What is the Uterine Fibroid Embolization (UFE) procedure like?

 

UFE is a relatively quick and less invasive treatment, and often you are sent home the same day, depending on where you have the procedure. Dr. Linda Hughes, M.D., describes more about this process.

“The typical uterine fibroid embolization procedure is done under what we call a twilight sedation or moderate sedation, where patients are given Versed to make them sleepy and Fetanyl which is for pain control. The procedure can take anywhere from 30-60 minutes and what we typically do is, using sterile technique, we numb up the tissues in the right groin, in the hip area. We make a little tiny nick in the skin, and we insert a catheter, which is like IV tubing.

“Under x-ray through that catheter we inject a dye, and we get a road map to see what the blood supply looks like to the fibroid tissue. Typically it comes from both the left and the right uterine arteries, that you need to embolize both of those in order to have a successful result. Once we identify the abnormal blood vessels to be embolized under x-ray, we’re able to guide the catheter into the uterine arteries. We confirm that we’re in a safe spot and then we inject our gelatin beads. We do the left side, we do the right side, and we take a final picture to confirm that we’ve treated all of the branches that we think are necessary.

“After that, typically patients are on bed rest between three to six hours, and depending on if it’s an outpatient center, are discharged home later that day. In a hospital environment they will be discharged home after breakfast the next morning.”

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Are there medications or natural remedies used to treat fibroid symptoms?

 

There are several medications and natural treatments that can be used to treat the symptoms of fibroids, but these do not reduce the size or control the fibroids themselves. Dr. Linda Hughes, M.D., gives some examples.

“There are a number of medications that patients have utilized over the years to try to control their fibroid symptoms. Typically they end up being hormones. There are some natural remedies out there as well as some of the pain medication to control some of the symptoms. However, as an Interventionist Radiologist, we typically would not prescribe hormones or medication to treat the fibroids, that would be done by the gynecologist.

“Typically if we are administering or prescribing medication for patients, it’s after we’ve done the uterine fibroid embolization and it’s an antibiotic to prevent infection. It is the non steroidal anti-inflammatory such as Ibuprofen or Percocet for control of the pain and cramping related to the procedure.”

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Is it always necessary to treat fibroids?

 

Most women with fibroids do not show symptoms, and in that case, it is usually not necessary to treat fibroids. Dr. Linda Hughes, M.D., explains:

“It is not necessary to treat all women that have been diagnosed with fibroids. The vast majority of women are asymptomatic, however if women develop symptoms they’re entitled to treatment. Typically the symptoms include heavy bleeding, including passage of blood clots with their menstrual cycle, they can be anemic, and have low blood counts.

“Some women have required iron transfusions, or blood transfusion, or have to take iron tablets. They can also have pain, cramping, pain with intercourse, as well as what we call bulk symptoms where the fibroids are big, and they’re pushing on the bladder typically. This causing them to urinate more quickly, get up at night to urinate, or they can have back pain which worsens with their menstrual cycle. I’ve also seen a number of women that have had issues with constipation, because the fibroids are pushing on the rectum, or they have pain in their pelvis or even pain radiating down their thighs because the fibroids are pushing on the nerves in the area.”

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When is a myomectomy better than a Uterine Fibroid Embolization (UFE)?

 

Depending on the size, location, and types of your fibroids, there may be different treatment options that will work best for you. Dr. Linda Hughes, M.D., explains when a myomectomy may be the better choice.

“Fibroids are made out of smooth muscle. The uterus is a smooth muscle organ, and the myometrium of the wall of the uterus is typically where fibroids grow. In a small percentage of women, they can have what are called pedunculated fibroids that grow on a stalk. Typically, the stalk tends to be like a mushroom where it has a broad base and the fibroid is the mushroom cap. That is a safe fibroid for us to embolize, because when you cut the blood flow off, it’s going to shrink and retract into the wall of the uterus.

“In a very small percentage of women, the stalk can be thin like a lollipop. So you have a thin stalk and the top of the lollipop is actually the fibroid. In that situation, an embolization is probably not the most appropriate, because there is the potential for the thin stalk to snap off and for the fibroid to be rolling around in the belly, and can cause peritonitis and pain.

“In this day and age we have MRIs that we do on every woman prior to an embolization to assess the size, number and location of the fibroids. So, there are situations where either we’ll say it’s not appropriate for us to do the embolization, or there are situations where we’ll do the embolization in conjunction with the gynecologist, and laparoscopically they can remove that one thin pedunculated fibroid if that needs to be done.”

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What is a myomectomy? What are the challenges with a myomectomy?

 

While uterine fibroid embolization is a less invasive procedure performed by an interventional radiologist, a myomectomy is performed by a gynecologist and is slightly more invasive. Dr. Linda Hughes, M.D., details exactly what happens in this procedure.

