The center for disease control states that over 600,000 hysterectomies are performed in the United States each year. However, most women are not aware of a procedure that has altered the need for this invasive procedure that we all have known as the hysterectomy. This procedure is a safe and minimally invasive alternative to the hysterectomy, and it is called, Uterine Artery Embolization (UAE) also known as Uterine Fibroid Embolization (UFE).
This procedure is done to shrink or destroy uterine fibroids without a hysterectomy for women who do not plan to be pregnant. Uterine Fibroid Embolization blocks blood flow to fibroids while maintaining the blood supply to the uterus itself. The procedure usually takes between 1 and 3 hours by a radiologist. The radiologist uses a video screen fluoroscope to guide his or her catheter from the groin to the blood vessel that supplies the fibroid.
The catheter is placed into a blood vessel in the upper thigh (femoral artery). The patient may feel a warming sensation as a substance called, “contrast material” is injected into the catheter as it travels up to the uterus. A solution of polyvinyl alcohol (PVA) particles is then injected into uterine arteries through the catheter which build up in the specific arteries and block blood flow to the fibroid. It is not uncommon to have some vaginal flow of blood for a couple of weeks from a fibroid that is breaking down and bleeding.
The patient should refer to the doctor’s instructions for when to stop eating and drinking. Medications can be taken the day of the procedure if the patient’s doctor has instructed her to take them, using only a sip of water. The patient may also be given a sedative to help her relax during the procedure but not enough to make her fall asleep since it is important that the patient is awake to follow instructions during the procedure. After the procedure is over, unless there are problems with bleeding, the catheter is removed and pressure is applied to the puncture site for 10 to 15 minutes; then, a bandage is applied. If the pain is under control and the patient has at least 4 hours of bed rest after the procedure, she may be sent home, or she may spend the night in the hospital for more observation depending on how well she does after the procedure.
Moderate to severe pelvic pain is common for 6 to 12 hours after this procedure. If the patient gets nauseas or is vomiting, anti-nausea medicine is suggested. Some women are able to control their pain with non-steroidal anti-inflammatory drugs, such as ibuprofen or aspirin, and the patient should be able to return to her usual activities in 5-7 days and have some vaginal bleeding for a couple of weeks from the fibroid breaking down. When bleeding or pain persists for several months, some women have been known to pass a fibroid from the vagina, usually 6 weeks to 3 months after having UFE or even a year afterward the procedure. If this occurs, the patient should contact her doctor immediately, making sure that there is no infection developing or bleeding problems. It is recommended that follow-up care after UFE should include a checkup 1 to 3 weeks afterward followed by an ultrasound or MRI 3 to 6 months later.
As an effective treatment, Uterine Fibroid Embolization reduces the size of fibroids on an average of about 50%, with approximately 80 out of 100 women treated with UFE for uterine fibroids reported that their symptoms improved.
The most serious, potentially life-threatening complication of UFE is infection. Next is premature menopause which is more likely to happen to women over 40 years than younger women. Loss of menstrual periods (amenorrhea), scar tissue formation (adhesions), and pain that lasts for months can also occur.
In addition, UFE may not be a good choice if a woman wants to get pregnant. It is possible to get pregnant afterward, but it is uncertain how good the odds are. This procedure does have a risk of damaging an ovary or the uterus, which would make it much harder to get pregnant, and there may be a higher risk for pregnancy related problems.
To be sure, for a UFE procedure, a woman should have a specially trained interventional radiologist who has a lot of experience with the procedure. Uterine fibroid embolization may be a good treatment option for women who do not wish to receive blood transfusions (which can be needed after myomectomy) or who have other serious health conditions that make general anesthesia dangerous. UFE is not safe for women who are allergic to “contrast material” (used for fluoroscopy during UFE).
Indeed, Uterine Fibroid Embolization has several advantages over the hysterectomy because all fibroids may be treated at the same time with no blood loss and a general anesthesia and an abdominal (belly) incision are not required. To receive more information on this procedure, please contact us to schedule a FREE consultation ator by calling (844) MINTS – MD.