- Pelvic
pain
- 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.
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.
How
does UFE work?
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.
We make 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).
We inject 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 available in our clinic for
more than six years and we have already done more than one hundred
procedures. Personally I am refereed in the list of doctors performing
routinely UFE embolisation by the European Society of Cardiovascular
Interventional Radiology
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 embolization.
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 determination that your fibroids
should best be treated with embolization, we will let you know how to prepare
for the intervention. Usually the embolization 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? microparticules)
We
inject 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 night.
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 or your gynecologist for a
check-up after 1 and 6 months. A control MRI will be probably prescribed at 3
or 6 months.
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