Uterine Fibroid Embolization (UFE) Procedure

In 2008 it was recommended that consideration be given to the Uterine Fibroid Embolization (UFE) procedure, thus giving women another alternative to current treatments already available to them.  Uterine fibroid embolization (UFE) is a minimally invasive treatment for fibroid tumors.  The procedure is also sometimes referred to as Uterine Artery Embolization (UAE), but this term is less specific and, as will be discussed below, UAE is used for conditions other than fibroids.  Fibroid tumors, also known as myomas, are benign tumors that arise from the muscular wall of the uterus.  It is extremely rare for them to turn cancerous. More commonly, they cause heavy menstrual bleeding, pain in the pelvic region, and pressure on the bladder or bowel.

In a UFE procedure, physicians use an x-ray camera called a fluoroscope to guide the delivery of small particles to the uterus and fibroids. The small particles are injected through a thin, flexible tube called a catheter.  These block the arteries that provide blood flow, causing the fibroids to shrink. Nearly 90 percent of women with fibroids experience relief of their symptoms.

Because the effect of uterine fibroid embolization on fertility is not fully understood, UFE is typically offered to women who no longer wish to become pregnant or who want or need to avoid having a hysterectomy, which will remove the uterus.  As in my case.

How is this procedure performed?

The procedure involves inserting a catheter through the groin, maneuvering it through the uterine artery, and injecting the embolic agent into the arteries that supply blood to the uterus and fibroids. As the fibroids die and begin to shrink, the uterus fully recovers.

What are the benefits vs. risks?

Benefits

  • Uterine fibroid embolization, done under local anesthesia, is much less invasive than open surgery done to remove uterine fibroids or the whole uterus (hysterectomy).
  • No surgical incision is needed—only a small nick in the skin that does not have to be stitched closed.
  • Patients ordinarily can resume their usual activities weeks earlier than if they had a hysterectomy.
  • Blood loss during uterine fibroid embolization is minimal, the recovery time is much shorter than for hysterectomy, and general anesthesia is not required.
  • Follow-up studies have shown that nearly 90 percent of women who have their fibroids treated by uterine fibroid embolization experience either significant or complete resolution of their fibroid-related symptoms. This is true for women with heavy bleeding and for those with bulk-related symptoms such as pelvic pain or pressure. On average, fibroids will shrink to half their original volume, which amounts to about a 20% reduction in their diameter.
  • Follow-up studies over several years have shown that it is rare for treated fibroids to regrow or for new fibroids to develop after uterine fibroid embolization. This is because all fibroids present in the uterus, even early-stage masses that may be too small to see on imaging studies, are treated during the procedure. Uterine fibroid embolization is a more permanent solution than another option, hormone therapy, because when hormonal treatment is stopped the fibroid tumors usually grow back. Regrowth also has been a problem with laser treatment of uterine fibroids.

Risks

  • Any procedure that involves placement of a catheter inside a blood vessel carries certain risks. These risks include damage to the blood vessel, bruising or bleeding at the puncture site, and infection.
  • When performed by an experienced interventional radiologist, the chance of any of these events occurring during uterine fibroid embolization is less than one percent.
  • Any procedure where the skin is penetrated carries a risk of infection. The chance of infection requiring antibiotic treatment appears to be less than one in 1,000.
  • There is always a chance that an embolic agent can lodge in the wrong place and deprive normal tissue of its oxygen supply.
  • An occasional patient may have an allergic reaction to the x-ray contrast material used during uterine fibroid embolization. These episodes range from mild itching to severe reactions that can affect a woman’s breathing or blood pressure. Women undergoing UFE are carefully monitored by a physician and a nurse during the procedure, so that any allergic reaction can be detected immediately and addressed.
  • Approximately two to three percent of women will pass small pieces of fibroid tissue after uterine fibroid embolization. This occurs when fibroid tissue located near the lining of the uterus dies and partially detaches. Women with this problem may require a procedure called D & C (dilatation and curettage) to be certain that all the material is removed so that bleeding and infection will not develop.
  • In the majority of women undergoing uterine fibroid embolization, normal menstrual cycles resume after the procedure. However, in approximately one percent to five percent of women, menopause occurs after uterine fibroid embolization. This appears to occur more commonly in women who are older than 45 years.
  • Although the goal of uterine fibroid embolization is to cure fibroid-related symptoms without surgery, some women may eventually need to have a hysterectomy because of infection or persistent symptoms. The likelihood of requiring hysterectomy after uterine fibroid embolization is low—less than one percent.
  • Women are exposed to x-rays during uterine fibroid embolization, but exposure levels usually are well below those where adverse effects on the patient or future childbearing would be a concern.
  • The question of whether uterine fibroid embolization impacts fertility has not yet been answered, although a number of healthy pregnancies have been documented in women who have had the procedure. Because of this uncertainty, physicians may recommend that a woman who wishes to have more children consider surgical removal of the individual tumors rather than uterine fibroid embolization. If this is not possible, then UFE may still be the best option.
  • It is not possible to predict whether the uterine wall is in any way weakened by UFE, which might pose a problem during delivery. Therefore, the current recommendation is to use contraception for six months after the procedure and to undergo a Cesarean section during delivery rather than to risk rupturing the wall of the uterus during the contractions of labor.

What are the limitations of Uterine Fibroid Embolization (UFE)?

