Uterine Artery Embolisation
Although fibroids are a common problem, the way they and their treatment affect you physically and emotionally is unique to you. Take time to gather all the information, talk to your doctors, assess the options, and make sure you receive the treatment that is right for you. This webpage should help answer some of your questions. You can arrange an appointment to see Dr Nimit Goyal if you wish to proceed with uterine artery embolisation or have further queries.
What are fibroids?
Fibroids are non-cancerous swellings (benign tumours) of the womb (uterus). They are not cancerous and are therefore very unlikely to be life-threatening. Fibroids are very common, affecting about half of all women at some stage in their lives. Most women with fibroids have no symptoms and may not even know they have them, but a minority experience very distressing symptoms.
Fibroids are made up of muscle and fibrous tissue and tend to have a rich blood supply. Their exact cause is not well understood, but they are influenced by hormones, and are most likely to grow when oestrogen levels are highest, typically in a woman’s mid-life. For this reason, they are rare in teenagers, most common between the ages of 30–50, and shrink naturally after the menopause.
Fibroids are more common in black women than in white women. Your risk of developing them is also higher if you are overweight, if other members of your family have been diagnosed with them, or if you have not had children. Fibroids vary greatly in size and number; some may be as small as a marble, while others can grow as large as a pumpkin.
Learn more
What are the symptoms caused by fibroids?
Many women do not experience symptoms, but in some cases fibroids can have a significant impact on daily life. Up to a third of patients may develop:
- Heavy or painful periods (menorrhagia)
- Tummy (abdominal) pain
- Lower back pain
- A frequent need to urinate
- Constipation
- Pain or discomfort during sex
- In rare cases, further complications caused by fibroids can affect pregnancy or cause infertility
Infertility and Problems with Pregnancy
Most fibroids do not affect the ability to conceive or the pregnancy itself, although some may make pregnancy more uncomfortable.
In certain cases, fibroids can make conception difficult or increase the risk of miscarriage. This may occur if a fibroid blocks the fallopian tube and prevents the egg travelling from the ovary to the womb, or if a fibroid within the womb lining interferes with the embryo’s growth.
Large fibroids may also obstruct the passage of the baby during childbirth, sometimes requiring delivery by caesarean section.
How are Fibroids diagnosed?
Your symptoms and clinical examination will make your GP or gynaecologist suspect a diagnosis or fibroids. A scan will help to confirm this suspicion.
Ultrasound
An ultrasound scan uses sound waves to produce images of the internal organs. It can reliably show whether you have fibroids. Sometimes the scan is performed internally (through the vagina), which may provide additional information.
Magnetic Resonance Imaging (MRI)
MRI provides detailed images of the pelvic anatomy, including the womb. It can show the number, size, and location of fibroids (e.g. submucosal, subserosal, intramural), whether they are pedunculated (attached by a stalk), their blood supply, and whether another condition may be present. MRI is more accurate than ultrasound and often helps guide treatment choice.
Hysteroscopy
Hysteroscopy is having a look directly at the lining of the womb. This is done by inserting a small camera into the womb through the cervix. This can usually be done without need for general anaesthesia. It can be useful for diagnosing sub-mucosal fibroids. A biopsy of the lining of the womb can be taken at the time of the hysteroscopy.
Your gynaecologist may recommend a hysteroscopy particularly if your main problem is heavy periods.
How are fibroids treated?
Fibroids don’t need to be treated if they aren’t causing symptoms. However, if you have symptoms caused by the fibroids, there are several treatment options. Your GP or Gynaecologist will be able to discuss these options with you.
Medication: Medicines are available that can be used to reduce heavy periods, but they are generally less effective the larger your fibroids are. If medications prove ineffective, surgery or other, less invasive procedures may be recommended.
Uterine Artery Embolisation: This is a non-surgical procedure performed by an Interventional Radiologist which is NICE approved and has further advantage of keeping fertility options open.
Surgical options: Surgery to remove your fibroids may be considered if your symptoms are particularly severe and medication has been ineffective. Some of the surgical options include:
- Hysterectomy
- Myomectomy
The surgical procedures generally tend to have longer recovery times although your gynaecologist will be able to provide you with more details about these procedures.
