What is a fibroid?
Fibroids, or uterine myomas, are benign muscle tumors of the uterus. Many women have fibroids and never know it, but fibroids can cause excessive menstrual pain, heavy menstrual bleeding (sometimes causing anemia), breakthrough bleeding in between menses, and infertility. Some women also experience constipation or frequent urination, and sometimes may note “fullness” due to the mass effect of the fibroid(s).
Fibroids may remain stable over time or grow in size until a woman reaches menopause when the uterus and fibroids shrink and symptoms resolve.
There are three types of fibroids, and it is possible for a woman to have all three types. The most common type is a fibroid in the wall of the uterus. A second type grows on the outer surface of the uterus and may have a discrete attachment or stalk. The third type grows within the uterine cavity and may fill the uterine cavity.
Uterine fibroid embolization (UAE) or uterine artery embolization (UAE) is an alternative to hysterectomy or myomectomy for the treatment of symptomatic uterine fibroids.
Why is it done?
Fibroid embolization is an option to resolve or decrease the symptoms related to uterine fibroids. It is typically most successful for symptoms of heavy bleeding (menorrhagia), though it can possibly help with symptoms due to the size of the fibroid (bulk symptoms). When compared to hysterectomy, it is a less invasive procedure, and therefore, has a faster recovery time of usually < 3 days.
What are the risks?
Major complications are rare in uterine fibroid embolization. The risk of complications from uterine artery embolization is about the same as those for surgical treatment of fibroids. These may include:
Infection. A degenerating fibroid can provide a site for bacterial growth and lead to infection of the uterus. Many uterine infections can be treated with antibiotics, which you will be prescribed after the procedure as prevention, but in extreme cases, infection may require a hysterectomy.
Damage to other organs. Unintended embolization (blockage) of another organ or tissue can occur, although it’s very rare and not as high a risk as with surgery since UFE is done under fluoroscopy (X-ray) guidance and an angiogram (mapping of the arteries) is done before embolization.
Possible problems in future pregnancies. Many women have healthy pregnancies after having uterine fibroid embolization. However, some evidence suggests pregnancy complications, including abnormalities of the placenta attaching to the uterus, may be increased after the procedure.
If you want to have children, talk to your doctor about the risks of surgery and how uterine artery embolization might affect your fertility and future pregnancy.
How is the procedure done?
Your procedure will be done at El Camino Hospital where you will be set up with an IV to allow access for moderate, also known as “twilight” sedation. You will then be taken to the procedure room where you will have a team of two nurses, a radiology technician and your interventional radiologist. You will be connected to heart, blood pressure and oxygen monitors during the entire procedure. IV medication will be administered to make you comfortable (moderate sedation). Then your interventional radiologist will administer numbing medication (local anesthetic) to the procedure site. Using ultrasound guidance a catheter will be inserted through an artery that leads to the fibroid. An angiogram using fluoroscopy (x-ray) guidance is performed where a small amount of contrast dye will “map” out the small arteries that feed the fibroid. Once these vessels are identified, small particles are injected through the catheter into these arteries. These block the arteries so the fibroid can no longer receive nutrients to grow. A repeat angiogram is done to confirm successful blockage (embolization) of the targeted arteries. The catheter is then removed and a seal is placed at the procedure site. The procedure takes about 30-60 minutes.
What can you expect after the procedure?
Cramping, Menstrual Periods, Spotting, Fever…
Following UFE most women will have crampy pain that becomes most severe within the initial 6-12 hours, and then gradually lessens. Following the procedure you will be watched for a couple hours in the hospital and given pain medication and any other medication to treat symptoms such as nausea or constipation. Occasionally overnight admission for observation and pain management is necessary, but nearly all women feel well enough to go home after a couple of hours following UFE.
Cramping pain usually lasts 1-2 weeks with gradual improvement over this time. Ibuprofen (Motrin) is effective for helping to relieve the pain, but some women may need a stronger medication. After two weeks, pain is gone or nearly gone. During the two weeks after the procedure women are encouraged to try and resume all usual activities, though many women who work decide to take the first week off from their job.