Uterine fibroid embolization should not be performed in women who have no symptoms from their fibroid tumors, when cancer is a possibility, or when there is inflammation or infection in the pelvis. Uterine fibroid embolization also should be avoided in women who are pregnant or in women whose kidneys are not working properly—a condition known as renal insufficiency.  A woman who is very allergic to contrast material (which contains iodine) should be offered a different treatment option.

Advertisements

What are Fibroid Tumors

Fibroid tumors are grow in the uterus usually during women’s fertile years.  They are the most common, non-cancerous pelvic masses.  They are rarely cancerous and can grow to be quite large and uncomfortable. Fibroid tumors can range in size from quite small (measured in millimeters) to large (many centimeters.) Large fibroid tumors can distort the urterus, making it appear lumpy when visualized during a pelvic exam.

Causes of Fibroid Tumors

Some theories about the causes of uterine fibroid tumors are conclusive, while others are only speculative. There is conclusive evidence that fibroids can be caused by:

  • The hormone estrogen: uterine fibroids grow in the presence of estrogen. This is why they tend to develop and grow during the fertile years of a woman’s life (when she has the highest levels of estrogen in her body), and they stop growing and new fibroids usually don’t develop after menopause.
  • Heredity: apparently scientists have found gene mutations in fibroid tissue cells. A patient’s risk of developing fibroids increases if a close family member (mother and/or sister) has the tumors.
  • Race: for reasons unknown, African-American women are more likely to develop fibroids than any other race. They are more likely to have larger and/or multiple fibroids as well.

Possible factors that decrease the risk for developing fibroids (speculative):

  • Oral contraceptives
  • Pregnancy (although some theorize that they actually grow during this time, due to increased estrogen levels)
  • Being athletic (whereas being overweight has been thought to increase the odds of developing fibroids)

Symptoms of Uterine Fibroid Tumors

  • Abdominal or pelvic pressure, fullness, or chronic pain
  • Bladder problems such as difficulty emptying or an increase in urgency
  • Difficulty moving bowels
  • Very heavy and/or painful periods
  • Bleeding between periods

If you experience some or all of these symptoms, or if you have a family history of fibroids, you might want to consider scheduling an appointment to see your gynecologist as soon as possible.

Knowing that they can distort the overall appearance of the uterus, uterine fibroids are actually quite smooth, rounded, and said to be well-defined.  They are overgrowths of the muscular, middle layer of the uterus, the myometrium.  When the tumors they project into the endometrium, the submucosal, they can cause heavy menstrual bleeding which can go beyond the days of a normal cycle.  Fibroid tumors can project outward,  the subserosal, and can press on the bladder or rectum.  This can cause additional problems.  One other type of fibroid actually grows outside of the uterus and is attached by a very narrow band of blood vessels, known as the “pedunculated.”

What you should also know about fibroids is that they can cause a heavy, full feeling in the abdomen and can be singular or multiple in number.  For some women, they feel hard when they touch the lower area of their abdomen.

Types of Fibroid Tumors

There are types of tumors you should be familiar with, starting with the utering fibroids which are classified according to their location within the uterus.  There are three primary types of fibroid tumors:

Subserosal fibroids develop in the outer portion of the uterus and continue to grow outward. These fibroids typically do not affect a woman’s menstrual flow, or cause excessive menstrual bleeding, but can cause pain due to their size and the added pressure on other organs.

Intramural fibroid tumors are the most common and develop in the uterine wall and expand. These fibroids can cause the uterus to appear larger in size which can be mistaken for weight gain or pregnancy. Associated symptoms include heavy menstrual bleeding, pelvic and back pain, frequent urination and pressure.

The other type of fibroid tumor is submucosal, the least common of the three. These fibroids develop within the uterine cavity and can cause excessive menstrual bleeding along with prolonged menstrual cycles.

A woman may have one or all of these types of fibroids. It is common for a woman to have multiple fibroid tumors and it may be difficult to understand which fibroid is causing your symptoms. Because fibroid tumors are a diffuse disease of the uterus, there are usually more fibroids present than can be detected because of their small size. Even a woman who has only one visible fibroid needs to assume that there are multiple uterine fibroids present when discussing therapy. Uterine fibroids may also be referred to as myoma, leiomyoma, leiomyomata, and fibromyoma.

If you think you may have uterine fibroids, or are experiencing any of the related signs and symptoms of uterine fibroids, please contact your primary care provider or OB/Gyn as soon as possible in order to rule out any other complications that could be causing your symptoms. Knowing the types of fibroids and understanding their symptoms can help you choose the right fibroid treatment.

Welcome to The Fibroid Awareness Group

It’s important that women diagnosed with fibroid tumors be aware of the many options available to them today.  New treatements are being introduced in the hopes of providing women with better and additional options with shortened recovery periods.  But it is amazing as to the number of women who are not aware and are not given the opportunity to make choices suitable to their own health needs.

This blog is created to provide information and resources for women who are considering treatments for their fibroid tumors, women who are post surgery, and women who are unsure of what to do after being diagnosed.  It bothered me that a number of women who have had a hysterectomy are feeling like their are living in a nightmare, regretting having gone through that process.  This leads me to believe that they did not have the opportunity to view their options, discuss what’s available with their physician or even research the number of treatments available.  Ladies, this site is for you!  I hope I bring some comfort to many by bringing women together.