Uterine Artery Embolization to Treat Fibroids
What are fibroids?
A fibroid is made up of benign (non-cancerous) growth of smooth muscle within the uterus. About 30% of U.S. women over the age of 35 have them. About 10 – 20% of these women have symptoms due to their fibroids. The symptoms caused by the fibroid depend upon its size and location.
- Submucosal – A fibroid that is under the inner lining of the uterus can often result in very heavy menstrual bleeding.
- Intramural – A fibroid within the wall of the uterus is the most common and results in an increase in the size of the uterus. Symptoms can include heavy menstrual bleeding and pelvic pain. This type of fibroid can cause bulk symptoms by pushing on the organs around it. Bulk symptoms include frequent urination (pushing on the bladder), constipation (pressing on the lower bowel), or lower back pain (pressure on the lower back).
- Subserosal – A fibroid under the outer lining of the uterus can also cause bulk symptoms.
Are fibroids causing your symptoms?
The key is to be certain that heavy menstrual bleeding and other symptoms are related to fibroids and not due to other causes. You should be sure to see your doctor, and have your symptoms checked. This will include a review of your health history, a physical exam including a pelvic exam, a Pap smear, and a blood test to check for anemia and other problems. Your doctor often will schedule an ultrasound exam (a test using sound waves) to look at the size of the uterus and for any fibroids. A Magnetic Resonance Image (MRI) of the pelvis may also be done to check the uterus, ovaries, bladder, and lower bowel.
What are the treatments for fibroids?
In the past, the treatment for fibroids has been a hysterectomy. Today, instead of surgery, doctors may choose to do a Uterine Artery Embolization (UAE). This treatment blocks the blood supply to the fibroid, causing it to shrink so that the symptoms go away or lessen. At the same time, it saves the uterus.
Once your doctor decides that fibroids are the cause of your symptoms, you have many choices for treatment. As you decide, keep in mind certain goals:
- Do you wish to keep your uterus?
- Do you wish to have children?
- Are you a few years away from menopause (perimenopausal)?
Options
- Watch and wait until menopause begins. Fibroids are hormone sensitive. At menopause, estrogen levels begin to drop, and fibroids get smaller. If you are in perimenopause, this may be an option, although you may suffer with symptoms in the meantime.
- Hormone therapy. Progesterone or GnRH agonists (gonadotrophin releasing hormone agonists such as Lupron®) can shrink the size of the uterus. The size of the fibroid will also shrink. This can improve the symptoms. The side effects of GnRH agonists are hot flashes and osteoporosis. It is best if GnRH agonists are only used for six months.
- Myomectomy (surgery to remove only the fibroid) is an option for a woman who wishes to become pregnant in the future.
- Hysterectomy. This would remove the uterus and the symptoms of the fibroids.
- Uterine artery embolization (UAE)
Are you a candidate for Uterine Artery Embolization?
If you wish to keep your uterus, then UAE may be a good option. If you wish to bear children, you should know that there is a 4 – 20% chance of damage to your ovaries.
What will happen before the UAE?
You will see an Interventional Radiologist (a radiology doctor who performs UAE) and a Nurse Practitioner in the IVR (Interventional Radiology) clinic before your treatment. The nurse practitioner will take your health history and review your physical exam. The doctor will review your ultrasound or MRI. Both will talk with you about the procedure. If you have not had an MRI of the pelvis, one may be ordered. Once this is done and reviewed, we will review your case again to be sure that fibroids are the cause of your symptoms. At this point, if you are a candidate for UAE and you would like to proceed, you will be scheduled for UAE. You will need to spend a night in the hospital after your UAE. Plan to be off work for at least a week.
How is the Uterine Artery Embolization done?
Getting ready
When you arrive, you will be taken to Interventional Radiology (IVR) to have two intravenous (IV) lines placed and a urinary catheter put in your bladder. You will be given antibiotics and an anti-nausea drug. When you are in the IVR suite, either the right or left groin will be washed with Betadine® soap. You will be covered with a sterile drape. A nurse will give you two IV drugs. One is for anxiety and the other is for pain relief. During the UAE, you will be drowsy and likely not remember it.
