Uterine Fibroid Embolization (UFE)

Uterine fibroid embolization (UFE) is a procedure done by a radiologist. It blocks blood flow to fibroids in the uterus. (It is also called uterine artery embolization.) For women who are not planning a pregnancy in the future, UFE is a possible option in place of surgery for fibroids.

Follow your doctor's instructions exactly about when to stop eating and drinking, or your procedure may be canceled. If your doctor has instructed you to take your medicines on the day of your procedure, do so using only a sip of water. About an hour before the procedure, you may be given asedative to help you relax. It will not put you to sleep, because it is important that you be awake to follow instructions during the procedure.

First, a thin, flexible tube called a catheter is placed into a blood vessel in the upper thigh (femoral artery). A substance called contrast material is then injected into the catheter. You may feel a warming sensation as it travels up to the uterus. The radiologist uses real-time X-ray on a video screen (fluoroscopy) to see the arteries and then guides the catheter to the arteries that supply blood to the fibroid. A solution of polyvinyl alcohol (PVA) particles is injected into those uterine arteries through the catheter. These particles build up in the targeted arteries and block blood flow to the fibroid.

What To Expect After Treatment

Uterine fibroid embolization usually takes between 1 and 3 hours, depending on how long it takes to position the catheter and how easy it is to position the catheter in the arteries in the uterus. When the procedure is over, the catheter is removed and pressure is applied to the puncture site for 10 to 15 minutes, unless there are problems with bleeding. A bandage is then applied. You can expect to have at least 6 hours of bed rest after the procedure.

You may be sent home after the bed rest period if your pain is under control, or you may spend the night in the hospital for more observation or pain control. This will depend on your radiologist's normal practice. And it will depend on how well you do after the procedure.

Moderate to severe pelvic pain is common for 6 to 12 hours after this procedure. A stay in the hospital and narcotic pain medicine are used to control this pain, if needed. You can also ask for antinausea medicine if you have nausea or vomiting. Some women are able to control their pain with nonsteroidal anti-inflammatory drugs, such as ibuprofen oraspirin. Be safe with medicines. Read and follow all instructions on the label.

You may have some vaginal bleeding for a couple of weeks. This is from a fibroid that is breaking down and bleeding.

In some cases, bleeding or pain persist for several months. Some women also pass a fibroid from the vagina, usually 6 weeks to 3 months after having UFE. This can happen even a year afterward. If you do pass fibroid tissue, see your doctor right away to be sure that you do not develop infection or problem bleeding.

You should be able to return to your usual activities in 7 to 10 days.

Recommended follow-up care after UFE includes a checkup 1 to 3 weeks afterward and an ultrasound or MRI 3 to 6 months later.

Why It Is Done

Uterine fibroid embolization is used to shrink or destroy uterine fibroids. It is used in women with fibroid problems who do not wish to treat fibroids with hysterectomy, do not plan to be pregnant in the future, and have not reached menopause. Although there are no size limits, UFE is not recommended for all types of fibroids.

If you are strongly against ever having a hysterectomy, UFE may not be a reasonable option for you. In some cases of infection or uterine damage, UFE has led to a need for a hysterectomy.

How Well It Works

UFE is an effective treatment, but fibroids may return.

• Uterine fibroid embolization reduces the size of fibroids an average of about 50%.¹
• Approximately 80 out of 100 women treated with UFE for uterine fibroids report that their symptoms improved.¹
• UFE does not always cure fibroids. In one study, nearly 1 out of 5 women who had UFE had a repeat UFE or a hysterectomy within the next couple of years.²

Risks

The rate of complications after UFE is low but includes:

• Infection. This is the most serious, potentially life-threatening complication of UFE. In rare cases, hysterectomy is needed to treat an infected uterus.
• Premature menopause. This seems more likely to happen to women over 40 years of age than in younger women.
• Loss of menstrual periods (amenorrhea).
• Scar tissue formation (adhesions).
• Pain that lasts for months.

What To Think About

UFE may not be a good choice if you want to get pregnant. It's possible toget pregnant afterward, but it's uncertain how good the odds are. This procedure does have a risk of damaging an ovary or the uterus, which would make it much harder to get pregnant. There may be a higher risk for pregnancy problems.

For a uterine fibroid embolization, be sure that you have a specially trained interventional radiologist who has a lot of experience with the procedure.

Uterine fibroid embolization may be a good treatment option for women who do not wish to receive blood transfusions (which can be needed aftermyomectomy) or who have other serious health conditions that makegeneral anesthesia dangerous. UFE is not safe for women who are allergic to contrast material (used for fluoroscopy during UFE).

UFE has several advantages over hysterectomy, myomectomy, and treatment with GnRH-a (the hormone-suppressor medicine used to shrink fibroids).

• General anesthesia and an abdominal (belly) incision are not required.
• There is no blood loss, so there is no need for blood transfusions.
• All fibroids may be treated at the same time.
• It does not cause bone-thinning (osteopenia) or the other serious side effects associated with GnRH-a therapy.

Disadvantages of UFE include:

• Cost. UFE is as expensive as hysterectomy.
• An unpredictable effect on fertility. It is not recommended for women who hope to become pregnant.
• The possibility of delayed infection sometime in the first year, which can become life-threatening if not treated.
• Not being a sure cure. In one study, nearly 1 out of 5 women who had UFE had a repeat UFE or a hysterectomy.²
• The possibility that some insurance plans will not cover this procedure.