Uterine Fibroid Embolization (UFE)
Interventional Radiologists can provide diagnosis of uterine fibroids and offer minimally-invasive treatment
What is Uterine Fibroid Embolization?
Uterine fibroid embolization (UFE), a minimally invasive interventional radiology treatment for uterine fibroids, is a safe and effective, non-surgical option for women to consider. Most women with symptomatic fibroids are candidates for UFE and should obtain a consult with an interventional radiologist to determine whether UFE is a treatment option for them.
Interventional radiologists use MRIs to determine if fibroids are present, detect alternate causes for the symptoms and identify which treatments are best suited for each patient. Women often undergo an ultrasound at their gynecologist's office as part of the evaluation process to determine the presence of uterine fibroids. An MRI is a much better imaging tool for uterine fibroids than ultrasound because it can differentiate fibroids from other disease processes.
What is a Fibroid?
Uterine fibroids are the most common tumors of the female genital tract. Twenty to 40 percent of women age 35 and older have uterine fibroids of a significant size. African American women are at a higher risk for fibroids: as many as 50 percent have fibroids of a significant size.
You might hear them referred to as "fibroids" or by several other names, including:
For most women, fibroids either do not cause symptoms or cause only minor symptoms. Uterine fibroids can range in size from very tiny (a quarter of an inch) to larger than a cantaloupe. Occasionally, they can cause the uterus to grow to the size of a five-month pregnancy. In most cases, there is more than one fibroid in the uterus.
While fibroids do not always cause symptoms, their size and location can lead to problems for some women, including pain and heavy bleeding. Fibroids can dramatically increase in size during pregnancy because of the increase in estrogen levels. After pregnancy, the fibroids usually shrink back to their pre-pregnancy size. They typically improve after menopause when the level of estrogen decreases dramatically. However, menopausal women who are taking supplemental estrogen (hormone replacement therapy) may not experience relief of symptoms.
Types of Uterine Fibroids
- Subserosal Fibroids - Develop in the outer covering of the uterus and expand outward through the wall They typically do not affect a woman's menstrual flow, but can cause pelvic pain, back pain and generalized pressure.
- Intramural Fibroids - These develop within the body of the uterus and expand inward, increasing the size of the uterus, and making it feel larger than normal in a gynecologic internal exam. The most common fibroids, intramural fibroids can result in heavy menstrual bleeding and pelvic pain, back pain or the generalized pressure that many women experience.
- Submucosal Fibroids -These are just under the inner lining of the uterus and are the least common fibroids, but they tend to cause the most problems. Even a very small submucosal fibroid can cause heavy bleeding, and very heavy and prolonged periods.
Symptoms of Uterine Fibroids
Most fibroids don’t cause symptoms—only 10 to 20 percent of women who have fibroids require treatment. Depending on size, location and number of fibroids, they may cause:
- Heavy, prolonged menstrual periods and unusual monthly bleeding, sometimes with clots - can lead to anemia
- Pelvic pain and pressure
- Pain in the back and legs
- Pain during sexual intercourse
- Bladder pressure leading to a frequent urge to urinate
- Pressure on the bowel, leading to constipation and bloating
- Abnormally enlarged abdomen
Uterine Fibroid Treatment
Nonsurgical Uterine Fibroid Embolization – A Major Advance in Women’s Health
Uterine fibroid embolization (UFE), also known as uterine artery embolization, is performed by an interventional radiologist, a physician who is trained to perform this and other types of embolization and minimally invasive procedures. It is performed while the patient is conscious, but sedated and feeling no pain. It does not require general anesthesia.
The interventional radiologist makes a tiny nick in the skin in the groin and inserts a catheter into the femoral artery. Using real-time imaging, the physician guides the catheter through the artery and then releases tiny particles, the size of grains of sand, into the uterine arteries that supply blood to the fibroid tumor. This blocks the blood flow to the fibroid tumor and causes it to shrink and die.
UFE is a very safe method and, like other minimally invasive procedures, has significant advantages over conventional open surgery. However, there are some associated risks, as there are with any medical procedure. A small number of patients have experienced infection, which usually can be controlled by antibiotics. There also is a less than one percent chance of injury to the uterus, potentially leading to a hysterectomy.
These complication rates are lower than those of hysterectomy and myomectomy.
Fibroid embolization is an outpatient procedure that may require 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. 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, 85-90 percent of women who have had the procedure experience significant or total relief of heavy bleeding, pain and/or bulk-related symptoms. The procedure is effective for multiple fibroids and large fibroids. Short and mid-term data show UFE to be very effective with a very low rate of recurrence.