Uterine fibroid embolization (UFE) is a minimally invasive interventional radiology procedure for uterine fibroids. Most women with symptomatic fibroids can undergo UFE after due consultation with an interventional radiologist. Fibroid tumors are a common occurrence among 20 to 40% of women over age 35. Uterine fibroids are benign and noncancerous growth in the walls of the uterus. These could be small or large in size and most women do not know they have fibroids as they do not cause any symptoms. Some experience heavy menstrual bleeding and periods last longer than usual.
What does uterine fibroid embolization (UFE) mean?
The term embolization means to stop or block the flow of blood. In UFE, blood supply to the fibroid is blocked. Fibroid tumors grow due to the large blood supply that keeps them growing. Fibroids will shrink if the blood supply to them is stopped completely.
Symptoms of fibroids
Preparation for the UFE procedure
An MRI, or an ultrasound is performed prior to the UFE procedure to determine if fibroid tumors are the cause for the symptoms and to fully assess the size, number and location of the fibroids. Some gynecologists prefer to perform a laparoscopy, which enables a direct look at the uterus. A biopsy of endometrium is performed to rule out cancer.
Any allergies to the local anesthetic medications should be informed to the doctor. Physicians normally advise stopping supplements, local anesthetic medications and anti inflammatory drugs or blood thinners. It is advised not to eat or drink anything after midnight before the procedure.
The patient has to remain in the hospital overnight to receive pain medications and remain under observation. They can return to normal activities in a week's time. UFE procedures are used to stop pelvic bleeding caused by trauma, gynecological tumors that are malignant, hemorrhage after childbirth.
Side effects of UFE
As is with any other procedure, there is a certain risk involved with UFE. Most women can expect moderate to severe cramps for the first few hours following the procedure. Some women may experience nausea and fever. Sometimes an infection may occur and antibiotics are prescribed. Although rare, injury to the uterus occurs in about 1% of procedures and can make hysterectomy necessary. In some women, immediate menopause following the procedure is reported.
Benefits and risks of UFE
The advantages or benefits of UFE include:
Risks of UFE procedure
The normal tissue gets deprived of oxygen supply if the embolic agent is lodged in the wrong place.
Those who wish to have children should consider surgical removal of individual tumors as the effects of uterine fibroid embolization on pregnancy are not yet conclusive. Since it is not possible to predict whether the uterine wall is weakened by UFE, it is recommended to undergo a Cesarean section rather than risk rupturing the wall of the uterus.
Limitations of UFE
Uterine fibroid embolization should not be performed in women who exhibit no symptoms from the fibroid tumors, or when there is a possibility of cancer or when there is inflammation or infection in the pelvis. Women who desire to have a baby sometime in the future should not be recommended UFE. There are cases of ovarian failure after UFE and these need hysterectomy to treat infection after UFE.
It is imperative to have UFE done with a trained interventional radiologist who has enough experience in this procedure. Any woman who may be allergic to contrast material should also not be offered UFE line of treatment.
UFE is a good treatment option for those women who do not wish to receive blood transfusion or who have other health problems that make general anesthesia dangerous. UFE has several advantages over hysterectomy, mynomectomy and other treatments like GnRH, where hormone suppressor medicine is used to shrink fibroids. Most insurance company does pay for this UFE procedure and it is advised to check with the insurance company to see if the policy is about this procedure.