Overview

Up to 80 percent of women with fibroids can be treated with uterine artery embolization (UAE), which is also known as uterine fibroid embolization (UFE). Uterine fibroids are benign tumors that form on the uterus. They occur most often in women between the ages of 35 and 50. African-American women and those with a family history are more likely to develop fibroids. Even though these tumors are not malignant, they can cause prolonged bleeding, anemia, abdominal swelling and pelvic pain. They are also the leading cause of hysterectomy in pre-menopausal women. For women who do not meet the criteria for the minimally invasive procedure, surgical procedures are available to remove fibroids.

UAE is a non-surgical radiology procedure that may help reduce inflammation and pain from uterine fibroids. 

Related conditions

Eligibility

Eligible candidates for this treatment include:

  • Pre-menopausal women with symptomatic fibroids
  • Women who have been screened to rule out possible infection, malignancy, and pregnancy
  • Women who understand that long-term data with regard to fertility have not been fully evaluated

Ineligible candidates include:

  • Post-menopausal women
  • Women who desire to maintain their fertility and who are candidates for myomectomy

Evaluation

Women who fit the eligibility criteria will meet with an interventional radiologist to discuss uterine artery embolization in detail. The radiologist will answer the patient's questions and perform a brief physical exam to make sure that the patient is a good candidate for the procedure.

Reports of recent pelvic sonograms as well as those of recent Pap smears are required. An MRI of the pelvis may be ordered to better define the anatomy of the uterus and to exclude other possible causes for uterine bleeding.

The procedure

Patients are admitted for uterine artery embolization on the day of the procedure. The embolization procedure is performed early in the morning and usually takes between 60 and 90 minutes.

The procedure begins with preparation of the patient's groin with a sterile soap and a local anesthetic. An intravenous antibiotic is given as well as an intravenous sedative, if needed. Then, a tiny incision is made in the groin and a thin hollow tube called a catheter is placed into an artery. The diameter of this catheter is similar to the diameter of a piece of spaghetti. The catheter is then placed into both the left and right uterine arteries, where small particles are injected to simply block the blood flow to the fibroids and deprive them of the oxygen they need. This causes the fibroids to shrink and prevents them from causing further symptoms. The particles do not contain any medication and do not move once they have been placed. They are injected under X-ray guidance, which enables the doctors to track their position at all times. Once the blood flow in both uterine arteries has been reduced, the catheter is removed and the incision site is compressed to prevent bleeding.

Patients are then transferred to a hospital bed where they receive strong pain medication to control any "crampy pain" they might have. While most patients stay overnight, a few patients go home the same afternoon on oral pain medications.

Post-procedure management

After embolization, patients can expect to have "crampy" pelvic pain. This typically lasts a few days and rarely can last up to several weeks. Most patients resume their normal routine within one week. A low grade fever (less than 101ºF), light intermittent spotting of blood and passage of small amounts of tissue can be expected after the procedure.

Results

Studies both in Europe and in the United States reveal a success rate of approximately 85-90 percent with regard to control of heavy menstrual bleeding and excessive menstrual pain. All fibroids in the uterus are treated simultaneously during the procedure, resulting in this high success rate.

Shrinkage (volume reduction) of the fibroids can also be expected after UAE. The post-procedure volume reduction of the fibroids is variable; however, many studies reveal a reduction in size of approximately 40-60 percent. There is only a small chance that existing fibroids might re-grow or that new fibroids might appear after UAE.