Uterine Fibroid Embolization

What is uterine fibroid embolization?

Uterine fibroid embolization is a procedure to shrink uterine fibroids. They are noncancerous tumors that develop from the muscle tissue of the uterus. Uterine fibroid embolization is not a major surgery, so you may recover faster. You also may not need to stay in the hospital.

Uterine fibroid embolization shrinks fibroids by blocking their blood supply. The healthcare provider injects very small particles (about the size of sand grains) into the arteries that supply the fibroids. The particles stick to the vessel wall. This causes a clot to develop that blocks off the blood supply. Once the blood supply is gone, the fibroids shrink. Your symptoms often ease or go away over time.

Several types of particles are used for uterine fibroid embolization. These substances have safely been used by providers for many years.

The procedure is done by a healthcare provider called an interventional radiologist. This provider specializes in treating conditions without using major surgery. Instead, they use small tools plus imaging tests. These tests include X-rays, CT scans, MRI, fluoroscopy, or ultrasound. These may be used before, during, or after the procedure.

Why might I need a uterine fibroid embolization?

The main reason to have a uterine fibroid embolization is to treat uterine fibroids that are causing pain, too much vaginal bleeding, or other problems. Nearly all fibroids are not cancer (benign). It's rare to have a cancerous fibroid.

Not all fibroids are diagnosed, because they are too small. The fibroids can range from the size of a pea to as large as a softball or small grapefruit. Uterine fibroid embolization may not be advised if your fibroids are very large.

Your healthcare provider may advise this procedure if you have fibroids causing:

• Low blood count (anemia) from uterine bleeding

• Fullness or pain in your belly

• An enlarged uterus

• Belly that is larger than normal

• Infertility

• Bladder pressure that makes you feel like you need to urinate often

• Pressure on the bowel that causes constipation and bloating

• Pain during sex

• Pain in your back or legs, which may be caused by the fibroids pressing on nerves

Your healthcare provider may have other reasons to advise a uterine fibroid embolization.

What are the risks of uterine fibroid embolization?

Any procedure can have complications. Possible complications of this procedure include:

• Abnormal bleeding (hemorrhage)

• Injury to the uterus

• Infection of the uterus or the puncture site in the groin

• Collection of blood under the skin (hematoma) at the puncture site in the groin

• Injury to the artery being used or nearby structures

• Blood clots

• Infertility or problems with a future pregnancy

• Loss of menstrual periods (amenorrhea)

• Premature menopause

• Allergic reaction to contrast or other medicines that may be given

Some women have postembolization syndrome. Symptoms include:

• Pelvic pain and cramping

• Vaginal discharge

• Nausea and vomiting

• Low-grade fever

• Fatigue and discomfort

Symptoms of postembolization syndrome may last 2 to 7 days. It's treated with pain medicines and anti-inflammatory medicines. Medicine to help with nausea may also be used.

Some women will go through menopause after the procedure. This is especially true for women older than age 45.

The uterus is not removed during uterine fibroid embolization. So you could still have a baby. But more research is needed to find out how this procedure might affect fertility and pregnancy.

You may have other risks that are unique to you. Discuss any concerns with your healthcare provider before the procedure.

How do I get ready for a uterine fibroid embolization?

• Your healthcare provider will explain the procedure to you. Ask them any questions you have about the procedure.

• You will be asked to sign a consent form that gives permission to do the procedure. Read the form carefully and ask questions if anything is not clear.

• You may need a physical exam before the procedure to make sure you are in good health. You may also need blood tests or other tests.

• Follow any directions you are given for not eating or drinking before the test.

• Tell your provider if you are pregnant or think you may be pregnant.

• Tell your provider if you are allergic to contrast dye or iodine.

• Tell your provider if you are sensitive to or are allergic to any medicines, latex, tape, or local and general anesthesia.

• Tell your provider about all the medicines you are taking. This includes prescriptions, over-the-counter medicines, and herbal supplements.

• Tell your provider if you have had a bleeding disorder. Also tell your healthcare provider if you are taking blood-thinning medicine (anticoagulant), aspirin, or other medicines that affect blood clotting. You may need to stop these medicines before the test.

• You will be given medicine to help you relax and a local pain medicine at the groin site.

• You should arrange for someone to help around the house for a day or two after the procedure.

• Follow any other instructions your healthcare provider gives you to get ready.

