Uterine Fibroid Embolization
What are Uterine Fibroids?
Uterine fibroids are benign, noncancerous growths within the uterus or in the muscular wall of the uterus. Uterine fibroids are also known as Leiomyomas. 20% to 40% of women over the age of 35 will have fibroids. These may be solitary or multiple, and can vary in size from tiny (pea size) to enormous (melon size). Fibroids are benign and will never become cancerous. They are classified depending on location within the uterus. Most women don’t know they have uterine fibroids because they often cause no symptoms. You may only discover you have a fibroid when you have a pelvic exam or pelvic Ultrasound.
What are the most common symptoms?
Most women won’t have any symptoms, but in those that do, this can vary depending on the size, location, and how many fibroids are present.
One may experience:
- Heavy menstrual bleeding, which may last more than a week
- Bloatedness and pain along with cramps and a heaviness in the pelvis area
- Pressure on the bladder and frequent urination
- Constipation
- Backache and pain down the legs
- Anaemia from excessive menstruation
- Dyspareunia (pain during sexual intercourse)
The most common of these symptoms are excessive, prolonged menstruation and pain. Tests will have to done to confirm the presence of the fibroids. These test may include a pelvic examination by your doctor and an Ultrasound scan.
How do you treat Uterine Fibroids?
Small, solitary fibroids are often asymptomatic and there is no treatment necessary. Women with larger fibroids or multiple fibroids often suffer from increased pain andmenorrhagia (excessive, prolonged menstrual bleeding). This often results in anaemia. For these patients, there are three treatment options available:
1. Medication
Anti-inflammatory and antihaemorrhagic drugs along with hormonal treatments can be used. These treatments are usually only effective for a limited time and only give temporary relief to symptoms.
2. Surgery
There are various surgical interventions that can be used to remove the fibroids. This would involve a general anaesthetic and surgery in theatre with a 3-5 day hospital stay and a longer postoperative recovery time, and possibly being off from work for several weeks. These procedures may affect fertility.
- Myomectomy – this is the removal of the individual fibroids, while leaving the healthy uterine tissue intact. Various techniques may be used and this may include major surgery. This approach maintains fertility.
- Hysterectomy – this is the removal of the uterus.
- Endometrial Ablation –this is the removal of the endometrial lining of the uterus. It is done as a day procedure.
3. Embolization
This is an excellent alternative treatment option for women who do not want to have a hysterectomy, or where drug treatment is not controlling the menorrhagia. Studies have shown that fertility is not affected. This also helps resolve dyspareunia (deep pelvic pain) experienced during sexual intercourse. This is a non-surgical procedure that requires a short stay in hospital and is performed in the Interventional Suite in the X-ray department. It will not have lasting effects on the uterus, and shrinks the fibroids by cutting off the blood flow to the fibroid. Embolization is performed by one of our Interventional Radiologists.
What happens during an Embolization?
- Although we do welcome self referrals, you may also be referred via your Gynaecologist for this procedure after a full physical and gynaecological examination.
- We will arrange a consultation with you, where one of our Interventional Radiologists will discuss the procedure, risks and any concerns you may have.
- Once all your questions have been answered, and you are happy to go ahead with the procedure, we will arrange a date which best suits you.
- On the day, you will be admitted into hospital for at least 24hours
- The embolization is performed in the X-Ray department with the use of conscious sedation and pain-relieving drugs. You are carefully monitored throughout the procedure by our trained Interventional nursing and radiography staff.
- The procedure is done under X-ray guidance.
- A small catheter is introduced into the radial artery (arm) or femoral artery (groin). In most women we will use the radial artery approach, as this is more comfortable for our patients, but also makes the procedure easier for us, leading to quicker procedure times, and less radiation exposure.
- The catheter is advanced into the pelvic area where the Radiologist will identify which arteries need to be embolized. This requires a small amount of contrast dye to be injected.
- Embolization is done by injecting small particles (microspheres), the size of sand grains, into the identified arteries.
- The microspheres block the arteries limiting blood supply, which causes the fibroids to shrink and symptoms to reduce or disappear.
What happens after the Embolization?
- You will remain in hospital for between 24 (which is the usual) and 48 hours for pain management. Most women tolerate the procedure very well.
- The Interventional Radiologist and your Gynaecologist will work together to monitor your recovery and follow up after the procedure.
- You may return to work 7 to 10 days after the Embolization.
- Pelvis cramping/mild fatigue and a low fever maybe experienced after the Embolization.
- Some bleeding my occur in the months following the embolisation but generally your menorrhagia will significantly reduce.
- Routine follow up is performed with Ultrasound after three (3) months
- Our interventional team is always on hand to answers any questions or concerns you may have following the procedure.