Uterine fibroid embolization (UFE)
Treatment Overview
Uterine fibroid embolization (UFE) is a procedure performed by a radiologist that blocks blood flow to fibroids in the uterus. (It is also called uterine artery embolization.) Fibroids treated with this procedure shrink an average of 48% to 78%.1, 2 For women who are not planning a pregnancy in the future, UFE is a possible option in place of surgery for fibroids.
You should not eat or drink anything for 4 to 8 hours before uterine fibroid embolization. About an hour before the procedure, you may be given a sedative to help you relax. It will not put you to sleep, because it is important that you be awake to follow instructions during the procedure.
First, a thin, flexible tube called a catheter is placed into a blood vessel in the upper thigh (femoral artery). A substance called contrast material is then injected into the catheter. You may feel a warming sensation as it travels up to the uterus. The radiologist uses real-time X-ray on a video screen (fluoroscopy) to see the arteries and then guides the catheter to the arteries that supply blood to the fibroid. A solution of polyvinyl alcohol (PVA) particles is injected into those uterine arteries through the catheter. These particles build up in the targeted arteries and block blood flow to the fibroid.
What To Expect After Treatment
Uterine fibroid embolization usually takes between 1 and 3 hours, depending on how long it takes to position the catheter and how easy it is to position the catheter in the arteries in the uterus. When the procedure is over, the catheter is removed and pressure is applied to the puncture site for 10 to 15 minutes, unless there are problems with bleeding. A bandage is then applied. You can expect to have at least 6 hours of bed rest after the procedure.
You may be sent home after the bed rest period if your pain is under control, or you may spend the night in the hospital for more observation or pain control. This will depend on your radiologist's normal practice, as well as how well you do after the procedure.
Moderate to severe pelvic pain is common for 6 to 12 hours after this procedure. A stay in the hospital and narcotic pain medicine are used to control this pain, if needed. You can also ask for antinausea medicine if you have nausea or vomiting. Some women are able to control their pain with non-steroidal anti-inflammatory drugs, such as ibuprofen or ASA.
You may have some vaginal bleeding for a couple of weeks. This is from a fibroid that is breaking down and bleeding.
In some cases, bleeding or pain persist for several months. Some women also pass a fibroid from the vagina, usually 6 weeks to 3 months after having UFE. This can happen even a year afterward. If you do pass fibroid tissue, see your doctor right away to be sure that you do not develop infection or problem bleeding.3
You should be able to return to your usual activities in 7 to 10 days.
Recommended follow-up care after UFE includes a checkup 1 to 3 weeks afterward and an ultrasound or MRI 3 to 6 months later.4
Why It Is Done
Uterine fibroid embolization is used to shrink or destroy uterine fibroids. It is used in women with fibroid problems who do not wish to treat fibroids with hysterectomy, do not plan to be pregnant in the future, and have not reached menopause. Although there are no size limits, UFE is not recommended for all types of fibroids.
If you are strongly against ever having a hysterectomy, UFE may not be a reasonable option for you. In some cases of infection or uterine damage, UFE has led to a need for a hysterectomy.
How Well It Works
UFE is an effective treatment, but fibroids may return.2
- Uterine fibroid embolization shrinks fibroids an average of 48% to 78%.
- Approximately 85% of women treated with UFE for uterine fibroids report that their symptoms improved.
- After 6 years, uterine fibroids return in up to 27% of women treated with UFE.
- UFE does not always cure fibroids. In one study, nearly 1 in 5 women who had UFE had a repeat UFE or a hysterectomy within the next 3½ years.5
Risks
The rate of complications after UFE is low but includes:
- Infection. This is the most serious, potentially life-threatening complication of UFE. See your doctor immediately if you have a high fever and feel ill or notice pus in your vaginal discharge. In rare cases, hysterectomy is needed to treat an infected uterus.
- Premature menopause. This seems more likely to happen to women over 40 years of age than in younger women.
- Loss of menstrual periods (amenorrhea).
- Scar tissue formation (adhesions).
- Pain that lasts for months.
In up to 14% of cases (although some studies say less than 5%), the ovaries are affected by UFE.6 This causes ovulation and menstrual periods to stop, either temporarily or permanently.
What To Think About
If having a baby sometime in the future is important to you, UFE is not recommended. Some women have had ovarian failure after UFE, and there are reports of needing a hysterectomy to treat infection after UFE.7
For a uterine fibroid embolization, be sure that you have a specially trained interventional radiologist who has a lot of experience with the procedure.
Uterine fibroid embolization may be a good treatment option for women who do not wish to receive blood transfusions (which can be needed after myomectomy) or who have other serious health conditions that make general anesthesia dangerous. UFE is not safe for women who are allergic to contrast material (used for fluoroscopy during UFE).
UFE has several advantages over hysterectomy, myomectomy, and treatment with GnRH-a (the hormone-suppressor medicine used to shrink fibroids).
- Symptoms improve in about 85% of women.2
- General anesthesia and an abdominal incision are not required.
- There is no blood loss and therefore no need for blood transfusions.
- All fibroids may be treated at once.
- It does not cause bone-thinning (osteopenia) or the other serious side effects associated with GnRH-a therapy.
Disadvantages of UFE include:
- An unpredictable effect on fertility. It is not recommended for women who hope to become pregnant.
- The possibility of delayed infection sometime in the first year, which can become life-threatening if not treated.
- UFE does not offer a sure cure. In one study, nearly 1 in 5 women who had UFE had a repeat UFE or a hysterectomy.5
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| Author: | Kathe Gallagher, MSW | Last Updated: October 8, 2007 |
| Medical Review: | Kathleen Romito, MD - Family Medicine Kirtly Jones, MD - Obstetrics and Gynecology Donald Sproule, MD, CM, CCFP, FCFP - Family Medicine | |
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| Topic Contents | |
| Treatment Overview | |
| What To Expect After Treatment | |
| Why It Is Done | |
| How Well It Works | |
| Risks | |
| What To Think About | |
| References | |