Introduction
Uterine fibroid embolization (UFE), also known as uterine artery embolization (UAE), offers a non-surgical option for treating uterine fibroids. This procedure works by blocking the blood supply to fibroid tumors, which leads to their shrinkage. Uterine fibroids, also called uterine myomas, are benign growths that form in the muscular wall of the uterus. They are quite common in women during their childbearing years. While these fibroids typically do not pose serious issues during pregnancy, they can cause various symptoms, such as heavy bleeding, pelvic pain, and pressure on nearby organs.
What Are Uterine Fibroids?
Uterine fibroids, also known as uterine myomas, are noncancerous growths that develop in the muscular wall of the uterus. They are the most common type of benign tumor found in women of reproductive age. Fibroids can vary in size, ranging from small, undetectable nodules to large masses that can distort the shape and size of the uterus. These growths are typically composed of muscle cells and fibrous tissue. While the exact cause of fibroid development is not fully understood, it is believed to be influenced by various factors, including hormonal imbalances, genetics, and estrogen levels. Estrogen, a female reproductive hormone, plays a role in stimulating the growth of uterine tissue, and an excess of estrogen can contribute to fibroid formation.
What Is Embolization?
Embolization is a medical procedure that involves the use of embolic agents to block or reduce blood flow to a specific area of the body. The purpose of embolization can vary depending on the condition being treated, but it is commonly used to target tumors, control bleeding, or treat vascular malformations.
What Are the Symptoms of Uterine Fibroids?
Uterine fibroids can cause various symptoms, including:
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Heavy bleeding during menstruation, sometimes with clots.
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Bleeding between periods.
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Back and leg pain.
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Constipation and bloating.
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Frequent urination.
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Pelvic cramping or pain.
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Pressure in the lower abdomen.
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Pain during sexual intercourse.
How to Prepare for Uterine Fibroid Embolization (UFE) Procedure?
Before undergoing UFE, several important preparations should be considered:
Fasting: Refrain from eating or drinking beverages for at least six hours before the procedure. However, drinking water is allowed up to two hours before.
Medications: Discontinue certain medications, such as antiplatelet drugs, blood thinners, or nonsteroidal anti-inflammatory drugs (NSAIDs), as advised by the doctor. Birth control pills should be continued until the procedure and may be discontinued afterward.
What Are the Factors to Be Considered Before Uterine Fibroid Embolization?
Before undergoing UFE, several factors should be considered:
Pregnancy: UFE is not recommended for pregnant women or those planning to become pregnant soon.
Active Endometritis: UFE may not be suitable for individuals with inflammation of the uterine lining.
Malignancy: UFE is not recommended for women with uterine or cervical malignancies.
Fibroid Size and Location: Fibroids smaller than 1 cm or located in the cervix are generally not treated with UFE.
Immunocompromised Patients: UFE may not be suitable for patients with compromised immune systems.
Allergies and Contraindications: UFE may not be recommended for individuals with allergies to contrast materials or local anesthetics, severe renal insufficiency, history of pelvic radiation therapy, severe bleeding disorders, or other contraindications.
How Is Uterine Fibroid Embolization (UFE) Performed?
The procedure known as uterine fibroid embolization is carried out by a specialized doctor who is trained in minimally invasive procedures called an interventional radiologist. The process involves a series of specific steps.
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Sedation and Local Anesthesia: Sedation is administered through an intravenous line (IV) to induce relaxation and drowsiness. Local anesthesia is injected around the groin area to numb it and minimize pain.
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Catheter Insertion: At the spot, a small cut is made, about the size of a pencil tip. In the femoral artery, which is at the top of the leg, a tube is put in. Through the catheter, contrast material is injected, and then X-rays are used to find the exact spot. The tube is then put into the uterine artery, which gives the uterus its blood supply.
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Embolic Agent Injection: To treat uterine fibroids, tiny plastic or gelatin particles called embolic agents are injected into the blood vessels that supply them. This blocks the blood flow to the fibroids, causing them to gradually shrink and die. The procedure involves injecting the particles into both the right and left uterine arteries through a single incision.
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Completion and Recovery: Once the procedure is complete, the catheter is removed, and pressure is applied to the incision site to stop any bleeding. An overnight hospital stay may be required for observation. Painkillers will be provided to manage any discomfort. The entire procedure usually takes around two hours, although the duration may vary depending on the size and number of fibroids being treated.
What Are the Advantages of UFE Over Other Treatment Options for Uterine Fibroids?
Uterine fibroid embolization offers several advantages over other treatment options:
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There is minimal blood loss and no requirement for a blood transfusion.
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Avoidance of general anesthesia and surgical incisions.
