Uterine Fibroid Embolization
Uterine fibroid embolization (UFE), also known as uterine artery embolization (UAE), is performed by an interventional radiologist, a physician who is trained to perform this and other types of minimally invasive procedures under image guidance. It is performed while the patient is conscious, but sedated. It does not require general anesthesia. Most women with symptomatic fibroids are candidates for UFE and should obtain a consultation with an interventional radiologist to determine whether UFE is a treatment option for them.
To perform the embolization, the interventional radiologist makes a tiny incision in the skin of the groin and inserts a catheter into the femoral artery. Using real-time image guidance, the physician guides the catheter into the uterine artery and then releases tiny particles, about the size of grains of sand, into the arteries that supply blood to the fibroid tumor. This blocks the blood flow to the fibroid tumor and causes it to shrink and die.
In August 2008 the American College of Obstetricians and Gynecologists released a Practice Recommendation stating that Uterine Fibroid Embolization Is "Safe and Effective," based on good, consistent Level A scientific evidence and long- term outcomes. Women can and should be confident about their decision to consider UFE as a treatment option. Level A treatment choices are considered proven treatments that should be offered to patients for their conditions when discussing treatment options.
UFE Recovery Time
Fibroid embolization can be performed as an outpatient with discharge home the evening of the procedure or with hospital stay of one night. Pain-killing medications and drugs that control inflammation typically are prescribed following the procedure to treat cramping and pain. Many women resume light activities in a few days and the majority of women are able to return to normal activities within seven to 10 days.
UFE Efficacy
On average, 85-95 percent of women who have had the procedure experience significant or total relief of heavy bleeding, pain and/or bulk-related symptoms. The procedure is effective for multiple fibroids and large fibroids. Recurrence of symptoms from treated fibroids is rare. Multiple clinical studies have shown no difference in symptom relief or patient satisfaction when UFE is compared with hysterectomy (surgical removal of the uterus).
UFE, Fertility and Menopause
While some women have been able to become pregnant after UFE, the effects of UFE on a women's ability to concieve, carry a child to term and deliver are unknown. As the ability to have children may be compromised by the UFE procedure, we do not currently recommend UFE in those women with a desire to have children in the future. Myomectomy (surgical removal of fibroids) may be an option for some women wishing to preserve fertility and this should be discussed with your gynecologist. Some women treated with UFE may experience early menopause, with typical menopausal symptoms, and the chance of this happening increases with patient age.
Risks of UFE
UFE is a very safe method for treating symptomatic fibroids and, like other minimally invasive procedures, has advantages over conventional open surgery. However, there are some associated risks, as there are with any medical procedure. A small number of patients have experienced infection, which usually can be controlled by antibiotics. Injuries to the blood vessels through which the embolization is performed can occur and will rarely need surgical repair or result in an ineffective embolization. There also is chance of injury to the uterus, potentially leading to a hysterectomy. There is a small chance the fibroids can re-grow after UAE and a small number of women undergoing UAE will require more than 1 treatment for maximum effect. Overall complication rates are simliar to hysterectomy and myomectomy but complications tend to be less severe. You should discuss complications of any medical procedure with your doctor prior your procedure or surgery.
Other Surgical Treatments for Fibroids
Hysterectomy
Gynecologists perform hysterectomy and myomectomy surgery. Hysterectomy is the removal of the uterus and is considered major abdominal surgery. It typically requires two to four days of hospitalization and the average recovery period is six weeks. Hysterectomy is currently considered the most 'definitive' therapy for symptomatic fibroids as there is no chance of fibroid re-growth or recurrence after removal of the uterus.
Myomectomy
Myomectomy is the removal of one or more fibroids from the uterus and may be performed in both outpatient and inpatient settings. Myomectomy typically involves surgical resection of the largest fibroid or collection of fibroids and then stitching the uterus back together. In women with multiple fibroids it is usually not possible to remove all of them because it would remove too much of the uterus. While myomectomy is frequently successful in controlling symptoms, the more fibroids the patient has, generally, the less successful the surgery. After myomectomy, like UFE, fibroids may grow back several years later and become symptomatic again.
For true informed consent before surgery, patients should be aware of all of their treatment options. Patients considering surgical treatment should consider geting a second opinion from an interventional radiologist to determine if they are candidates for minimally invasive embolization. You can ask for a referral from your doctor.
Additional Resources
Additional information regarding Uterine fibriods may be found at ask4ufe.com.
