medical information

Uterine Fibroid Embolization | Description | Precautions | Aftercare | Purpose | Risks

Definition

Uterine fibroids are growths in the muscular tissue of the womb (uterus). Uterine fibroid embolization is non-surgical removal of the growths through the use of a tubular device called a catheter.

Purpose

It is estimated that between 20% and 40% of women over age 35 years have fibroids. These noncancerous tumors of the uterus, also called myomas, fibromyomas, or leiomyomas, can be as tiny as a pea or grow to as large as a cantaloupe. They grow along the muscular wall of the uterus and are made of both muscle and fiber-like tissue. Although they are not cancerous, they can cause uncomfortable symptoms in women, particularly pain and a feeling of pressure in the area between the hip bones (the lower pelvic area). Some women experience a feeling that they constantly need to urinate. Others may feel pressure in the bowel, and experience bloating or constipation.Sometimes, fibroids cause heavy menstrual bleeding and lengthier menstrual periods.

In some cases, women need no treatment for fibroids, since the growths may cause no symptoms or may stop causing symptoms when a woman reaches menopause. However, when the fibroidscause heavy bleeding that can lead to anemia, pelvic pain, and create pressure on other organs, the physician and patient may discuss treatment options. A woman still planning to have children may need to have fibroids removed to ensure they do not interfere with the ability of a fertilized egg to implant on her uterine lining. In rare cases, fibroids cause such severe and sharp pelvic pain that emergency treatment is required.

Although some medications may help ease the symptoms of fibroids or even slow their growth, they are not long-term solutions to the fibroid growths. Surgery also can remove the fibroids.Myomectomy is the most common surgery option still used to treat fibroids because it does not involve removing the uterus. In severe cases, women may have a hysterectomy and have their uterus removed.

The development of uterine fibroid embolization has offered women a non-surgical alternative to treating fibroids that are causing symptoms. It also is effective for treating multiple fibroids.

Precautions

Although uterine fibroid embolization has been shown in many studies to be effective, some physicians say it is a relatively new procedure that lacks long-term data on its effectiveness. Estimates show that at least 90% of women who have the procedure will have relief of symptoms and no return of fibroids. Some women have reportedly stopped having menstrual periods following the procedure. Since the long-term effects of uterine fibroid embolization on future pregnancies has not been studied extensively, patients still wanting to have children should discuss the latest research and fibroid treatment options with their physicians. Overall, however, the treatment is a safer and less invasive alternative than surgery.

Description

Uterine fibroid embolization usually is performed in a hospital, but sometimes in an outpatient imaging center. An interventional radiologist normally performs the procedure. Interventional radiologists are physicians who are specially trained to use x rays to see inside the body while guiding narrow tubes called catheters through blood vessels to diagnose or treat various diseases.

Uterine fibroid embolization also may be called uterine artery embolization. This is because the procedure injects tiny particles, called embolic agents, into the artery that supplies blood to the fibroid tumor, blocking off the tumor's blood supply. The radiologist reaches the uterine artery by first making a small nick (about one-quarter of an inch) in the patient's skin in the groin area. From this incision, the radiologist can inset the catheter into the femoral artery and then guide the catheter toward the area of the uterus. Patients do not feel the catheter as it moves along the artery and a nurse or anesthesiologist will provide drugs for pain relief at the insertion site. The nurse or a technologist also will insert a Foley catheter into the patient s bladder. This keeps the bladder emptied so that the radiologist can have a better picture of the uterus and the anatomy that surrounds the uterus during the procedure.

The radiologist can view the progress of the catheter using a moving x-ray technique called fluoroscopy. When the catheter reaches the artery supplying blood to the fibroid tumor, the radiologist injects the embolic agents, which are only about the size of grains of sand. When they gather together, they form a clot and since no more blood can reach the fibroids, they eventually will shrink and disappear. If a woman has fibroids on both sides, the radiologist will guide the catheter around to repeat the procedure on the other side of the uterus. After removing the catheter, the medical team will clean the puncture area and cover it with a bandage. They also remove the Foley catheter. The entire procedure takes about one hour and should cost less than hysterectomy or other surgical treatments. Most insurance companies will pay for uterine fibroid embolization.

Preparation

When the embolization is scheduled, the hospital or facility should provide instructions regarding medications or food and drink to avoid prior to the procedure. Once a patient checks in, a nurse or technician may draw blood for routine tests and a nurse or radiologic technologist who specializes in vascular procedures will start an intravenous (IV) line through which the patient will receiveantibiotics to prevent infection.

Aftercare

Although uterine fibroid embolization is an outpatient procedure, patients may stay in a recovery area for up to 23 hours. When patients are discharged, they will receive specific instructions about follow-up care and medication for relief of pain and swelling. Uterine fibroid embolization rarely requires stitches. Patients may be advised to use a stool softener while taking some of the aftercare medications to avoid constipation. They will be instructed to drink plenty of fluids for the first week following the procedure. Normally, the patient should avoid soaking in hot baths for the first three days and should not drive a car for about three days following uterine fibroid embolization.

Strenuous activity, such as climbing stairs, squatting, or lifting heavy objects should be avoided for about one week. Patients also should not stand in one position for long periods of time in the first week following the procedure. It is usually best to avoid heavy exercise routines, athletic activity and sexual relations for about up to month. Women also may be advised to avoid using tampons for menstrual periods for up to three months following uterine fibroid embolization, substituting sanitary pads.

Risks

Most patients experience moderate to severe pain and cramping for several hours after the procedure and some will have nausea and fever. There is a risk of infection from uterine fibroid embolization, but the risk is small and the infection usually can be controlled by antibiotics. A small percentage (about one percent) of women may experience an injury to the uterus or an infection that may lead to a later hysterectomy. There also is a small risk that a woman will stop having periods after uterine fibroid embolization. Overall, these risks are relatively low compared to surgical removal of fibroids.

KEY TERMS

Anemia— A condition in which the blood has a low number of red blood cells, low hemoglobin, or low total blood volume.

Artery— One of several tubular branches of muscular and elastic walled vessels that carry blood from the heart through the body.

Femoral artery— The chief artery of the thigh.

Groin— The fold that marks the meeting of the lower abdomen and the inner thigh.

Normal results

About 90% of women who have the procedure experience significant or complete relief of heavy bleeding, pain, and other symptoms. Patients usually will follow up with their gynecologist about two weeks following the procedure. Recurrence of fibroids is rare, though long-term studies of 10 years or more have shown that about 10% of patients may need additional treatment after 10 years. Additional studies continue on the procedure's long-term effectiveness.

Resources

PERIODICALS

Johnson, Kate. "Inform Patients of Long-term UFE Outcomes." Family Practice News (Dec. 15, 2004):40-41.

Johnson, Kate. "Recovery Fast in Uterine Fibroid Embolization: Most Patients Recover Within Two Weeks." Family Practice News (Aug. 15, 2002):40-41.

"Uterine Fibroid Embolization Is Minimally Invasive Alternative to Hysterectomy." Women s Health Weekly (Dec. 23, 2004):181.

ORGANIZATIONS

National Uterine Fibroids Foundation. 1132 Lucero Street, Camarillo, CA 93010. 805-482-2698.〈http://www.nuff.org〉.

Society of Interventional Radiology. 10201 Lee Highway, Suite 500, Fairfax, VA 22030. 703-691-1805. 〈http://www.sirweb.org〉.

OTHER

Brown, Linda. Alternatives to Hysterectomy: New Technologies, More Options. U.S. Food and Drug Administration website, 2001. 〈http://www.fda.gov/fdac/features/2001/601_tech.html〉.