Uterine Fibroid Embolization (UFE)
What are uterine fibroids?
Uterine fibroids are non-canerous tumors that develop within the muscular walls of the uterus. Fibroids are common, occurring in 20-40 percent of women over the age of 35. Most women who have fibroids have no symptoms, and do not require any treatment, but up to 25 percent of women with fibroids will develop symptoms such as pain, excessive and prolonged menstrual bleeding, and frequent urination.
What is uterine fibroid embolization (UFE)?
Uterine fibroid embolization is a minimally invasive treatment that preserves the uterus. Embolization is a non-surgical technique that has been used for over fifty years to treat tumors and a variety of other medical problems. First used for the treatment of uterine fibroids in 1995, embolization for symptomatic fibroids has been proven to be an effective non-surgical alternative to hysterectomy (removal of the uterus) or myomectomy (surgical removal of fibroids).
During UFE, patients are given pain and sedation medication, but are kept awake. A doctor known as an interventional radiologist (IR) inserts a small tube, called a catheter, into an artery in the top of the thigh through a tiny nick in the skin. The catheter is steered with imaging guidance into the blood vessels that lead to the fibroids. The IR blocks off the vessels with tiny particles that deprive the fibroids of their blood supply. The procedure takes about one hour to complete. Most women feel pelvic cramping for several hours after UFE, so intravenous pain medication is given and an overnight stay in the hospital is usually required.
Consultation with an experienced interventional radiologist is required to assess for individual safety and suitability of UFE. Most insurance companies cover UFE as a treatment for symptomatic fibroids.
What are the outcomes from UFE?
Because there are no incisions or scars to heal, UFE allows most patients to be back to work within 10 days. UFE is highly effective: over 90 percent of women report being satisfied with their results at 12 months. A long-term study has shown that symptom relief is durable out to 5 years and beyond.
1Spies, et al. Obstetrics and Gynecology, 2005; 106,5: 933-939.
Will my fibroids disappear after embolization?
Your fibroids will never completely go away after embolization because they haven’t been removed. Instead, fibroids shrink after their blood supply is blocked. Treated fibroids that have been studied after unrelated hysterectomy have shown to be composed mostly of scar tissue. Typically, fibroids decrease in size by 40 to 50 percent six months after embolization. Fibroids continue to shrink more slowly after the first six months.
My ultrasound shows more fibroids than they can count. Does this mean that embolization won’t work for me?
Almost all fibroids can be treated, regardless of size or number. Only a thorough evaluation by a doctor experienced with embolization can determine whether UFE is right for you. Usually, an MRI examination of the uterus is needed to exclude other causes of bleeding or pain prior to UFE.
I am thinking about having children. What effect does embolization have on fertility?
There are many reports of successful pregnancies after UFE, but the overall effect of UFE on fertility is not yet thoroughly known. If pregnancy is desired after UFE, surgical removal of the fibroids (myomectomy) is usually preferred. While there is no evidence that UFE risks fertility any more than myomectomy, most IR’s will withhold embolization unless the only alternative is hysterectomy.
What are the alternatives to fibroid embolization?
Hysterectomy (surgical removal of the uterus) is curative for fibroids. Myomectomy (surgical removal of fibroids) can be effective if there aren’t too many fibroids or if the individual fibroid causing symptoms can be identified and removed. Hormones can sometimes improve heavy bleeding caused by fibroids. Stronger drugs (such as Lupron) will shrink fibroids, but is usually not used for more than six months because of menopause-type symptoms. Lupron can be helpful for shrinking fibroids in preparation for myomectomy or hysterectomy. MRI-guided ultrasound is a promising investigational technique that can treat fibroids non-invasively.
How can I find out more about UFE?
The Society of Interventional Radiology is a good resource for information about UFE www.sirweb.org. To schedule a consultation at Utah Vascular Clinic, contact us for an appointment.