Interventional radiologist Karen Ehrman, MD, explains more about fibroids and the UFE procedure in this FREE video for women with fibroid symptoms.
For most women with symptoms of uterine fibroids, the standard treatment has been hysterectomy, (surgical removal of the uterus) or myomectomy, (surgical removal of the fibroids). Fortunately, with the advancement of medicine there are other options. One such option is embolization of uterine fibroids or “UFE.” This treatment helps shrink the fibroids and is a non-surgical, less invasive procedure that is performed by an interventional radiologist.
Benefits of UFE
- 80-90% of patients are satisfied with improvement or complete relief of symptoms.
- Minimally-invasive, non-surgical option.
- Growth of new fibroids or re-growth of embolized fibroids is rare.
- There is minimal blood loss and therefore no need for blood transfusions.
- Multiple fibroids may be treated during a single embolization procedure.
- Preserves the uterus; faster recovery time than a hysterectomy.
- Low complication rate.
Am I a candidate for UFE?
Most women with symptomatic fibroids are candidates for UFE. If you have symptoms, first discuss them with your doctor. Typically, a women’s health exam and an ultrasound is performed to determine the presence of fibroids. You may then be referred to an interventional radiologist to determine if you are a candidate for UFE.
UFE is a minimally-invasive option for women with painful symptoms of uterine tumors. UFE is an alternative to a hysterectomy, and may be a good treatment option for women who choose not to receive blood transfusions or who have other serious health conditions that make surgical procedures dangerous.
Uterine fibroid embolization (UFE) is 80-90% effective in reducing the symptoms caused by fibroids. Some patients' symptoms completely go away.
All patients participate in a detailed pre-procedure consultation with our physicians and nurse practitioner. Following the consultation, an MRI (magnetic resonance imaging) is performed to most accurately determine the location and size of the fibroids. The MRI will also look at how much blood flow is getting to the fibroids and check the surrounding structures of the pelvis. Once the pre-procedure consultation and MRI results are known, the UFE procedure may be scheduled if this is the treatment option chosen to relieve the fibroid symptoms.
Uterine fibroid embolization involves blocking off the blood supply to the fibroid(s). This is done by blocking off abnormal blood vessels stemming from the uterine arteries.
- After numbing a small area in the groin, the interventional radiologist makes a small puncture into the femoral artery (blood vessel in the groin) and places a small catheter, about the size of a piece of spaghetti, into the femoral artery.
- The interventional radiologist guides the catheter through the arteries (blood vessels). Once the tip of the catheter is in the uterine artery, an agent is injected into the uterine artery, blocking off the abnormal blood vessels that supply blood flow to the fibroid(s). The fibroid(s) then shrinks and dies due to lack of sufficient blood flow.
- The procedure usually takes between 1 to 2 hours.
- When the procedure is over, the catheter is removed and pressure is applied to the femoral artery puncture site for approximately 20 minutes to stop any bleeding. A bandage is then applied. There are no stitches.
- Patients are observed overnight in the hospital. Patients are discharged the next morning with specific, pre-printed instructions for recovery at home. Time is spent with each patient before discharge, reviewing the instructions and answering questions.
Following the embolization, you should be able to return to your usual activities in approximately 7 to 10 days. There is an approximate 40-60% shrinkage of all present fibroids over the course of a year. There is a noticeable decrease in fibroid symptoms in about 4-9 weeks.
Wondering about the day of, recovery, risks, insurance and more? Get answers to frequently asked questions about UFE below.
What are the particles used to block the blood supply to the uterine fibroid made of?
The particles are made of polyvinyl alcohol (PVA) or trisacryl gelatin (Embosphere®Microspheres). Both particle substances are medical grade material and FDA approved for embolization of vascular tumors. There is no silicone in PVA or embospheres. The FDA has approved biosphere embospheres specifically for use in the treatment of uterine fibroids.
Could the particles travel to another part of my body?
During the procedure, the particles are precisely injected into the vessel(s) (uterine arteries and/or ovarian arteries) that provide blood flow to the fibroids. The particles become lodged within the tiny blood vessels that feed blood to the fibroids. This process is called “embolization” and stops the blood flow to the fibroids. Once the particles are in place, they stay put because the blood immediately clots in these tiny vessels, ‘trapping’ the particles. The particles remain in place as the fibroids shrink and do not break free.
Does the procedure ever have to be done more than one time?
The UFE procedure provides treatment of all the fibroids present in the uterus at one time. The uterine arteries supply 99 % of all blood flow to the fibroids. By embolizing the uterine arteries, all of the fibroids are treated during a single procedure.
In a small number of women, the procedure may be performed more than one time due to continued blood flow to the fibroids after the initial UFE procedure. Typically, if there is another source of blood flow supplying the fibroids, it can be identified and treated during the initial UFE procedure.
Will the procedure work if I have multiple fibroids?
Yes, UFE is successful with treating one or multiple fibroids. If the right and left uterine arteries are embolized, 99% of the blood flow to the fibroids is blocked. Once the blood supply to the fibroids is blocked, the fibroids can shrink up to 40-60%. If each fibroid shrinks approximately 40-60%, regardless of the number, there should be a significant reduction of symptoms.
Will I feel the catheter or particles inside my body?
