Uterine fibroid embolization (UFE) is a non-surgical technique that shrinks fibroids without removing them. It is a minimally invasive procedure used to treat fibroid tumors of the uterus which can cause heavy menstrual bleeding, pain, and pressure on the bladder or bowel.
It uses a form of real-time x-ray called fluoroscopy to guide the delivery of embolic agents to the uterus and fibroids. These agents block the arteries that provide blood to the fibroids and cause them to shrink. Studies have shown that nearly 90 percent of women who undergo UFE experience significant or complete resolution of their fibroid-related symptoms. Deprived of blood, nutrition, and oxygen, fibroids shrink like prunes for the three to six months following embolization, and the symptoms from the fibroids often lessen as well. It has now been performed in about 30,000 women in the United States and another 20,000 women worldwide. Uterine artery embolization has been used for decades to stop severe pelvic bleeding caused by: trauma malignant gynecological tumors and hemorrhage after childbirth.
What Is Recovery Like After UFE? Following embolization blockage of the blood supply to the fibroids, the cells of the fibroid start to die off immediately. The dying cells release toxins that irritate the surrounding tissue and cause pain and inflammation. Almost all women have moderate to severe pain for the first day or so after uterine artery embolization and are kept in the hospital for one day so that they can be given narcotic pain medication. Anti-inflammatory medications, like Anaprox or ibuprofen, are also given to keep the inflammation down in the uterus. Tylenol is given for the fever that commonly follows the procedure. However, most women are able to go home the next morning and only need to take oral pain and anti-inflammatory medications for the next few days. As with all medical procedures, the recovery varies from woman to woman.
The Effectiveness and Safety of UFE Many women will notice a relief of fibroid symptoms within six weeks after the procedure. However, it takes a few months for the fibroids to fully shrink and the full effect of the procedure to be evident. Three to six months following UFE, the uterus and fibroids will have decreased about 40 percent in size. About 90 percent of women who were bothered by symptoms related to the size of their fibroids will have a significant improvement and be satisfied with the results. Likewise, about 85 percent of women who had heavy bleeding from their fibroids will have lighter and shorter periods and be satisfied with the results. About 25,000 women worldwide have had UFE performed for uterine fibroids. To date, the procedure has been extremely safe. The Society of Interventional Radiology reports only four deaths from this procedure or 1 out of every 6,000 women who have had UFE. For comparison, the risk of dying from surgery or anesthesia for a hysterectomy is about 2 out of 6,000 women. Risks for an individual are related to your medical condition, your age, and the disease for which you are being treated. Comparing risks of UFE to hysterectomy for women of similar age and condition with fibroids, it appears that the serious risks may be slightly lower with UFE.
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. 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 fibroids located inside the uterine cavity detach after embolization. Women with this problem may require a procedure called D & C (dilatation and curettage) to be certain that all the material is removed to prevent bleeding or infection from developing. In the majority of women who undergo 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 depends on how much time elapses until menopause. The younger the patient, the greater the tendency to develop new fibroids or recurrent symptoms.
Fertility rate after emobilization Embolization has a comparable fertility rate to myomectomy- the surgical removal of uterine fibroids, for women who want to conceive. A study however ” shows comparable fertility rates between the two primary uterus-sparing treatments widely available to treat fibroids: uterine fibroid embolization (UFE) and surgical myomectomy, which is considered the gold standard for symptomatic fibroids in women who wish to conceive,” said João Martins Pisco, M.D., an interventional radiologist at St. Louis Hospital in Lisbon, Portugal. “These results are surprising because other studies have favored surgical myomectomy over UFE for women who want to conceive. In this study of 743 women, UFE had a fertility rate of 58.1 percent, which is comparable to surgical fibroid removal (myomectomy), which has a fertility rate of 57 percent,” noted Pisco. “Our study proves that UFE not only allows women who were unable to conceive to become pregnant but also allows them to have normal pregnancies with similar complication rates as the general population in spite of being a high risk group,” he added. “In the future, UFE will probably be a first-line treatment option even for women who wish to conceive and are unable due to the presence uterine fibroids”, he said.
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