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Shorter recovery period compared to a hysterectomy or open myomectomy.
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Lower recurrence rate compared to myomectomy.
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Reduced risk of early menopause-like symptoms compared to hormonal therapy.
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Effective for treating multiple fibroids of varying sizes.
What Are the Complications of Uterine Fibroid Embolization?
Although complications are rare, the following risks may be associated with UFE:
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Misplacement of embolic agents affecting normal tissue blood supply.
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Allergic reactions to contrast material.
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Infection after embolization, despite antibiotic use during the procedure.
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Uterine injury requiring hysterectomy in rare cases.
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People who already have kidney disease or diabetes are more likely to have damage to their kidneys from contrast material.
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Post-UFE fibroid expulsion occurs weeks to months after the procedure.
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Uterine wall damage, which may pose pregnancy risks. Contraception is recommended for six months post-procedure, and cesarean delivery may be necessary to prevent uterine wall rupture during childbirth.
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Radiation exposure to the ovaries due to fluoroscopy use during the procedure.
How Effective Will the Uterine Fibroid Embolization (UFE) Procedure Be?
Following UFE, fibroids typically shrink by about 20 percent and become softer, relieving pressure on adjacent pelvic organs. Fibroids do not regrow after treatment, and new fibroids do not develop. UFE provides a permanent solution for uterine fibroids, unlike hormonal therapy, which leads to fibroid regrowth after discontinuation. Approximately 90 percent of women who undergo UFE experience complete resolution of symptoms.
What Are the Post-Embolization Symptoms?
Following uterine fibroid embolization (UFE), it is common for women to experience a range of post-embolization symptoms. The strength and length of this condition's symptoms can be different for each person who has it. Some women may not feel any pain at all, while others may have more obvious signs. It's important to remember that these symptoms normally only last a short time and should get better as the body heals.
Cramps and Pelvic Pain: Cramping and pelvic pain are the most common post-embolization symptoms. The pain is often described as similar to menstrual cramps and can range from mild to moderate. The severity of the pain may depend on the size and location of the treated fibroids. These symptoms are a natural response to the embolization process, as the fibroids undergo ischemia (lack of blood supply), leading to their shrinkage and eventual degeneration.
Nausea: Some women may experience nausea or an upset stomach following UFE. This symptom can be associated with the medications administered during the procedure or as a result of the body's response to the embolization. Nausea is typically mild and temporary, subsiding within a few days.
Fatigue: Fatigue or a feeling of general tiredness is a common post-procedure symptom. The body requires energy to heal and recover, so it is not unusual to feel more tired than usual. Adequate rest and proper nutrition can help combat fatigue and promote a faster recovery.
Low-Grade Fever: It is not uncommon for women to experience a low-grade fever after UFE. This fever is usually mild and transient, lasting for a few days. It is an inflammatory response triggered by the body as it absorbs the degenerating fibroid tissue. Drinking plenty of fluids and taking over-the-counter fever reducers, if recommended by a healthcare professional, can help alleviate this symptom.
Vaginal Discharge: Some women may notice an increase in vaginal discharge following UFE. This discharge may appear watery, pink, or brown in color. It is a normal part of the healing process as the the body expels the remnants of the degenerated fibroid tissue. The discharge should gradually decrease over time.
Back Pain: After undergoing UFE, you may experience back pain, especially in the lower region. However, this discomfort is usually temporary and can be relieved by taking over-the-counter painkillers or prescribed medication. You may also find relief from applying a heating pad or taking warm baths.
Urinary Symptoms: Women may experience changes in urinary patterns after UFE. This can include an increased frequency of urination or a temporary sense of urgency. These symptoms are usually temporary and should subside as the body heals. It is important to stay hydrated and avoid caffeine and bladder irritants during this time.
Emotions and Mood Swings: Some women may experience emotional changes or mood swings following UFE. These emotional fluctuations can be attributed to hormonal changes and the stress of the procedure itself. Open communication with healthcare providers, as well as support from family and friends, can help manage emotional well-being during the recovery period.
It is essential to communicate any post-embolization symptoms to the healthcare provider overseeing the recovery process. While these symptoms are generally considered normal, healthcare professionals can provide guidance, reassurance, and any necessary interventions to alleviate discomfort and ensure a smooth recovery.
Conclusion
Uterine fibroid embolization (UFE) is a well-established and minimally invasive procedure used for over two decades to treat uterine fibroids. With a shorter recovery period and fewer complications compared to surgical options, UFE is considered a highly safe and effective treatment. By shrinking fibroids and providing long-term symptom relief, UFE offers a valuable alternative to hysterectomy or myomectomy for women with uterine fibroids.
