More Information About Uterine Fibroid Embolization
The procedure is considered successful if symptoms are gone or greatly improved at three to six months after UFE and no other (surgical) procedure is needed. Abnormal fibroid bleeding usually stops within one to two months, but it may stop immediately. On average, fibroids shrink from approximately 40 percent to 60 percent in six months, and they may continue to shrink for a year or more. Symptomatic improvement may occur independent of the amount of shrinkage.
Patients who have symptomatic uterine fibroids (abnormal bleeding, pain or other symptoms) may be considered for UFE.
Each woman is an individual, and should discuss the potential risks and benefits of UFE and other treatments with her doctors to decide which option is best for her.
Before UFE is performed, all patients are examined by a gynecologist to be certain that fibroid tumors are the cause of their symptoms. Before the procedure, the gynecologist also will perform tests to ensure that the bleeding is not caused by a cancer, and a cervical swab test may be performed to rule out pelvic infection. Some patients may have multiple conditions, such as adenomyosis or endometriosis, which may be the actual cause of their symptoms. These patients must be considered on a case-by-case basis to determine whether they are likely to benefit from embolization (UFE). Some studies suggest that embolization may treat symptoms of adenomyosis successfully.
Women who wish to have children usually are advised to consider myomectomy first, since it is the current recommended therapy. Since UFE also spares the uterus, it may be an option for some. In some cases, the number, size, or position of the fibroids make myomectomy difficult, and increase the likelihood that a hysterectomy will eventually be required. In some patients, fibroids have recurred after myomectomy. For these women, UFE may be a reasonable choice.
The effect of UFE on fertility cannot be predicted in any particular case, and more studies are needed before UFE can be recommended as the first choice for women who desire pregnancy. Nonetheless, many women have reported successful pregnancies after UFE. A small percentage of women experience the onset of menopause after the procedure. This is uncommon in women under the age of 45 but increases as women approach the normal age of menopause. In one study (.pdf file), 17 pregnancies were reported by women after they had the procedure. Of these, 14 resulted in live births and 3 in miscarriage. One of the women who gave birth to a healthy baby after UFE had suffered 9 miscarriages before she had the procedure.
Postmenopausal women usually are not considered for UFE, since fibroid symptoms tend to lessen or go away after menopause. Recent studies have shown, however, that UFE can be very effective in post-menopausal women.
UFE is an especially good option for women with medical conditions that might increase the risks and complications of surgery. Also, since there is virtually no blood loss or need for transfusions with UFE, it may be ideal for patients who wish to avoid transfusion for health or religious reasons.
Almost all patients have crampy pelvic pain for six to twelve hours after UFE, which is controlled with pain relieving medication. This may be managed with an epidural catheter, or an IV pain medicine pump (PCA). One-third of patients may have a low-grade fever for a week or two, which usually is treated with Ibuprofen. A brief, self-limiting syndrome of high fever and elevated white blood cell count that subsides on its own is experienced by a small percentage of patients. The procedure may cause mild, spotty bleeding for a few months or a brown discharge. Patients are carefully screened for infections before UFE and antibiotics are given during the procedure to decrease the probability of infection. Delayed infections may occur in 3-4 percent of patients, which can be successfully treated with antibiotics in the majority of cases, but occasionally require hysterectomy. There have been reported cases of patients who stopped menstruating temporarily after the procedure, and some patients have gone into menopause, but this is uncommon in women under the age of 45. It is more common in older women who are approaching menopause. Nonetheless, premature menopause must be considered a potential risk.
Damage to other pelvic organs during UFE is extremely rare. This is a potential risk, however, and has been described in pelvic embolization done for other reasons, such as cancer. This is an extremely unlikely occurrence in the hands of a well-trained interventional radiologist.
Learn more about the History of Uterine Fibroid Embolization.
Medical references on Uterine Fibroid Embolization.