NICE guidance on heavy menstrual bleeding and Fibroids
NICE recommends referral for consideration of UAE or surgery (myomectomy or hysterectomy). All options should be discussed with patients. Women should be informed that UAE or myomectomy may preserve fertility. Myomectomy is recommended for women with heavy bleeding who wish to keep their womb. UAE is recommended for women with heavy bleeding who want to preserve their womb and/or avoid surgery.
Hysterectomy should only be considered when:
- Other treatments have failed, are contraindicated, or are declined
- The patient wishes for amenorrhoea (no periods)
- The woman specifically requests it
- The woman no longer wishes to retain her womb or fertility
Uterine Artery Embolisation
Although fibroids are a common problem, the way they and their treatment affect you physically and emotionally is unique to you. Take time to gather all the information, talk to your doctors, assess the options, and make sure you receive the treatment that is right for you. This webpage should help answer some of your questions. You can arrange an appointment to see Dr Nimit Goyal if you wish to proceed with uterine artery embolisation or have further queries.
Uterine Fibroid Embolisation
Fibroid treatment without surgery
Fibroid treatment without surgery is carried out by specially trained doctors called interventional radiologists. Uterine fibroid embolisation was first performed in 1995 and, since then, more than 200,000 women worldwide have had the procedure.
What is Uterine Fibroid Embolisation?
Fibroids are non-cancerous growths in the womb. They are common in women of childbearing age and usually shrink after the menopause. Most fibroids cause no symptoms, but when they do, these may include:
- heavy bleeding
- pelvic or period pain
- frequent urination
- pressure symptoms
- in some cases, infertility
Uterine Fibroid Embolisation (UFE), also known as Uterine Artery Embolisation (UAE), is a way of treating fibroid symptoms without surgery. In this procedure, blood flow to the fibroids is blocked, causing them to shrink and relieving symptoms. The womb is not removed.
UFE is performed in a special X-ray room, similar to an operating theatre. Contrast dye is injected into the bloodstream to show the arteries on live X-ray images. This enables the doctor to guide a catheter into the uterine arteries and block them.
How do I prepare for a Uterine Fibroid Embolisation?
UFE is performed in hospital. You will usually be asked to fast beforehand, and blood tests may be taken to check your kidney function and blood health.
On arrival, you will be admitted as a patient and a drip will be inserted into your arm or hand. You will be given antibiotics and pain relief. The hospital stay is usually 1–3 days, so bring clothes and essentials for this period.
Patients often worry about undergoing the procedure during a period. As UFE is performed inside the blood vessels, it does not matter where you are in your menstrual cycle. However, if you have a contraceptive coil, this will need to be removed beforehand.
What happens during a Uterine Fibroid Embolisation?
UFE will be performed in a special X ray room of the hospital. This is a room like an operating theatre that is specifically set up for this type of procedure. There is also monitoring equipment, trained medical staff and medications to ensure the procedure is performed comfortably and safely.
You may be anxious, and the staff are well trained and expecting this. You may be offered an injection of sedative medication (usually through the drip) at this stage to make you feel a little drowsy and treat any feelings of anxiety.
The procedure begins with a needle and wire being placed into the artery, usually in the right groin. However, sometimes arteries in the left groin or arm are used. The overlying skin will have been injected with local anaesthetic to make it go numb. You do not have feeling inside the blood vessels, so you do not usually feel anything during the procedure. Once the wire is put into the artery a plastic tube known as a catheter is steered into the arteries supplying blood to the fibroids. Most commonly these are the right and left uterine arteries, but also occasionally the ovarian arteries or other arteries supply the fibroids.
Blood supply to the fibroid is stopped by injecting tiny particles of plastic known as polyvinyl alcohol (PVA). Once this has been completed, the catheter is removed from the groin and firm compression with the finger is applied to the tiny hole in the artery to stop the bleeding. The procedure is now finished and you will be taken back to the ward.
How long does a Uterine Fibroid Embolisation take?
UFE usually takes about 60 minutes, although it can take longer depending on your anatomy and the number of arteries that need blocking.
Are there any after effects of a Uterine Fibroid Embolisation?
You usually do not feel anything during the procedure. However, there will be some effects experienced immediately after the procedure as well as for some time later.
