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What are Uterine fibroids?

Uterine fibroids are benign tumors of the muscle of the uterus. It is believed that up to 20 - 40% of women have uterine fibroids. Fortunately, the majority are without symptoms, but up to 25% of women can suffer from fibroids.

What are the symptoms of fibroids?

The most common symptom is increased or abnormal menstrual bleeding, or heavy periods, which can severely affect one’s quality of life. Other symptoms include pelvic pain, bulk or pressure symptoms including: urinary frequency or urgency, bloating/ fullness, constipation, and even infertility.


Image reprinted with permission of the Society of Interventional Radiology © 2003, www.sirweb.org.

What are the treatment options for symptomatic fibroids?

Fibroids are usually diagnosed by a combination of symptoms, physical examination, or pelvic ultrasound or MRI imaging study. Other causes for bleeding or pain need to be excluded prior to beginning any treatment for fibroid disease. This is usually done by your gynecologist or in some cases your primary care physician. Treatment options are explored based on the nature and extent of symptoms. Medical management is usually the first therapy. This may include pain medicines, birth control pills, or a drug called Lupron. Unfortunately, fibroids frequently come back after medical therapy.

Surgical options for fibroids include a procedure called myomectomy and hysterectomy. Myomectomy is an operation which is directed at removing the largest fibroids leaving the rest of the uterus in place. Hysterectomy is complete removal of the uterus, which essentially cures fibroid disease. Both of these procedures carry the usual risks of surgery and hysterectomy eliminates any future childbearing options. A gynecologist performs these procedures.

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MRI image of a fibroid uterus

What is Uterine Artery Embolization (UAE ) or Uterine Fibroid Embolization (UFE )?

UAE is a minimally invasive procedure that has been proven safe and effective for symptomatic uterine fibroids. Fibroids depend on a very rich blood vessel supply. Using this blood supply to our advantage, an interventional radiologist uses angiographic technique (x-ray study of blood vessels ) to treat symptomatic fibroids. Small, FDA approved, particles are placed into the blood vessels supplying the fibroids. These particles block, or occlude the blood supply to the fibroids causing them to shrink or degenerate, thus relieving the symptoms. Similar embolization procedures have been performed by radiologists for over 25 years for various other indications.

A recent study (November, 2002 issue of the American Journal of Obstetrics and Gynecology, Cost analysis of myomectomy, hysterectomy, and uterine artery embolization) demonstrated reduced costs and reduced hospital stays in patients undergoing uterine artery embolization when compared with vaginal hysterectomy.


Catheter is selectively positioned by the radiologist into artery feeding the fibroids. Then, small particles are injected to block the blood supply to the fibroids. (Image reprinted with permission of the Society of Interventional Radiology © 2003, www.sirweb.org.)

Images from real UAE cases:

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Left uterine artery pre-embolization

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Left uterine artery post-embolization

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Pelvic angiogram with large uterine arteries and fibroids before UAE.

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Pelvic angiogram after uterine artery embolization. Notice absence of large fibroid vessels.

What can I expect in the hospital?

You will be admitted to the hospital the morning of your procedure. A nurse will place an IV line. A radiology nurse will assist you through your procedure. An antibiotic will be given. You will arrive in interventional radiology and sedation will be provided to make you comfortable. The procedure will last roughly an hour, sometimes more, sometimes less. Pain and cramping is a very common side effect. This is managed with a patient controlled pain medicine pump (PCA) with medicines called Dilaudid or Morphine. Other medications are given as needed for any episodes of nausea. The vast majority of patients go home the following morning. Prescriptions are given for pain medications.

What can I expect when I get home?

Pain and cramping subside. These are controlled with the medications given. After approximately one week, the patient is usually back to normal activity. Detailed discharge instructions will be given to you.

What are the expected results?

Symptomatic improvement is seen in approximately 90 % of patients. The expected reduction in volume/ size of both the uterus and fibroids is up to 50%.

What complications have been reported?

The complication rate for UAE is low. Reported complications include problems related to the angiogram ( allergy to x-ray dye, damage to blood vessel). A 1% or less rate of uterine infection or injury requiring hysterectomy has been reported. There has been a low incidence of permanent loss of periods (approximately 5%). This is most common in women nearest menopause. The most common side effects are passage of fibroid material (less than 5 %) and post-embolization syndrome (15 -30%). Post-embolization syndrome is a flu like syndrome related to the death of the fibroids usually lasting a few days. A recent study (November, 2002 issue of Obstetrics and Gynecology) indicates a higher rate of miscarriage,Caesarian section, and other complications for patients who subsequently become pregnant after UAE (compared to the general population). However, this finding must be kept in proper context since many of these patients would have needed hysterectomy or were infertile unless the uterine artery embolization procedure was performed.

What needs to be done before the procedure?

A thorough history and physical must be done, usually by a gynecologist.

A pre-procedure ultrasound or MRI test must document fibroids.

Other cause of bleeding must be excluded if symptoms suggest this, specifically malignancy. I causes of bleeding other than fibroids are suspected, then endometrial biopsy may be performed.

A recent normal PAP smear (within 6 months) should be documented.

Routine blood work to check for anemia, signs of infection, and kidney function should be performed.

Insurance pre-approval is often required. This can be difficult in Wisconsin, but persistence is valuable.

Pre-procedure consultation with an Interventional Radiologist.

The procedure can be discussed in detail and more specific questions can be answered. A focused history and physical examination will be performed.

What do I do to arrange a consultation?

A consultation can be arranged by calling (608) 833 -7727.

Where can I find more information on the internet?

Informative and extensive sites can be found at:

www.sirweb.org

www.fibroidoptions.com

www.fibroidcorner.com/fc/

www.ufecenter.com/faqs.html

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