Uterine Fibroid Embolization Q & A
What is a Uterine Fibroid Embolization?
Uterine fibroid embolization (UFE) is a minimally invasive treatment for fibroid tumors of the uterus.
Uterine fibroid tumors, also known as myomas, are benign tumors that arise from the muscular wall of the uterus. It is extremely rare for them to turn cancerous. More commonly, they cause heavy menstrual bleeding, pain in the pelvic region, and pressure on the bladder or bowel.
In a UFE procedure, physicians use an x-ray camera called a fluoroscope to guide the delivery of small particles to the uterus and fibroids. The small particles are injected through a thin, flexible tube called a catheter. These block the arteries that provide blood flow, causing the fibroids to shrink. Nearly 90% of women with fibroids experience relief of their symptoms.
Because the effect of uterine fibroid embolization on fertility is not fully understood, UFE is typically offered to women who no longer wish to become pregnant or who want or need to avoid having a hysterectomy, which is the operation to remove the uterus.
How is the procedure performed?
UFE is an image-guided, minimally invasive procedure that uses a high-definition x-ray camera to guide a catheter into the uterine arteries to deliver particles to the uterus and fibroids, blocking the arteries that supply blood to the fibroid. The procedure can safely be performed by the experts here at Vascular Health Institute.
The procedure is performed as follows:
- You will be positioned on the examining table.
- You may be connected to monitors that track your heart rate, blood pressure, and pulse during the procedure.
- A nurse or technologist will insert an intravenous (IV) line into a vein in your hand or arm so that sedative medication can be given intravenously. Moderate sedation may be used.
- The area of your body where the catheter is to be inserted will be sterilized and covered with a surgical drape.
- Your physician will numb the area with a local anesthetic.
- A tiny skin incision is made at the site.
- A catheter is inserted into your femoral artery, which is located in the groin area, using X-ray guidance. Contrast material provides a roadmap for the catheter as it is maneuvered into your uterine arteries. The embolic agent is released into both the right and left uterine arteries by repositioning the same catheter that was originally inserted. Only one small skin puncture is required for the entire procedure.
- At the end of the procedure, the catheter will be removed, and pressure will be applied to stop any bleeding. The opening in the skin is then covered with a dressing. No sutures are needed.
- Your intravenous line will be removed.
This procedure is usually completed within 90 minutes, after which you will recover for a few hours and be observed during that time.
Will it be painful during or after the procedure?
Pain varies and depends on the patient and the extent of the procedure. You will feel a slight pinprick when the needle is inserted into your vein for the intravenous line (IV) and when the local anesthetic is injected. Most of the sensation is at the skin incision site, which is numbed using a local anesthetic. You may feel pressure when the catheter is inserted into the vein or artery.
If the procedure is done with sedation, the intravenous (IV) sedative will make you feel relaxed, sleepy, and comfortable for the procedure. You may fall asleep, depending on how deeply you are sedated. If you remain awake, you may feel slight pressure when the catheter is inserted, but you will not feel serious discomfort.
As the contrast material passes through your body, you may experience a warm feeling which quickly subsides.
You may experience pelvic cramps for several days after your UFE and possibly mild nausea and low-grade fever as well. The cramps are most severe during the first 24 hours after the procedure and will improve rapidly over the next several days.
Once you return home, you will be given prescriptions for pain and other medications to be taken by mouth. You should be able to return to your normal activities within one to two weeks after UFE.
Afterward, it is common for menstrual bleeding to be much less during the first cycle and gradually increase to a new level that is usually greatly improved as compared to before the procedure. Occasionally you may miss a cycle or two. Rarely, you may stop having periods altogether. Relief of symptoms usually takes two to three weeks to be noticeable as the fibroids continue to shrink and soften over several months. The shrinking process has usually finished by six months, and the amount of symptom improvement will stabilize.