Uterine fibroid embolization (UFE) is a nonsurgical radiology procedure used to treat uterine fibroids. Fibroids, also known as leiomyomas, are benign (noncancerous) masses of fibrous and muscle tissue in the uterine wall, which, due to size, location, and number, may cause heavy menstrual bleeding, pain in the pelvic region, or pressure on the bladder or bowel. With angiographic methods similar to those used in heart catheterization, a catheter is placed in each of the two uterine arteries and small particles are injected to block the arterial branches that supply blood to the fibroids. The fibroids shrink and, in most cases, symptoms are relieved. Uterine fibroid embolization, performed under local anesthesia and light sedation, is much less invasive than open surgery to remove uterine fibroids. The procedure is performed by an experienced interventional radiologist – a physician specially trained to perform uterine fibroid embolization and similar procedures.
Before and during uterine fibroid embolization, the interventional radiologist uses arteriogram and fluoroscopic techniques to visualize blood vessels.
Uterine fibroids are benign (noncancerous) tumors that grow on or within the muscle tissue of the uterus. Approximately 20 to 40% of women 35 years and older have fibroids and fibroids can also occur in younger women ages 20 to 35. While some women do not experience any symptoms, the location and size of fibroids can cause symptoms that can affect a woman’s quality of life. Of the 600,000 hysterectomies performed annually in the United States, one-third are due to fibroids.
During menopause, the levels of estrogen decrease dramatically, causing fibroids to shrink. However, women taking hormone replacement therapy (HRT) during menopause may not experience any symptom relief because the estrogen contained in this regime may cause fibroids to persist and symptoms of urinary frequency, pelvic bloating, and constipation to continue.
The size of fibroids ranges from very small (walnut size) to as large as a cantaloupe or even larger. Additionally, there can either be one dominant fibroid or many fibroids.
Fibroids are classified according to their location within the uterus. There are four primary types of fibroids:
Fibroids may also be referred to as myoma, leiomyoma, leiomyomata, and fibromyoma.
Fibroid tumors of the uterus are benign; however, they can cause symptoms. If a woman is diagnosed with uterine fibroids, embolization may be recommended when the condition causes:
Since uterine fibroid embolization may affect fertility, the procedure is not recommended to women who may wish to become pregnant in the future. However, it is an ideal treatment for a woman wants to avoid having surgery.
There have been numerous reports of pregnancies following uterine fibroid embolization; but prospective studies are needed to determine the effects of UFE on the ability of a woman to have children. One study comparing the fertility of women who had UFE with those who had a myomectomy showed similar numbers of successful pregnancies. However, this study has not yet been confirmed by other investigators.
When it comes to uterine fibroids, interventional radiologists provide patients and their healthcare providers better diagnosis and nonsurgical treatment options
Women typically have an ultrasound at their gynecologist’s office as part of the evaluation process to determine the presence of uterine fibroids. It is a basic imaging tool that often does not show other underlying diseases or all the existing fibroids. For this reason, MRI is the standard imaging tool used by interventional radiologists.
Magnetic resonance imaging (MRI) improves the ability for physicians to determine which patients should receive nonsurgical uterine fibroid embolization (UFE) for treatment. Interventional radiologists can use MRI to determine if a tumor can be embolized, detect alternate causes for the symptoms, identify pathology that could prevent a woman from having uterine fibroid embolization, and avoid ineffective treatments. By working with a patient’s gynecologist, interventional radiologists can use MRI to enhance the level of patient care through better diagnosis, better education, better treatment options, and better outcomes.
For true informed consent before surgery, patients should be aware of all of their treatment options. Patients considering surgical treatment can also get a second opinion from an interventional radiologist, who is most qualified to interpret the MRI and determine if they are candidates for the interventional procedure.
Once you have been diagnosed with fibroids, your provider will discuss with you the various methods for treating them. These methods range from “watchful waiting” to pharmaceutical therapy for fibroids that may have recently been diagnosed or may have some associated symptoms, but do not interfere with daily living. However, many patients may require additional treatment options to manage more severe symptoms. Your provider may advise you of minimally invasive, uterus-sparing therapy, such as uterine fibroid embolization, as well as surgical interventions, such as hysterectomy and myomectomy. It is important to discuss all of these options with your provider to see what the best option is for you.