It is normal to have brown or brownish red vaginal discharge or spotting after the embolization. This may continue for a few weeks or until your first period after the embolization. Use sanitary napkins or liners until this resolves. To avoid the risk of developing an infection, do not use tampons for at least one week after the procedure. Occasionally, patients can have a clear watery discharge for several weeks or months after the procedure, this does not indicate infection. However, a thick or foul smelling discharge, particularly accompanied by a fever or pelvic pain may indicate infection and you need to contact our physicians or your gynecologist.
Your next menstrual period may start early or you may skip a period or two. Your period may improve right away, but some patients may not notice an improvement for 2 or 3 cycles. You may have more discomfort with your first and possibly the second menstrual period. Don‘t be discouraged! These increased cramps should resolve as the fibroids shrink over the next few months. Fibroids are estrogen driven, and as they die you may have sudden change in hormones that may cause mild depression to “hot flashes”. This is usually self limiting and requires no treatment.
Low grade fever (<101 F) is noted by about one-third of all women after UFE, and typically resolves between 3-5 days. It is probably due to the initial response of the fibroids to embolization. It is easily treated with non-steroidal anti-inflammatory agents (NSAIDs). Fever that lasts more than a week, is greater than 100.5F, or starts more than 5 days after UFE should be noted and the Interventional Radiology Clinic should be notified by calling 650-404-8446.
Groin Puncture site…
We typically apply skin glue to the groin puncture site so you will not need a dressing and you can take a shower right after you are discharged. Some bruising is normal and the bruising may spread out over several days. This is the normal way for blood to be absorbed under the skin. You may feel a small knot, about the size of a large pea. under the skin of the puncture site. This is normal and will fade in a few months.
lf you have continuing pain at the puncture site, you may take Motrin or Advil and please contact our physicians at 650.404-8445.
If you notice any swelling or active bleeding from the puncture site: lie down flat and apply direct pressure with your fingers over the top of the site for a minimum of TEN minutes and call the office for advice. This is very rare. Notify our physicians if there is any separation, drainage, redness, severe pain, swelling or active bleeding.
What are the potential problems?
Symptoms that may indicate problems include:
Active bleeding from the groin puncture site.
Elevated temperature several days to weeks after the procedure (note that it may be normal to have slightly elevated temperature for the first 3-5 days).
Irregular vaginal discharge that may be foul smelling or copious. This can indicate either an infection or partial passage of a portion of the fibroid and may require gynecologic evaluation.
What should I do next?
You will follow up with the interventional radiologist in 1-2 weeks in the office.
You could have an MRI of the pelvis repeated in 6mo. We will schedule at the time of your follow up appointment.
Please do not hesitate to call us if you have any questions or concerns at (650) 404-8445.
Post-Procedure General Instructions:
If you received sedation, you should not drive, consume alcohol, operate heavy machinery or make any important decisions for the remainder of the day.
You may resume your regular activities (including driving) after 24 hours, unless you have been restricted for another reason.
No exercising, lifting heavy objects or strenuous activity for the next 24 hours.
You may shower 24 hours after the procedure.
You may use over the counter medication such as Acetaminophen (Tylenol) or Ibuprofen (Advil /Motrin) for minor discomfort, unless you are restricted from taking these medications.
If you feel that Tylenol or Advil are not enough to control your pain, please contact the Vascular and Interventional Radiology Clinic at 650-404-8445.
You can resume your normal diet. Some patients may develop nausea after the sedation. Therefore light meals are recommended until you know that you can eat without problems.
Make sure you drink enough fluids.
You can take a shower tonight. You should not soak the procedure site in water (eg. bath and swimming pool) for 1 week.
You should not drive until you are no longer taking the prescription pain medications (Percocet/Vicodin). These medications may make you sleepy. You also should not operate any machinery or kitchen appliances while you are taking these medications.
To avoid developing constipation, we recommend the use of Colace 100mg po twice a day during the first week or while taking narcotic medication.
When should you call your physician?
Chills or fever > 101 F
Worsening of redness or worsening of pain in the procedure site.
New lower extremity swelling.
You can reach your Interventional radiologist at 650-404-8446