What happens during a uterine fibroid embolization?

You may have uterine fibroid embolization as an outpatient, or you may need to stay overnight in a hospital. The way the procedure is done may vary depending on your condition and your healthcare provider’s practices.

Generally, a uterine fibroid embolization follows this process:

1. You will be asked to remove any jewelry or other objects that may get in the way of the procedure.

2. You will be asked to remove clothing. You will be given a gown to wear.

3. An IV (intravenous) line will be started in your arm or hand.

4. You may be given antibiotic medicine before the procedure.

5. You will lie on your back on the procedure table.

6. The healthcare provider will put a long, thin tube (catheter) into your bladder to drain urine.

7. Medical staff will watch your heart rate, blood pressure, breathing, and blood oxygen level during the procedure.

8. The provider will clean the groin area with an antiseptic solution.

9. They will put a small tube (sheath) into your groin area. This will be used as a guide to put the catheter in the arteries to be blocked off (embolized).

10. The provider will inject contrast dye into the catheter. The contrast dye will help the provider find the artery to be blocked off. They will use X-rays to help find the blood vessels that supply blood to each fibroid.

11. They will put a tiny catheter into the groin (femoral artery) and move it into the arteries that need to be blocked. They will inject very small particles into the blood vessels.

12. The provider will take more X-ray images to make sure the arteries are blocked.

13. Some providers will use 1 groin site to treat both the left and right uterine arteries if needed. Other providers may use 2 groin sites.

14. The sheath and catheter will be removed after the embolization is done.

What happens after a uterine fibroid embolization?

In the hospital

Medical staff will put pressure on the insertion site in the groin to stop bleeding. This often takes about 20 minutes.

You will then be taken to the recovery room. Staff will watch your blood pressure, pulse, and breathing. You will need to lie flat for a few hours. Your recovery process will vary depending on the type of medicine used to help you relax. Once your vital signs are stable and you are alert, you will be taken to your hospital room or sent home.

You may have cramping in your belly after the procedure. You may get pain medicine given by a nurse or through a device connected to your IV line.

You may have small to moderate amounts of fluid draining from your vagina for several days. The nurse will check the sanitary pads to see how much drainage you have.

You will be encouraged to get out of bed after you have rested and your groin puncture site has sealed. You should also do coughing and deep breathing exercises as your nurse tells you to.

You may be given liquids to drink a few hours after the procedure. Your diet may be gradually changed to more solid foods as you are able to eat them.

At home

Once you are home, it's important to keep the groin incision clean and dry. Your healthcare provider will give you specific bathing instructions. If adhesive strips are used, they should be kept dry. They usually will fall off within a few days.

You may have aching at the incision site and in your abdominal and pelvic muscles. This is especially true after you stand for long periods. Take a pain reliever for soreness as recommended by your healthcare provider. Aspirin or certain other pain medicines may increase the chance of bleeding. Be sure to take only recommended medicines.

Your provider will likely advise walking and limited movement. You will likely need to avoid strenuous activity. Your provider will tell you when you can go back to work and resume normal activities.

Make sure to include fiber and plenty of fluids in your diet. This will help keep you from getting constipated. Straining to have a bowel movement may cause problems. Your provider may advise a mild laxative.

You should not use a douche or tampons or have sex until your healthcare provider says you can do so. Also, don't go back to work until your provider says it is OK.

Tell your healthcare provider if any of these occur:

• Fever or chills

• Redness, swelling, or bleeding or other fluid drains from the incision site

• Increased pain around the incision site

• Abdominal pain, cramping, or swelling

• Increased vaginal bleeding or passing of tissue or other drainage

You will need to see your healthcare provider for a follow-up visit. This is often 1 to 2 weeks after the procedure. At that time, the provider may schedule an ultrasound or MRI in 6 months to see how well the procedure worked.

Your provider may give you other instructions, depending on your situation.

Next steps

Before you agree to the test or the procedure, make sure you know:

• The name of the test or procedure

• The reason you are having the test or procedure

• What results to expect and what they mean

• The risks and benefits of the test or procedure

• What the possible side effects or complications are

• When and where you are to have the test or procedure

• Who will do the test or procedure and what that person’s qualifications are

• What would happen if you did not have the test or procedure

• Any alternative tests or procedures to think about

• When and how you will get the results

• Who to call after the test or procedure if you have questions or problems

• How much you will have to pay for the test or procedure