Uterine Fibroid Embolization
Fibroid tumors are noncancerous, benign growths that develop in the muscular wall of the uterus. While fibroids do not always cause symptoms, their size and location can lead to problems for some women, including pain and heavy bleeding. They typically improve after menopause when the level of estrogen, the female hormone that circulates through the blood, decreases dramatically. However, menopausal women who are taking supplemental estrogen hormone replacement therapy may not experience relief of symptoms.
Fibroids range in size from very tiny to the size of a cantaloupe or larger. In some cases they can cause the uterus to grow to the size of a five month pregnancy or more. Fibroids may be located in various parts of the uterus. There are three primary types of uterine fibroids.
Uterine Fibroid Embolization
What are typical symptoms?
Depending on the location, size and number of fibroids, they may cause:
- Heavy, prolonged menstrual periods and unusual monthly bleeding, sometimes with clots - This often leads to anemia
- Pelvic pain
- Pelvic pressure or heaviness
- Pain in the back or legs
- Pain during sexual intercourse
- Bladder pressure leading to a constant urge to urinate
- Pressure on the bowel, leading to constipation with bloating
- Abnormally large abdomen
Who is most likely to have uterine fibroids?
Uterine fibroids are very common, although often they are very small and cause no problems. From 20 to 40 percent of women age 35 and older have uterine fibroids of significant size. African-American women are at higher risk for fibroids: as many as 50 percent have fibroids of significant size.
How are uterine fibroids diagnosed?
Fibroids are usually diagnosed during a gynecologic internal examination. Your doctor will conduct a pelvic exam to feel if your uterus is enlarged. The presence of fibroids is most often confirmed by an abdominal ultrasound. Fibroids can also be confirmed using magnetic resonance (MR) and computed tomography (CT) imaging techniques. Ultrasound, MR and CT are painless diagnostic tests. Appropriate treatment depends on the size and location of the fibroids, as well as the severity of symptoms.
How are uterine fibroids treated?
Most fibroids do not cause symptoms and are not treated. When they do cause symptoms, drug therapy is often the first step in the treatment. In many patients, symptoms are controlled with these drug treatments and no other treatment is required. Some hormone therapies do have side effects and other risks when used long term, so they are generally used temporarily. Fibroids often grow back after therapy is discontinued. The next step is to try more invasive therapy. The traditional treatment for fibroids is hysterectomy (surgical removal of the uterus). Less invasive procedures have been developed which are better tolerated by patients. These include myomectomy and uterine fibroid embolization. Myomectomy is a surgical procedure that removes visible fibroids from the uterine wall. Preservation of fertility is a potential benefit of these less invasive alternatives.
What is fibroid embolization?
It is a minimally invasive procedure, which means it requires only a tiny nick in the skin. The patient is given medicine through an IV which relaxes and relieves pain during the procedure. Fibroid embolization is performed by an interventional radiologist, a physician who is specially trained to perform this and other minimally invasive procedures.
The interventional radiologist makes a small nick in the skin (less than one-half of an inch) in the groin and inserts a catheter into an artery. The catheter is guided through the artery to the uterus while the interventional radiologist watches the progress of the procedure using a moving X-ray (fluoroscopy). The interventional radiologist injects tiny plastic particles the size of grains of sand into the artery that is supplying blood to the fibroid tumor. This cuts off the blood flow and causes the tumor (or tumors) to shrink. The artery on the other side of the uterus is then treated.
Fibroid embolization usually requires a hospital stay of one night. Medications are prescribed following the procedure to treat cramping and pain, which are common side effects. Fever is an occasional side effect and is usually treated with acetaminophen. Many women resume light activities in a few days and the majority of women are able to return to normal activities within one week.
While embolization to treat uterine fibroids has been performed since 1995, embolization of the uterus is not new. It has been used successfully by interventional radiologists for 20 years to treat heavy bleeding after childbirth. The procedure is now available at selected hospitals and medical centers across the country.
How successful is the uterine fibroid embolization procedure?
Studies show that between eight to nine out of 10 patients who have the procedure experience significant or total relief of heavy bleeding, pain and other symptoms. The procedure also is effective for multiple fibroids. Recurrence of treated fibroids is very rare.
Are there risks associated with the treatment of fibroid tumors?
All invasive procedures are associated with complications. Fibroid embolization is considered to be very safe. However, there are some associated risks, as there are with any medical procedure. Most women experience moderate to severe pain and cramping in the first several hours following the procedure. Some experience nausea and fever. These symptoms can be controlled with appropriate medications. A small number of patients have experienced infection, which can usually be controlled with antibiotics. Also, it has been reported that there is a one percent chance of injury to the uterus, potentially leading to hysterectomy. A small number of patients have entered into menopause after embolization. This is more likely to occur if the woman is in her mid forties or older, and is already nearing menopause.
You should talk with your doctor about possible side effects of any procedure you may choose.
Will my fertility be affected?
A recent study comparing the fertility of women who had uterine fibroid embolization with those who had myomectomy showed similar numbers of successful pregnancies for both groups.
However, this study has not yet been confirmed by other investigators and the long term effects of uterine fibroid embolization (UFE) on the ability of women to have children have not been fully determined.
What is an interventional radiologist?
Interventional radiologists are specially-trained physicians who use tiny, miniaturized tools, while watching their progress on X-ray or other imaging equipment, to diagnose and treat conditions. Typically, the interventional radiologist performs procedures through a very small nick in the skin. Interventional radiology treatments are generally easier for the patient than surgery because they involve no surgical incisions, less pain and shorter hospital stays. Your interventional radiologist will work closely with your primary care physician or gynecologist to be sure you receive the best possible care.
Uterine Fibroid Embolization
Uterine Fibroid Brochure
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