Uterine Fibroid Embolisation
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.
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.
Important information
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
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