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Uterine Fibroid Embolization (UFE)

Home Obstetrics & Gynaecology Uterine Fibroid Embolization (UFE)

What is it?

  • Performed by an interventional radiologist using x-ray guidance (fluoroscopy).
  • Minimally invasive procedure with only a puncture site; no large incisions.
  • Block blood flow to fibroids in the uterus to shrink and improve symptoms.
  • Catheter is inserted into the uterine artery from the groin (femoral access) or arm (radial access).
  • IV contrast dye is injected into the catheter to find arteries feeding the fibroids.
  • Then, beads are injected to cut off the blood supply to the fibroids.
  • Bead composition is leucite. Not recognized by the body.

Types of fibroids (leiomyoma)?

  • Subserosal, intramural, and submucosal

What does the work-up include?

-MRI pelvis WWO IV contrast to assess the location, number, and size of fibroids as well as blood supply to fibroids.

  • PAP test within 90 days
  • Endometrial biopsy (most often for only women 40 years and older)
  • STD cultures
  • Preprocedure blood work: CBC w PLTs, BMP, PT/INR, HCG

What does the procedure involve?

  • Moderate sedation and local anesthetic
  • Supine (back) position
  • Length of procedure: ~3 hours
  • Stay overnight for observation; and control of nausea and pain. Provide PCA pump. Usually, most intense abdominal/pelvic pain occurs within the 6 to 8 hours following the procedure. Controlled well with intravenous medications.
  • Get an IV antibiotic during the procedure.
  • Discharge the next day with prescriptions for antiemetic, stool softener, NSAID (ibuprofen), and narcotic (Percocet) for break through pain.

How will I feel after the procedure?

  • May experience post-embolic syndrome which is described as having “flu-like” symptoms. Post-embolic symptoms may include decreased appetite, fatigue, low-grade fever, nausea, and pain.

What is the recovery period?

  • Follow pelvic rest for 1 month. Pelvic rest includes nothing in the vagina (e.g., no douching, no intercourse, no foreign objects, no tampons).

  • Advise to take 2 weeks off from work (depending on type of job) due to moderate fatigue.

  • No physical activity or heavy lifting for 48 hours after the procedure.

  • Pre-UFE symptoms may persist for 3 to 6 months.

  • UFE results should be seen within 1 to 2 cycles. Fibroids usually shrink enough for a change in symptoms within 3 months, ~50 % shrinkage in 6 months. Stop shrinking after 1 year.

What is the follow-up plan?

  • Follow-up with gynecologist in 4 weeks. Gynecologist will determine whether to stop pelvic rest.

What are the risks?

  • Infection

  • Bleeding

  • Force into menopause. Why? Everyone’s anatomy is different. Occasionally, beads enter an artery that supplies an ovary and may stop blood flow to the ovary.

  • Submucosal fibroids have increased risk for prolonged vaginal discharge.

What are the benefits?

  • UFE spares the ovaries and uterus. Keep your organs.

  • No GENA required. Lowers sedation risks.

  • No large abdominal incisions. Quicker recovery period.

  • Many fibroids may be treated at the same time.

  • UFE is a highly effective treatment for menorrhagia; ~ 90% patients improve

What are the disadvantages?

  • Expensive procedure and not all insurance companies cover the UFE procedure.

  • New fibroids may grow and procedure may need to be repeated several years later.

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