It is common to get some degree of pelvic pain or cramping after the procedure as well as nausea (feeling sick) or vomiting. You may also have a slight fever. This is often called post embolisation syndrome and you will be given medications to lessen the chance of this happening or to lessen the feeling of nausea, often before and after the procedure. Post embolisation syndrome differs greatly between patients and if you do not get this it does not mean that the UFE did not work.
Approximately 1 out of 20 patients suffer a more severe post embolisation syndrome, which can be quite uncomfortable and requires a longer stay in hospital. If this happens, strong medications can be given to keep you comfortable. This does not mean there are problems with the procedure or that you are not going to get a good result.
What are the risks and complications?
All medical procedures carry some risk, though complications with UFE are less common than with surgical treatments for fibroids.
Uncommon risks include:
- damage to the artery in the groin
- allergic reaction to medication or the contrast dye
- very rarely, blocking blood supply to other organs
Less than 1 in 50 women may develop fever, sweats, or worsening pelvic pain two weeks or more after the procedure. This could indicate an infection in the fibroid and requires urgent medical attention.
If your periods have not returned after three months, you should contact your doctor, as this may suggest ovarian damage leading to early menopause. This is uncommon but more likely if the procedure is performed near the time of natural menopause or if the ovarian arteries had to be blocked.
What are the benefits of a Uterine Fibroid Embolisation?
The main benefit of UFE is effective relief of fibroid-related symptoms such as pain and heavy bleeding, without the need for surgery. The womb is preserved.
UFE is considered safe and effective both in the short and long term.
Symptom relief is often better than with myomectomy (fibroid removal surgery), with fewer side effects.
UFE is less effective than hysterectomy (womb removal) but has a much lower complication rate.
About 10–15% of women may require repeat treatment or an alternative procedure.
When can I expect the results of my Uterine Fibroid Embolisation?
Blood flow to the fibroids reduces significantly after the procedure causing the fibroids to shrink. Blood supply to uterus from surrounding arteries prevents the uterus from dying while the fibroids decrease in size as they receive most of the blocking material. Fibroid shrinkage happens over the next few weeks after the procedure resulting in fibroid treatment without surgery. The benefit from UFE is usually seen within a few period cycles for heavy bleeding and pain related symptoms. It may take some months for the increased need to pass urine and pressure related symptoms to go away.
Further Information
British Society of Interventional Radiology
https://www.bsir.org/patients/fibroids/
Why have a Fibroid Embolisation?
- NICE Approved
- Minimally Invasive ‘Pinhole’ Surgery
- Faster Recovery Times
- Lower Complication Rate than Open Surgery
- Lower Recurrence Rate than Myomectomy
- Keeps Fertility Options Open
Clients.
Forward Thinking Clients.
About Us.
Curious About Our Culture?
Proin gravida nibh vel velit auctor aliquet. Aenean sollicitudin, lorem quis bibendum auctor, nisi elit consequat ipsum, nec sagittis sem nibh id elit. Duis sed odio sit amet nibh vulputate cursus a sit amet mauris. Morbi accumsan ipsum velit. Nam nec tellus a odio tincidunt auctor a ornare odio.
Sed non mauris vitae erat consequat auctor eu in elit. Class aptent taciti sociosqu ad litora torquent per conubia nostra, per inceptos himenaeos. Mauris in erat justo. Nullam ac urna eu felis dapibus condimentum sit amet a augue.
Sed non neque elit. Sed ut imperdiet nisi. Proin condimentum fermentum nunc. Etiam pharetra, erat sed fermentum feugiat, velit mauris egestas quam, ut aliquam massa nisl quis neque. Suspendisse in orci enim.
Partner / Strategy
Amanda Johnston
Nibh vel velit auctor aliquet. Aenean sollicitudin, lorem quis bibendum auctor, nisi elit consequat ipsum, nec sagittis sem nibh id elit. Duis sed odio sit amet nibh vulputate.
Partner / Art Director
Brandon Harrison
Nibh vel velit auctor aliquet. Aenean sollicitudin, lorem quis bibendum auctor, nisi elit consequat ipsum, nec sagittis sem nibh id elit. Duis sed odio sit amet nibh vulputate.
