Uterine Fibroid Embolisation (UFE)
What are uterine fibroids?
Uterine fibroids are the most common tumours of the female genital tract. You might hear them referred to as "fibroids" or by several other names, including leiomyoma, leiomyomata, myoma and fibromyoma. Fibroids are non-cancerous (benign) growths that develop in the muscular wall of the uterus. While fibroids do not always cause symptoms, their size and location can lead to problems for some women, including pain and heavy bleeding.
The exact causes for fibroid development are unclear, but researchers have linked them to both a genetic predisposition and a subsequent development of susceptibility to hormone stimulation. Women may have a genetic predisposition to fibroid development and then subsequently develop factors that allow fibroids to grow under the influence of a number of hormones. This would explain why certain ethnic groups are more likely to develop fibroids and also why there tends to be genetic predisposition in some families. Fibroids range greatly in size from very tiny to the size of a cantaloupe or larger. In some cases, they can cause the uterus to grow into the size of a five-month pregnancy or more. Fibroids may be located in various parts of the uterus. In most cases, there is more than one fibroid in the uterus. There are three primary types of uterine fibroids.
Subserosal fibroids develop under the outside covering of the uterus and expand outward through the wall, giving the uterus a knobby appearance. They typically do not affect a woman's menstrual flow, but can cause pelvic pain, back pain and generalized pressure. The subserosal fibroid can develop a stalk or stem-like base, making it difficult to distinguish from an ovarian mass. These are called pedunculated. The correct diagnosis can be made with either an ultrasound or magnetic resonance (MR) exam.
Intramural fibroids develop within the lining of the uterus and expand inward, increasing the size of the uterus, and making it feel larger than normal in a gynecologic internal exam. These are the most common fibroids. Intramural fibroids can result in heavier menstrual bleeding and pelvic pain, back pain or the generalized pressure that many women experience.
Submucosal fibroids are just under the lining of the uterus. These are the least common fibroids, but they tend to cause the most problems. Even a very small submucosal fibroid can cause heavy bleeding - gushing, very heavy and prolonged periods.
What symptoms can be caused by uterine fibroids?
Most fibroids do not cause symptoms - only 10 percent to 20 percent of women who have fibroids ever require treatment. Depending on location, size and number of fibroids, a woman might experience the following:
Pelvic pressure or heaviness caused by the bulk or weight of the fibroids pressing on nearby structures
Pain in the back or legs as the fibroids press on nerves that supply the pelvis and legs
Pain during sexual intercourse
Bladder pressure leading to a constant urge to urinate
Pressure on the bowel, leading to constipation and bloating
Abnormally enlarged abdomen
Heavy, prolonged menstrual periods and unusual monthly bleeding, sometimes clots. This often leads to anaemia.
If you are experiencing these types of symptoms, consult with your personal physician.
Who is most likely to have uterine fibroids?
Uterine fibroids are very common, although often they are very small and cause no problems. From 20 - 40 percent of women age 35 and older have uterine fibroids of a significant size. African-American women are at a higher risk: as many as 50 percent have fibroids of a significant size.
Fibroid tumours may start in women when they are in their 20s, however, most women do not begin to have symptoms until they are in their late 30s or 40s. Physicians are not able to predict if a fibroid will grow or cause symptoms.
Known medically as uterine artery embolisation, this approach to the treatment of fibroids blocks the arteries that supply blood to the fibroids causing them to shrink. It is a minimally-invasive procedure, which means it requires only a tiny nick in the skin, and is performed while the patient is conscious but sedated - drowsy and feeling no pain.
Fibroid embolisation is performed by an interventional radiologist, a physician who is specially trained to perform this and other minimally-invasive procedures.
The interventional radiologist makes a small nick in the skin (less than one-quarter of an inch) in the groin to access the femoral artery, and inserts a tiny tube (catheter- like a piece of spaghetti) into the artery. Local anaesthesia is used so the needle puncture is not painful. The catheter is guided through the artery to the uterus while the interventional radiologist guides the process of the procedure using a moving x-ray (fluoroscopy).
