fibroid embolization is used as an alternative to surgery to treat uterine fibroids and minimize their symptoms. Women often choose fibroid embolization over surgery for one or more of the following reasons:
- Significantly shorter recovery period — typically a one-night hospital stay and return to normal activities soon after
- Lower complication rate
- No general anesthesia — twilight anesthesia is used
- No surgical incisions — a small puncture at the groin only
- Minimal or no scarring
- Minimal blood loss – For those who can’t or prefer not to have a blood transfusion, this is an option because a transfusion may become necessary during surgery.
- Potentially preserves fertility
- Simultaneous treatment of all fibroids
According to a multicenter study in the American Journal of Obstetrics & Gynecology*, the benefits of UFE are:
|1.||Shorter hospital stay||UFE||<1 day|
|2.||Work to return faster||UFE||10.7 days|
|(after 30 days)||Hysterectomy||32%|
* Spies J, et al. Outcome of Uterine Embolization and Hysterectomy for Leiomyomas: Results of a Multicenter Study. American Journal of Obstetrics & Gynecology. July 2004: 191:1.
The uterine fibroid embolization procedure is performed under minimal sedationin a hospital outpatient setting. The procedure takes approximately one hour.
Once you are lightly sedated, a catheter is threaded through the femoral artery to the uterus through a tiny incision. Using X-ray guidance and contrast material, the specific arteries that feed the uterine fibroid are identified and injected with small, inert particles.
The particles wedge into the uterine vessels, blocking the flow of blood to the fibroid; this causes the fibroid tissue to die and shrink. All fibroids in the uterus can be treated in a single session.
Uterine fibroid embolization is a very safe procedure. However, every procedure is associated with some risk, and this procedure is no exception. Since a catheter is placed within the blood vessels, there is a risk of damage to a blood vessel, bruising or bleeding at the puncture site, or infection.
You could have an allergic reaction to the contrast material used during the procedure.
Two to three percent of women pass small pieces of fibroid tissue after the procedure. If this occurs, you may need to have a D & C (dilatation and curettage) to remove the tissue and prevent bleeding and infection.
It is not yet known if fibroid embolization affects fertility; however, women have had successful pregnancies after the procedure.
There is the risk of radiation exposure; however, it is well below the level that generally causes adverse affects.
In approximately 1-5% of women, menopause begins shortly after fibroid embolization. However it is rare for this to occur in a woman under the age of 45. The risk of early menopause is higher with surgery.
It is possible that fibroid embolization will not sufficiently reduce your symptoms, or that the uterus will become infected. In such a case, a hysterectomy may be needed. This occurs in less than 1% of cases.
In advance of your exam, let your RIA Endovascular medical staff know if any of the following circumstances apply to you:
- Previous reaction to iodine or a known iodine contrast allergy
- Previous reaction to anesthesia
- Currently taking blood thinning medication
- Kidney dysfunction or need for dialysis
Most insurance companies cover this procedure. Please contact your insurance provider to determine coverage under your specific plan.
Our dedicated in-house precertification specialist will work directly with your insurance company to obtain preauthorization for you prior to your procedure.
The consultations for uterine fibroid embolization are done at RIA Endovascular. The procedure is performed at one of several partner hospitals in the Denver, Colorado area.
To schedule a consultation to discuss a uterine fibroid embolization, please call 720.493.3406.
You will visit with an RIA Endovascular interventional radiologist to determine your candidacy for the procedure or recommend another alternative for you.
Your PAP smear must be within the last year. For a very small number of patients, your gynecologist may perform an endometrial biopsy. If you have not had one, the interventional radiologist will order an MRI of the pelvis.
When all pertinent information has been gathered and it is determined that the procedure will likely be of benefit to you, we will have our precertification specialist request preauthorization of the procedure with your insurance company. Once authorization has been received, we will contact you to schedule the uterine fibroid embolization procedure.
Following are the general preparation guidelines for uterine fibroid embolization. You may receive additional or differing guidelines based on your specific situation. Please contact us at 720-493-3406 if you have any questions.
- Do not eat or drink anything but clear liquids for 8 hours before the procedure; do not drink anything for 4 hours before the procedure.
- Prepare for an overnight stay in the hospital.
- Arrange for someone to drive you home from the procedure.
Prior to the date of the procedure, you will have to receive a pelvic ultrasound and possibly a blood test. You will fill out paperwork and consent forms so the radiologist will know your medical history.
When you come in for the procedure, you will be asked to change into a gown. After answering any questions you have, a nurse will start an intravenous (IV) line in your arm. You will be given conscious sedation through the IV to help you relax. A catheter is placed in your bladder and a PCA (patient controlled anesthesia) pump will be connected to your IV. This allows you to push the button and have pain medicine administered to you so that you do not need to wait for a nurse if you have pain after the procedure when you are back in your room.
Next you will be positioned on a table. The area near your groin the will be cleansed and local anesthetic will be administered. A fluoroscope will be positioned above your abdomen. The interventional radiologist will make a small incision near the groin then thread the catheter through the incision into the femoral artery.
Using real-time x-rays, the radiologist will guide the catheter to the location of the fibroid. The radiologist will inject contrast material into your arteries to increase their visibility as the catheter is guided into the uterine arteries. After locating the specific arteries that feed the fibroid, the radiologist will inject tiny particles through the catheter into them to block the blood flow. After treating all the known fibroids, the catheter is removed and the incision is cleaned and taped. You should not feel any pain or discomfort during the procedure. If you do, let the radiologist know immediately. The procedure takes 1 to 2 hours. Afterward, you will be taken to a recovery area where you will be carefully monitored. This procedure usually requires an overnight stay in the hospital.
Most women experience moderate to severe cramping and pain after the procedure, which is usually alleviated with narcotic medication (PCA) and anti-inflammatory medications while in the hospital. Some women experience nausea and fever. Fever is usually treated with acetaminophen. These side effects are significantly reduced after 12 hours but may last several days, and should improve rapidly. Most women can resume light activities within a few days and return to their normal activities within 5-10 days. Heavy bleeding often improves during the first menstrual cycle following the procedures. Other symptoms usually improve after 2-3 months.
Call RIA Endovascular at 720.493.3406.