Uterine fibroid embolization, performed under local anesthesia, is a much less invasive procedure than laparoscopic surgery to remove individual uterine fibroids (myomectomy) or the whole uterus (hysterectomy).
No surgical incision is necessary—only a small incision in the skin is needed that does not require stitches.
Patients ordinarily can resume their usual daily activities much earlier than if they had hospital surgery to treat their fibroids.
As compared to surgery, general anesthesia is not required and the recovery time is much shorter, with minimal blood loss.
Follow-up studies have shown that nearly 90 percent of women who have their fibroids treated by uterine fibroid embolization experience either significant or complete resolution of their fibroid-related symptoms. This is true both for women who have heavy bleeding as well as those who have bulk-related symptoms including urinary frequency, pelvic pain, or pressure. On average, fibroids will shrink to half their original size, which amounts to about a 20 percent reduction in their diameter. More importantly, they soften after embolization and no longer exert pressure on the adjacent pelvic organs.
Follow-up studies over several years have shown that regrowth of treated fibroids after uterine fibroid embolization is quite rare. This is because all fibroids present in the uterus, even early-stage nodules that may be too small to see on imaging exams, are treated during the procedure. Uterine fibroid embolization is a more permanent solution than the option of hormonal therapy, because when hormonal treatment is stopped the fibroid tumors usually grow back. Regrowth also has been a problem with the laser treatment of uterine fibroids.
Any procedure that places a catheter inside a blood vessel carries certain risks. These risks include damage to the blood vessel, bruising or bleeding at the puncture site, and infection. The doctor will take precautions to mitigate these risks.
When the procedure is performed by an experienced interventional radiologist, the chance of these events occurring is less than one percent.
An occasional patient may have an allergic reaction to the x-ray contrast material used during uterine fibroid embolization. These symptoms range from mild itching to severe reactions that can affect a woman’s breathing or blood pressure. Women undergoing UFE are carefully monitored by a physician and a nurse during the procedure so that any allergic reaction can be detected immediately and addressed.
Approximately two to three percent of women will pass small pieces of fibroid tissue after uterine fibroid embolization. This occurs when fibroids located inside the uterine cavity detach after embolization. Women with this problem may require a procedure called D & C (dilatation and curettage) to be certain that all the material is removed to prevent bleeding or infection from developing.
In the majority of women who undergo uterine fibroid embolization, normal menstrual cycles resume after the procedure. However, in approximately one percent to five percent of women, menopause occurs after uterine fibroid embolization. This appears to occur more commonly in women who are older than 45 years.
Patients are exposed to x-rays during uterine fibroid embolization, but exposure levels are well below those where adverse effects on the patient or future childbearing would be a concern.
The question of whether uterine fibroid embolization impacts fertility has not yet been answered, although several healthy pregnancies have been documented in women who have had the procedure. Physicians may recommend that a woman who wishes to have more children consider surgical removal of the individual tumors rather than undergo uterine fibroid embolization.
It is difficult to predict whether the uterine wall is in any way weakened by UFE, which might pose a problem during pregnancy and delivery. Therefore, the current recommendation is to use contraception for six months after the UFE procedure and to undergo a Cesarean section during delivery rather than to risk rupture of the wall of the uterus from the intense muscular contractions that occur during labor.