What are fibroids? Do they require medical treatment?

Fibroids are benign tumors of the uterus that occur commonly in young and middle aged women. Although they are often asymptomatic they can be associated with heavy menstrual bleeding, painful menstrual periods and pelvic pain or fullness. Treatment may include removal of the uterus (hysterectomy), removal of the tumor (myomectomy), hormonal therapy or by reducing the blood supply to the uterus (uterine artery embolization or UAE). Hysterectomy and myomectomy are procedures typically performed by a gynecologist while UAE is performed by an interventional radiologist.

What is UAE?

UAE is performed by passing a thin tube through a blood vessel in front of the hip. The tube is then manipulated into the blood vessels that supply the uterus. The vessels are evaluated by performing an angiogram. Following this, small particles are carefully injected into the blood vessels supplying the uterus. These particles lodge in the vessels, effectively blocking the blood flow. Because fibroids have a higher blood flow than the rest of the uterus this causes more damage to the fibroid than the normal uterine tissue, resulting in shrinkage of the fibroid and symptom reduction or resolution.

How does UAE compare to a hysterectomy?

UAE is effective in alleviating or completely resolving symptoms in 85-90% of patients. UAE tends to be better tolerated than hysterectomy with shorter full recovery times. Most patients are back at work in about a week. However, because the blood flow to the uterus is reduced, there is considerable discomfort immediately following the procedure. Because of this we prefer not to perform this procedure on an outpatient basis. Additionally, we employ aggressive pain management techniques, typically relying on patient controlled anesthesia (PCA pumps) in order to achieve timely pain relief. In addition to discomfort, some women experience some nausea. These symptoms typically improve rapidly and most patients are ready to go home the next day. Patients are discharged on a combination of oral anti-pain and anti-nausea medications.

Are there any risks to having a UAE procedure?

Although UAE is generally safe, as in all medical procedures, there is some risk of complication. Infection of the uterus occurs in 3-5% of patients. Sometimes infection can be severe enough to require hysterectomy. Transient or permanent ovarian failure occurs in less than 1% of patients. Uterine necrosis (death of the uterine tissue) is a very rare complication that would require a hysterectomy. The chance of successful pregnancy after UAE is reduced so women who plan on becoming pregnant should consider other options before deciding on UAE.

Prior to UAE each patient should have her uterus evaluated with ultrasound or MRI. In general we have a preference for MRI as is it more helpful in planning the procedure. If a patient is experiencing bleeding in the middle of the cycle a biopsy (D&C) may be required before proceeding. We meet with all patients prior to scheduling a UAE to discuss the procedure and review their symptoms. We ask that patients eat or drink nothing after midnight the night before the procedure.

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