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Why Uterine Fibroid Embolization?
What is UFE?
Uterine Fibroid Embolization (UFE) is a procedure that cuts off (embolizes) blood supply to fibroids. All living tissues in the body need an ample blood supply to live. Permanently cutting off the blood supply ensures tissue will die and be partially reabsorbed by the body. Consequently, fibroids treated with UFE die and shrink, resolving your symptoms.
What Happens During the Procedure?
Typically, this 60-90-minute procedure is performed under conscious sedation with local anesthesia. In rare instances, patients will be offered an epidural or spinal anesthesia.
By using an arteriogram imaging map of the pelvic blood vessels and making a small incision in the groin, doctors run a catheter (a hollow, spaghetti-sized tube) into the femoral artery. Once the catheter reaches the uterine arteries, they inject small, sand-grain sized particles of polyvinyl alcohol (PVA) or Embrospheres mixed with X-ray dye to stop the blood supply to the fibroids. Using the same incision, they repeat the same procedure in the other uterine artery. Most patients are observed for 23 hours and then discharged. UFE is highly successful. In more than 98% of cases, both uterine arteries are embolized. Women who undergo the procedure can expect these results:
- 85-90% abnormal bleeding control, especially by the second post-procedure menstrual cycle
- 80-90% bulk-related symptom control within the first 6-8 weeks
- Approximately 50% reduction in average uterine volume
- 40-70% shrinkage of individuals fibroids
- Approximately 85% of women see significant improvement in their quality of life.
What is UFE?
Who’s a candidate?
While UFE is an effective procedure, it isn’t the best option for everyone.
Good candidates are:
- Premenopausal women wishing to avoid surgery who have uterine fibroid symptoms not caused by endometriosis, extensive growth of endometrial tissue in the uterine muscle, or other non-fibroid causes.
- Women who don’t want to have more children (though the desire for future fertility doesn’t eliminate UFE as a treatment option).
- Women with a uterus larger than 24 weeks gestational size. A larger uterus can be treated, but a 50% volume reduction may not adequately relieve symptoms.
- Women hoping, for health or religious reasons, to avoid a transfusion for surgically related blood loss.
Who’s not a candidate?
There are certain circumstances when UFE should not be performed.
These include:
- Pregnancy: Concerns over radiation and decreased placental blood flow to the fetus make UFE problematic during this time
- Cancer
- Active infection, such as pelvic inflammatory disease, due to the risk of infecting dead fibroids
- IUD: Remove prior to UFE to reduce infection risk
- Post-menopause: Post-menopausal fibroid reduction isn’t expected. UFE can be considered for HRT-related fibroids, but the cancer risk is higher in these patients.
- History of severe allergic reaction to X-ray contrast
- Renal insufficiency due to a higher risk of contrast-related kidney toxicity
Advantages
There are several advantages to choosing UFE:
- Safe, effective symptomatic fibroid treatment
- Minimally invasive
- Simultaneous treatment of all fibroids
- Permanent fibroid death (infarction) without regrowth
- Effective control of abnormal bleeding, pain, and bulk-related symptoms
- Avoid hysterectomy and related complications
- Little-to-no blood loss with no need for transfusion
- Potential fertility preservation
Side Effects & Complications
Overall, UFE is safe and well tolerated. Side effects and complications are possible, but they occur less often than with myomectomy or hysterectomy. The following side effects are common:
- Some degree of crampy pelvic pain is normal for the first 6-8 hours post-procedure. Using a morphine PCA (patient-controlled analgesia) pump, patients give themselves IV pain medication with the push of a button. Cramping usually improves before patients are discharged home, but it can linger for a few days. NSAIDs or oral narcotics, if needed, can provide pain relief. Most patients can return to their usual activities within 7-10 days.
- Spotting or brown discharge is possible for up to a few weeks. In approximately 5% of submucous fibroid cases, the mass can detach from the uterine wall, fall in the cavity, and pass out the vagina. This fibroid expulsion can happen within days or months post-procedure. Your gynecologist may need to remove it if it’s too large for you to pass on your own.
Serious complications are rare. For an estimated 100,000 UFE procedures worldwide, there have only been four deaths—an incidence rate of 1:25,000. The risk of death following elective hysterectomy is 1:1,000 to 1:1,500. Two of the four UFE deaths were from post-procedure infection, one was caused by a pulmonary embolism (a blood clot that moved to the lungs), and one was due to the patient’s advanced age (she wouldn’t have been treated with UFE in the United States).