Patients cannot feel the catheter moving inside the body or particles being injected into the uterine arteries. A local anesthetic is provided before the procedure to numb the area where the catheter is inserted. Additionally, medications are provided intravenously (through an IV) to keep you comfortable during the procedure.
How long will it take to see an improvement in my symptoms?
Patients typically see an improvement approximately 4 to 9 weeks after the procedure. During the first or second menstrual cycle after the procedure, the same types of symptoms that were present before the procedure are typically still experienced. It is important to not get discouraged. By the third menstrual cycle after the procedure, a notable improvement in symptoms should occur. Fibroids may continue to shrink up to one year following the procedure, so continued improvement in symptoms may be expected.
How will I feel after the procedure and when can I return to work and daily activities?
You may experience a mild to moderate amount of pelvic cramping for approximately 4-6 hours after the procedure. Each patient experiences varying amounts of pain/cramping. However, our goal is to keep the cramping pain at a tolerable level with pain medication and nursing comfort measures.
You are able to control the amount of pain medication you receive by using a patient controlled analgesia pump (PCA pump). This pump delivers narcotic pain medication intravenously (through your IV) only when you push the control button allowing you to adjust the amount of pain medication based on your own, personal comfort level. The PCA pump is specially programmed so that you do no receive too much pain medication.
You may also experience nausea, which is controlled with medication. Typically, mild to moderate pelvic cramping continues intermittently for approximately one week to fourteen days following the procedure. To help keep pain at a tolerable level while recovering at home, you will be instructed on the use of ibuprofen, oral narcotic medications, and nursing comfort measures before leaving the hospital.
After embolization, some patients may experience “post embolization syndrome”. This is a combination of symptoms that occur approximately 3-5 days after embolization. The symptoms occur in response to cutting off the blood supply to the fibroids. This is a normal body reaction to the fibroid tissue dying and inflammation. Symptoms include fatigue, achiness, low-grade fever, and nausea. Many patients describe it as feeling like you have the “flu”. These symptoms usually go away in about 3-5 days. Patients may return to work one week after the procedure. This is an average recovery time; some women require more or less time depending on how they are feeling. Heavy lifting and strenuous exercise restrictions are suggested for 1-2 weeks after the procedure.
Will the fibroids grow back?
Embolizing the uterine arteries stops the blood supply to all of the fibroids present in the uterus. Once this blood supply is “blocked”, new fibroids typically do not grow. All of the fibroids may shrink about 40-60% after the procedure. Although the fibroids will always be present, they become small enough to relieve symptoms. Typically after the fibroids shrink, they do not grow larger at a later date.
What is the chance of entering menopause after UFE?
For women over 45 years of age, the incidence of entering menopause increases to about 2-10% after UFE. In addition, if the fibroids are receiving blood flow from the ovarian arteries and these blood vessels are embolized, the chance of entering menopause after the procedure is slightly increased.
Will my insurance cover the procedure?
UFE is covered by most insurance companies for the treatment of symptomatic fibroids. It is not an experimental procedure and the particles used for embolization are FDA-approved for the treatment of vascular tumors. The FDA has approved biosphere embospheres specifically for use in the treatment of uterine fibroids.
You should contact your insurance company for particular details about coverage/eligibility and to determine if pre-certification/ preauthorization is necessary. Specifically, ask the following questions:
- Is a referral required for consultation and is the interventional radiologist in your network?
- Is pre-certification required for the pre-procedure pelvic MRI?
- Is pre-certification required for the UFE procedure?
Typically, our patients have an overnight stay in the hospital, but are released the next morning. UFE is considered an outpatient procedure.
Who does pre-certification?
Typically, the referring physician will fill out a referral/request for consultation form and pre-certify the patient for an initial consult (with an interventional radiologist) and treatment. During the consultation, the interventional radiologist will determine if the patient is a candidate for UFE based on clinical symptoms and medical history. Then, a pelvic MRI will be performed to determine if you are a good candidate, based on the size, location, and vascularity (blood flow) to the fibroids. Once the results of the MRI are known, the UFE procedure will be scheduled (if indicated).
The patient needs to contact their insurance company with their diagnosis, symptoms, previous treatment, and any previous imaging studies. The insurance company may need to know specific codes or more information than can be provided by the patient before it pre-certifies/authorizes the UFE procedure. In this situation, a direct phone number and name of the contact person from the insurance company should be provided to the interventional radiology office. Additionally, the patient should inform the office of the type of information the insurance company is requesting.
What are the risks?
- <1% uterine infection (infection of the uterus). Typically, treated with antibiotics. There have been a few cases of severe uterine infection reported in the United States. These resulted in additional medical treatment.
- <1% non-target embolization. Embolization (blocking the blood flow) of tissue other than fibroid tissue. Most common area of non-target embolization is tissue of the uterus. This occurrence may be mild and not require further treatment. However, it could be serious and result in additional medical treatment. There have been a few cases of non-target embolization reported in the United States.
- <2% hysterectomy related to a complication from the UFE procedure. Most common reasons for hysterectomy are uncontrolled uterine infection and non-target embolization of the uterus.
- 2-10% Menopause following the procedure (typically women over 45 years of age)
- <5% hematoma (bruising under the skin where the puncture site is made). This typically does not require further medical treatment.
- A reaction to the special dye used during the procedure to help visualize the arteries. This is a rare occurrence.