“A myomectomy is a surgical procedure performed by the gynecologist that involves removing the actual fibroids but leaving the uterus intact. Typically, that is done for future fertility or if a woman wants to get pregnant in the future. Myomectomy used to be a lot more popular, but as embolization has gotten more popular, myomectomy has gotten less popular.

“Whether it’s a laparoscopic myomectomy or an open myomectomy, it still involves general anesthesia, surgical incision, a longer recovery time, a higher incidence of bleeding and blood transfusions because you’re not cutting off or reducing the blood supply, as well as about a third of them recur or grow back.”

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What happens after a Uterine Fibroid Embolization (UFE)?

 

A UFE has several effects on the fibroids and your body, namely that your symptoms should diminish and the fibroids should shrink. Dr. Linda Hughes, M.D., explains more.

“Typically after a uterine fibroid embolization or UFE, three things will happen in terms of a woman’s fibroid uterus. Number one, by cutting off the blood flow it’s going to control the bleeding, and women that are heavy bleeders should have a more normal menstrual cycle, shouldn’t be passing clots, and if they’ve had issues with anemia or low blood counts as a result of the heavy menstrual cycle, that should correct itself.

“Secondly, by cutting off the blood flow, the fibroids that are there should shrink. The amount of shrinkage is extremely variable, and on a low end they shrink as little as 30%, on the high they can shrink as much as 90%, and different fibroids within an individual can shrink different amounts. Just as important is the shrinkage though, is the fact that the fibroids also get softer.

“Pathologists, if they look at a hysterectomy or myomectomy specimen, typically describe fibroids as being like a firm rubber ball. They’re smooth muscle because the uterus is smooth muscle. If they have a specimen after someone has had an embolization procedure, typically they tend to be very soft and mushy, and almost like a scoop of oatmeal.

“And the reason we know this is not that the majority of women after an embolization are going on to have a surgery to have them removed, but the whole way this procedure came about, is that there were certain gynecologists over the years, that used to ask the Interventional Radiologist to embolize the uterine arteries before they did a myomectomy or hysterectomy to minimize bleeding at the time of surgery.

“It was a fellow about 18 years ago in Paris that noticed in the time frame between women having the embolization procedure and then going on to have the surgery that the vast majority of these women were better clinically and didn’t need to have surgery, which is how embolization came about specifically for fibroids as a stand alone treatment.”

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How can fibroids affect sexual intercourse? What changes after a Uterine Fibroid Embolization (UFE)?

 

Fibroids can make sexual intercourse increasingly painful or unappealing, and most women see an improvement after UFE. Linda Hughes, M.D., explains further.

“A lot of women, when they come in for a consultation to see if they’re a candidate for the fibroid embolization procedure, are either embarrassed or bashful about discussing their sexual activity and if they have pain with sexual activity as a result of the fibroids. There are some women, depending on the size and the location of the fibroids, that intercourse can be extremely painful, as well as they can also have bleeding issues.

“So, many women with these symptoms notice that they do have a dramatic improvement after the embolization procedure. It’s extremely unusual, and I’m not aware of any patients in my practice that have had pain or worse issues with intercourse after an embolization. Typically they present with the symptoms, and they improve after the procedure.”

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Will my fibroids still be a problem after menopause?

 

For many women, fibroids do shrink and symptoms decrease after menopause, but for others, this does not happen. Dr. Linda Hughes, M.D., explains the changes that your body can go through.

“Fibroids are extremely common and many women don’t have symptoms from their fibroids. Of women that do have symptoms with their fibroids, a number of them when they go into menopause, with the fibroid shrinking because of the change in hormones, their symptoms will go away.

“I have, however, seen and treated a number of women that are post-menopausal. They are no longer menstruating but are still having symptoms in terms of pain with intercourse, back pain, pressure on the bladder and we performed successful embolizations for that reason and they’ve still had relief. Actually the oldest woman I’ve treated was 69 years old.”

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Why would someone need a second Uterine Fibroid Embolization (UFE)?

 

The need for a second UFE is rare, but it does happen in a few patients. Dr. Linda Hughes, M.D., explains the reasons this might happen.

“It’s extremely unusual for someone to need a second uterine fibroid embolization or UFE, but in a small amount of patients there is flow coming from other sources besides the uterine arteries. Depending on the age of the patient and their desire for future fertility or having children will determine how aggressive we are with that individual with an embolization. So, in a small percentage of patients it’s not unusual for them to have to come back for a second embolization.”

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Will my insurance cover a Uterine Fibroid Embolization (UFE)?

 

Every insurance company is different, and you will need to find out what kind of coverage yours offers for UFE. Dr. Linda Hughes, M.D., had this to say:

“Most insurance companies will pay for the uterine fibroid embolization. It has been many years since we’ve had an issue with an insurance company challenge the actual procedure for they realized it is a short procedure compared to surgery. It is a shorter recovery time and patients are back to work sooner. So it’s in everyone’s best interest for them to authorize and pay for the procedure.”

See Dr. Suzanne Slonim’s answer to this question.

 

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