Placing the arterial catheter
The doctor will inject a small amount of medicine into your groin to numb it. This will sting at first. The doctor will then place a small hollow tube (sheath) through a small incision in your groin. The tube will be placed into the groin artery. A catheter will be passed through the tube where it will be guided into the uterine artery. See Figure 1.
Blocking the blood supply
With the catheter in place, the doctor will inject small particles into the left uterine artery until there is very little blood flow in the artery. This is called the “embolization” of the uterine artery. The catheter will then be guided from the left uterine artery to the right uterine artery. Particles will be injected again to embolize the blood flow to this artery. See Figure 2.
Once it is done, the tube will be removed from the groin. A pressure dressing will be placed on the groin for 15-20 minutes. You will be taken to a nursing unit and watched overnight. Most often, you will be sent home the next afternoon or within 23 hours.
What can I expect after the UAE?
Most women have some symptoms after UAE. These symptoms include fever, nausea, vomiting, and pelvic pain. The symptoms often begin shortly after the procedure, and are at their worst about 12 hours later. They can last, to some degree, for a week. You may take nonsteroidal anti-inflammatory agents (Motrin®, Aleve®) for the fever. To reduce the nausea or vomiting, you will be given an anti-nausea drug like Compazine®, Kytril®, or Ondansetron®. You will not have anything to eat or drink for the first 8 hours or so. The pelvic pain may feel like very intense menstrual cramps. You will have a PCA pump to control the pain at first and then pain pills.
The next morning, you will get out of bed, the urinary catheter will be removed, and you will begin eating and drinking. You will start taking pills for pain, fever, and nausea, as you are able. You will be able to leave the hospital once your pain is under control and you can get out of bed, eat, drink, and take these medicines.
You should not return to work for at least a week. You will return to the IVR Clinic in one to two weeks. We will schedule a follow-up MRI of the pelvis in three to six months to measure the shrinkage of the fibroid. Shrinkage will occur over the next 3 – 12 months. Please see your primary doctor within six months.
Are there problems that might happen later?
In a small number of patients with submucosal fibroids, the fibroid tissue may slough off and enter the inside of the uterus (endometrial cavity). When this happens, labor-like pain may start. The tissue may be passed through the cervix. However, a larger fibroid may not pass. In this case, you may need a D&C (dilatation and curettage) to remove this tissue. If this tissue is not removed, there is a chance that it will become infected and lead to serious problems.
What are other complications?
- Groin site hematoma (collection of blood at the needle entry site)
- Allergic reaction to the x-ray dye used (contrast reaction)
- Damage to the kidneys from the x-ray dye (contrast induced renal failure)
- Early menopause due to accidentally cutting off the blood supply to both ovaries (ovarian failure)
- Blood clot in leg due to inactivity (deep venous thrombosis)
What is the success rate?
The success rate for reduced pain, bleeding, or bulk symptoms is about 85%.
When to call Interventional Radiology
You should call the IVR if you:
- Have a fever over 100.5° F for 2 readings taken 4 hours apart.
- Have foul smelling vaginal drainage.
- Have labor-like pains.
- Have pain that is not controlled.
- Cannot keep any food or liquids in you.
Phone numbers
Interventional Radiology Department, Monday - Friday 8:00am to 4:00pm at 608-263-8355.
Weekends, nights or holidays call (608) 262-0486 or toll free at1-800-323-8942. This will give you the paging operator. Ask for the Interventional Radiology Resident on call. Give the operator your name and phone number with the area code. The doctor will call you back.
For further details, go to: http://www.scvir.org/fibroid/index.htm
The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Any duplication or distribution of the information contained herein is strictly prohibited.
Last Updated: 12/06/2012
Copyright © 12/06/2012 University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#5688
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