If your fibroids do not cause symptoms, there is no need to treat them. Your doctor may want to watch them and monitor for any fibroid growth at each of your annual examinations. Some women may have fibroids, but do not experience symptoms.
If you experience some or many of the symptoms previously indicated, there are several other treatment options that may be available to you. These include drug therapies, minimally invasive non-surgical options, and surgical options. Your doctor should discuss all the alternatives with you based on your condition.
Uterine fibroid embolization (UFE) is a procedure in which an interventional radiologist uses a catheter to deliver tiny particles that block the blood supply to the fibroids. This is a minimally invasive, nonsurgical therapy that treats all fibroids that are present. Clinical data suggests that patients treated with uterine fibroid embolization return to work and daily activities on average within 7-11 days. There are many benefits to having UFE:
Overall, uterine fibroid embolization is a safe procedure for treating symptomatic fibroids with minimal risk. 90 to 95% of patients indicated that they are happy with their outcome and would recommend UFE to a friend. Most reported risk factors and complications associated with UFE are transient amenorrhea, irregular periods for a few months, vaginal discharge/infection, possible fibroid passage, and post-embolization syndrome.
Birth-control pills will be prescribed by many medical providers as a means of controlling excessive bleeding caused by fibroids. Non-steroidal anti-inflammatory agents (NSAIDs) may be prescribed for pain relief. Certain birth-control pills may help to control fibroid symptoms. There are several potential side effects of the use of birth control pills, including risk of high blood pressure, development of blood clots, increased risk of heart disease, and/or liver disease.
GnRH agonists can be prescribed by physicians when symptoms are not controlled by birth control pills or can be prescribed as a first attempt in controlling fibroid symptoms. Generally, they cannot be taken for longer than six months. GnRH agonists are used to decrease the production of estrogen in the ovaries, which may reduce the size of fibroids and help manage the associated symptoms. Because of the decrease in estrogen production, there may be menopausal-like side effects, such as hot flashes or mood swings. Furthermore, there may be some bone loss associated with prolonged use of GnRH agonists. In addition, data indicates that fibroids re-grow after this treatment ends.
Hysterectomy is defined as the “surgical removal of the uterus.” It is one of the most common of all surgical procedures and can also involve the removal of the fallopian tubes, ovaries, and cervix. Following this operation, you will no longer have periods, nor will you be fertile or able to have children.
The most common way is to remove the uterus through an incision in the lower abdomen. Another way is to remove the uterus through a cut in the top of the vagina and there are also laparoscopic and robotic assisted techniques. Each operation lasts between one to two hours and is performed in the hospital under general anesthesia.
Physically, there are a number of issues that are common to all women having a hysterectomy. You will not have any more periods and you will not be able to have children. If you have your ovaries removed, you will go through menopause regardless of your age. Menopause is not related to age, it is related to the production of the female sex hormone, estrogen. Your physician should discuss hormone replacement therapy (HRT) with you to help you understand its pros and cons.
Myomectomy is the surgical removal of the fibroids. While this procedure keeps your uterus intact, it can be a surgically challenging procedure and is not performed by all physicians. In addition, only certain fibroids may be treated with this therapy. An abdominal myomectomy is performed through a horizontal incision through the abdomen – similar to a “bikini cut” used in a cesarean section. Most types of fibroids, even very large ones, can be removed in an abdominal myomectomy. The recovery time varies with each patient, but typically is 4 to 6 weeks in length. Pedunculated and subserosal fibroids can be removed via a laproscopic myomectomy, which is performed through three small incisions. When a resectoscope is used to remove submucous fibroids, this is called a hysteroscopic myomectomy. In addition to abdominal and hysteroscopic myomectomy, there are also laparoscopic and robotic-assisted myomectomy approaches.
MR-Focused Ultrasound for fibroids is a technique that uses magnetic resonance for guidance that sends highly focused ultrasound waves to the precise location of the fibroids, destroying with heat while sparing the surrounding tissue. It is limited by the location, size, and number of fibroids it can treat.
Laparoscopic radiofrequency ablation for fibroids uses a special ultrasound tool to visualize the location of fibroids after which they are individually heated, sparing the health surrounding tissue. Over a period of a few months, fibroids shrink to about 40% to 50% of their original size.
To schedule a consult for uterine fibroid embolization, please call our interventional team at (512) 467-9729.
You can also request a consultation online.
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