Post-UFE hysterectomies are rare, occurring in less than 1% of cases due to uterine infection or inadequate blood supply to normal uterine tissue. Embolization of unintended blood vessels is possible but unusual. Careful fluoroscopy monitoring by an experienced interventional radiologist makes this unlikely to occur.
The average UFE radiation dose is comparable to multiple barium enemas or pelvic CT scans. The dose falls below the level that could negatively affect you or your unborn children. Reports of radiation-induced skin injury have been with procedures lasting three-to-four hours. In seven years, we’ve had no radiation injuries at our center.
Normal periods resume within a few months post-UFE for most women. A small number of women under age 45 – 1-2% — will not have a period again (amenorrhea) after UFE. For perimenopausal women over age 45, that incidence rises to 15-20%. Hormone replacement therapy (HRT) can be considered when amenorrhea comes with menopausal symptoms, such as hot flashes, irritability, and vaginal dryness.
Case Studies
A 49-year-old black woman with a three-year history of severe menstrual cramping and refractory anemia. She has excessive, irregular uterine bleeding, bleeding at one point for 30 consecutive days. She also reported pain during sex, urinary frequency, and lethargy. Upon examination, her uterus was 20-weeks gestational size, firm, and tumor filled. She elected UFE over hysterectomy.
Results: At 6 months post-procedure, her periods had returned to normal, her other symptoms were resolved, and her energy had dramatically improved. Her uterine volume decreased by 55% with no recurrence of symptoms after three years.
A 51-year-old white female with a history of severe menstrual cramping; excessive, irregular uterine bleeding; and anemia. She received three Lupron injections in preparation for a planned vaginal hysterectomy. Two months after her last Lupron injection, she opted for UFE instead.
Results: Her periods returned to normal and have remained unchanged one year post-procedure.
A 39-year-old black female who is a Jehovah’s Witness reported several years of severe excessive, irregular uterine bleeding, pelvic heaviness, lethargy, and pain during sex. A hysteroscopy revealed a submucous leiomyoma, and MRI visualized a 3-cm fibroid, as well as several smaller ones. After her child-bearing years, she was offered a hysterectomy. Due to concerns of surgical blood loss and possible transfusion risk, she chose UFE.
Results: At 6 months post-procedure, her periods had normalized, and all symptoms had resolved. MRI revealed a 70% decrease in the largest fibroid and a 50% reduction in total uterine volume. After four years, she’s had no recurrence.
A 45-year-old white female with a three-year history of severe menstrual cramping, menstrual bleeding that lasts for more than seven days, and anemia. Her other symptoms included pelvic pressure and pain, back and leg pain, bloating, lethargy, and urinary frequency. Upon examination, her uterus was 14-weeks gestational size, and MRI revealed a 6-cm dominant fibroid.
Results: After 6 months post-procedure, her uterus had diminished in size, and the dominant fibroid had decreased by 79%. All symptoms were significantly improved.
Testimonials/Patient Stories
“Having the Uterine Fibroid Embolization procedure to treat my fibroids was one of the best things I have done for myself in the past few years. I was able to have UFE and retain my uterus and improve my well being. Possibly the greatest benefit has been an increase in my energy level. I really haven’t felt so good in several years. “It truly was one of the best decisions I have made. I believed it then and the last 12 years have proven it to be true.”
“Since relocating from the area, I just wanted to let you know that I have had no complications from the procedure, all of my symptoms have been relieved and my uterus has decreased dramatically (from 20 to 10 wks). I could not be more pleased with the result. Thanks so much for all of your help.”
– Jane D., RN, Nurse Executive
“Thanks for giving back my life and letting me keep my uterus!”
– Janine, age 46
“Thank you for your help in ‘fixing’ my fibroid problem. It’s amazing how much better I feel.”
– Karen, age 50
“On a scale of 1-to-10, I rate my UFE experience a 10 for the following reasons: less invasive and quick recovery time.
Dr. Cockerill and the team were wonderful (professional).
I would strongly encourage women to do their research and ask fact-finding questions before consenting to the standard fair used to treat benign uterine fibroids. Ladies, this revolutionary procedure deserves a look-see. Check out the overall success rate, too.”
– Susie, age 46
“Having the UFE procedure to treat my fibroids was one of the best things I’ve done for myself in the past few years. I was able to have UFE and retain my uterus and improve my well being. Possibly the greatest benefit has been an increase in my energy level. I really haven’t felt so good in several years.”
– Denise, age 45
