5
Questions & Answers
About Uterine Fibroid Embolization (UFE)

 

About the UFE Procedure

Will my fibroid(s) totally disappear after UFE?

After the procedure, the fibroid(s) will begin to shrink and die over time. The fibroid(s) shrink primarily in the first six months, but they may continue to shrink for up to a year. Although the fibroid(s) never completely go away, they usually become small enough to relieve most symptoms such as heavy bleeding, pressure, frequent urination and pain.


Will my heavy periods go away after the procedure?

Most women notice a lighter flow right away. Some women, however, may not notice a significant decrease in menstrual bleeding until after their first few periods following UFE.


What is the success rate of UFE?

According to the combined results of major studies of UFE, the average success rate is approximately 90 percent. A successful procedure is defined as one that significantly reduces or eliminates uterine fibroid symptoms and which requires no further treatment with surgery or other options.


After five years, approximately 75% of patients are asymptomatic. In other words, in three-quarters of patients, it is not necessary to have a hysterectomy for uterine fibroid disease.


What are the risks and/or side effects?

Although UFE is very safe and less risky than surgery, any medical procedure has some potential side effects or risks. Most women experience moderate to severe pain and cramping during the first several hours after the procedure, and some also experience nausea and fever. All of these can be successfully controlled with appropriate pain medications. It is common to have a low-grade fever, mild nausea, and malaise for a few days after the embolization. In a very small number of cases (3-4 percent), the fibroids and uterus become infected. This can usually be controlled with antibiotics, but sometimes a hysterectomy may be required.


There is a less than 1 percent chance of uterine injury, which may require a woman to undergo a hysterectomy. A small number of patients have reported beginning menopause after the procedure, but this rarely occurs in women under the age of 45 and is most common in older women who are approaching menopause.


Is fibroid embolization an approved procedure?

Yes. The FDA has approved embolizing particles for treatment of uterine fibroids with UFE. The same technique has been performed for more than twenty years to treat emergency bleeding, which is known as uterine artery embolization. Uterine fibroid embolization, or UFE, is the same procedure. It has been performed to treat fibroids in more than 15,000 patients in the USA. We have been performing UFE since April 1998 at LaGrange Memorial hospital.


There now are multiple published studies showing this treatment to be safe and effective, and it is wrong to say it is “experimental.” It has been approved by the U.S. FDA and the American College of Obstetrics and Gynecology.

 
Links to: FDA statement | ACOG statement

Will I have to be put to sleep during the procedure?

No. General anesthesia is not used. You will be sedated but conscious during the procedure. A local anesthetic, usually Lidocaine or Novacaine, is used to numb the site where the physician inserts the catheter. UFE is not painful, and many patients don’t remember anything about the procedure due to the effects of the “twilight” sedation.


Is the UFE procedure painful?

The procedure itself is not painful. Most women experience moderate to severe pain and cramping during the first 6-12 hours after the procedure. This pain is typically controlled with intravenous narcotics, but an epidural may be used, which may numb the pelvic area for several hours.


What tests do I need before I can undergo UFE?

All patients must have a thorough gynecologic examination to be certain that fibroids are indeed the cause of their symptoms. All patients also must have an MRI examination. Most patients who complain of bleeding will have an endometrial biopsy, an outpatient gynecologic procedure that is performed to rule out cancer of the lining of the uterus. Occasionally, laparoscopy might be needed to rule out other possible conditions that may be factors.


Can UFE be performed regardless of the number and size of the fibroids?

Yes. There is no set limit on the size or number of fibroids we consider treating. One of the advantages of embolization is that it treats all fibroids at once. In a few cases, there may be a slightly lower success rate for very large fibroids, but most can be treated satisfactorily with embolization. What matters most is the result you want from the procedure, and your expectations are an important part of the discussion at your first consultation appointment.


Why don’t gynecologists perform this procedure?

Although UFE is used to treat a gynecological problem, it was developed and is performed by interventional radiologists. They are physicians who have the special skills needed to treat conditions without surgery using micro tools inserted through a nick in the skin and guided by X-rays. Interventional radiologists must complete years of specialty training

(link to .pdf)

to successfully perform these procedures, whereas gynecologists receive specialty training in other areas, such as performing hysterectomy, myomectomy and other types of open surgery.


The best care is when interventional radiologists and gynecologists work together to make sure each woman gets the right treatment for her.

 

About Lifestyle


Can I have children after UFE?

Most women who undergo UFE do not plan to have children in the future, or are past their childbearing years. In certain cases women who desire future fertility are considered as candidates, and there are many women who have become pregnant and given birth after UFE. Myomectomy, however, has traditionally been the first option for women who wish to become pregnant. When fibroids recur after myomectomy, or if a woman has other health conditions or reasons to avoid surgery, UFE may be the best option. Studies also show that fertility usually has not been affected among women who have undergone embolization for other reasons, such as to control post-partum bleeding. Although these results are encouraging, we do not have enough evidence yet to offer UFE as a primary treatment of fibroid related infertility. The risks and effects of UFE on future fertility and pregnancy should be discussed with your doctor.


How soon after the procedure can I have sex?

Patients may generally resume sex and other normal activities in about a week.


How quickly can I go back to work?

Because the procedure is less invasive than surgery, recovery time is much shorter than hysterectomy or myomectomy. Most women go back to work within a few days, and are completely recovered in about a week. Recovery from abdominal hysterectomy or myomectomy, on the other hand, can take up to six weeks or more.


Will I experience any hormonal changes after the procedure?

Because UFE usually does not affect the ovaries, most women will not experience the hormonal changes or depression that are common with hysterectomy/removal of the ovaries. Women near the age of menopause, however, may be more likely to start menopause after UFE.


Is UFE covered by insurance?

Yes, most insurers cover the procedure. If you are a patient of Dr. Smith or Dr. Sewall, Our Clinical Coordinator can assist you in obtaining coverage information from your insurance plan.


My gynecologist seems opposed to my even considering embolization, what should I do?

We are happy to talk with your gynecologist about your case, and whenever possible we work with a woman’s gynecologist to be certain that she receives the treatment that is best for her. A cooperative, collaborative approach to your treatment is the key to a successful outcome.


Will I get my flat stomach back after UFE?

In most cases the fibroid(s) shrink to a size where they are not noticeable on the outside. It depends, however, on the size of your fibroid(s) and the amount of time it takes for them to shrink. Because UFE does not completely remove the fibroid, there is the possibility that a slight protrusion in the stomach will remain.