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Uterine Fibroid Embolization

Fibroids are benign (non-cancerous) growths in the muscular wall of the uterus. Growths can be as tiny as a grape or as large as a cantaloupe. Fibroids are common. Between 20 and 40% of women older than 35 years have fibroids. African-American women are at a higher risk of having fibroids.

Heavy bleeding during menstrual periods, pain, pressure, or heaviness in the lower pelvic area, pain during sexual intercourse, a constant urge to urinate, or bloating may be a symptom of uterine fibroids. 

Fibroids have a large blood supply that makes them grow. Fibroids will shrink or go away completely if the blood supply is stopped. While medicine can shrink some fibroids, a procedure called uterine fibroid embolization blocks the blood flow to these growths. By blocking blood flow to the fibroids, uterine fibroid embolization in effect "starves" them of the blood they need to grow.

When deprived of blood, the tumor masses die, develop into scar tissue, and shrink in size. Symptoms become less bothersome or disappear altogether.

Before the procedure

  • A gynecological work-up is performed to confirm that fibroid tumors are the actual cause of her symptoms.
  • Imaging of the uterus by magnetic resonance imaging (MRI) or ultrasonography is performed to fully assess the size, number, and location of the fibroids.
  • If bleeding is a major symptom, a biopsy of the endometrium—the inner lining of the uterus—may be done to rule out cancer.
  • Eat a normal meal the evening before your procedure. DO NOT eat, drink or chew anything after 12 midnight.
  • Aspirin, Advil, Motrin or Ibuprofen should not be taken five days before the procedure as these medications can thin you blood.
  • The morning of the procedure, you may take other medications that you usually take with a small sip of water.
  • If you take Coumadin, Plavix, Lovenox, Glucophage or Heparin, please talk to your doctor about when to stop taking these medications

During the procedure

  • An IV (intravenous line) inserted in your arm administers sedatives, medications, and fluids during the procedure.
  • Your groin area is cleansed with an antiseptic solution, and the catheter insertion site(s) is shaved.
  • The insertion point is numbed with a local anesthetic. You will also be sedated, which will keep you awake but sleepy during the procedure.
  • Your doctor will make a tiny cut in the skin in your groin area.
  • A contrast dye is injected into the artery supplying blood to the uterus to make the fibroids visible and a series of X-ray images are taken.
  • Your doctor will pass a tiny tube called a catheter through an artery to your uterus.
  • When the catheter is in place, the doctor will inject tiny particles into the catheter. These particles, made of plastic or gelatin sponge, are about the size of grains of sand.
  • The particles move through the catheter into the arteries that send blood to the fibroid and stop the blood flow to the fibroid. Over time, the fibroid will shrink in size.
  • After the left and right uterine arteries are blocked, another arteriogram is performed.
  • The catheter is removed and pressure is held over this area for approximately 15 minutes.
  • The procedure takes approximately two hours

After the procedure

  • After the procedure, you must be on bed rest for six hours lying flat with the leg in which the catheter was placed straight. Pain usually occurs immediately following the procedure and over the next six hours.
  • Patients usually stay overnight in the hospital, so that the arterial access site and your pain are monitored.
  • Once you return home, you must adhere to the following instructions to ensure a smooth recovery:

    • Drink eight glasses of liquid such as water, juice or soda once you return home. You may begin your usual diet when you leave the hospital.
    • Avoid strenuous activity such as housework and heavy yard work for 48 hours. Most patients can return to their normal activities in a week.
    • Do not drive a car for 24 hours.
    • Do not take a hot bath for five days. You may shower.
  • Notify your doctor is if any of the following reactions occur:

    • Bleeding at the entry site.
    • Any unusual pain in the entry site or the leg in which the catheter was placed.
    • Any change in color or temperature of the leg. A small bruise may develop and is normal.

About 85% of women have a lot of or total relief of pain and other symptoms caused by fibroids. Because the effects of uterine fibroid embolization (UFE) on fertility are not yet known, the ideal candidate is a premenopausal woman with symptoms from fibroid tumors who no longer wishes to become pregnant, but wants to avoid having a hysterectomy (surgical removal of the uterus).

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