The interventional radiologist injects tiny plastic particles the size of grains of sand into the artery that is supplying blood to the fibroid tumour. This cuts off the blood flow and causes the tumour (or tumours) to shrink. The artery on the other side of the uterus is then treated. The skin puncture where the catheter was inserted is cleaned and covered with a bandage.
Fibroid embolisation usually requires a hospital stay of one night. Pain-killing medications and drugs that control swelling typically are prescribed following the procedure to treat cramping and pain. Fever sometimes occurs after embolisation and is usually treated with acetaminophen. Many women resume light activities in a few days and the majority of women are able to return to normal activities within one week.
While embolisation to treat uterine fibroids has been performed since 1995, embolisation of arteries in the uterus is not new. It has been used successfully by interventional radiologists for more than 20 years to treat heavy bleeding after childbirth. UFE is now available at hospitals and medical centres across the globe. To find a site near you, visit our Doctor Finder
What are the benefits of UFE?
Fibroid embolisation usually requires a hospital stay of one night
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
On average, 90 percent of women who had the procedure experience significant or total relief of heavy bleeding
The procedure is about 85 percent effective for pain
The procedure is effective for multiple fibroids and large fibroids
Recurrence of treated fibroids is very rare. Short and mid-term data show UFE to be very effective with a very low rate of recurrence. Long-term (10 year) data is ongoing and not yet available, but in one study in which patients were followed for six years, no fibroid that had been embolised regrew.
What are the risks of UFE?
Fibroid embolisation is considered to be very safe; however, there are some associated risks, as there are with almost any medical procedure. Most women experience moderate to severe pain and cramping in the first several hours following the procedure. Some experience nausea and fever. These symptoms can be controlled with appropriate medications. A small number of patients have experienced infection, which usually can be controlled with antibiotics. It also has been reported that there is a 1 percent chance of injury to the uterus, potentially leading to hysterectomy. These complication rates are lower than those of hysterectomy and myomectomy (surgical removal of fibroids).
A small number of patients have entered into menopause after embolisation. This is more likely to occur if the woman is in her mid-forties or older, and is already nearing menopause.
Myomectomy (surgical removal of fibroids) and hysterectomy also carry risks, including infection and bleeding leading to transfusion. Patients who undergo myomectomy may develop adhesions causing tissue and organs in the abdomen to fuse together, which can lead to infertility. In addition, the recovery time is much longer for abdominal myomectomy, generally one to two months.
You should talk to your doctor about possible risks of any procedure you may choose.
How should I prepare for UFE?
After your interventional radiologists has determined that your fibroids should best be treated with embolisation, he will let you know how to prepare for the intervention. Usually the embolisation is carried out under local anaesthesia during a short stay in the hospital. You will need a standard pre-operative work up including a blood test and an EKG.
What does the material used in UFE look like?
The interventional radiologist injects tiny plastic particles (microparticules) the size of grains of sand into the artery that is supplying blood to the fibroid tumour. This cuts off the blood flow and causes the fibroid to shrink. The artery on the other side of the uterus is then treated. The skin puncture where the catheter was inserted is cleaned and covered with a bandage.
What will I experience during UFE?
Fibroid embolisation usually requires a hospital stay of one or two nights. During the intervention and immediately after you will be treated with pain killing medication, such as patient controlled analgesia or other techniques. Pain-killing medications and drugs that control swelling will be prescribed following the procedure to treat cramping and pain. Fever sometimes occurs after embolisation and is usually treated with appropriate drugs. Many women resume light activities in a few days and the majority of women are able to return to normal activities within one week.
What do I have to do after the procedure?
Usually, you will receive anti-inflammatory drugs and subcutaneous anticoagulants for 48 hours. Upon leaving the hospital, you can take little exercise when feeling better and go back to work after a few days (usually after 6-7 days). You will have to see your IR for a check-up after 1 and 6 months. A control MRI will be probably prescribed at 3 or 6 months.
edited by M. Sapoval