Uterine fibroids are tumors composed of smooth muscle that form in the uterus. They may also be called leiomyomas or myomas. Typically they are not cancerous. They can grow singularly or in groups, and can vary in size.
While most fibroids do not cause any symptoms, some women experience heavy menstrual bleeding, painful intercourse, painful periods, swelling of the lower abdomen, and complications with pregnancy and labor.
Depending on your symptoms, your doctor might suggest having your fibroids removed. There are several surgical options, and your doctor can help you decide which option is best for your situation.
Uterine artery embolization (UAE) is a newer approach in treating fibroids. It is a minimally invasive procedure that stops certain arteries from supplying blood to the fibroids. Without blood, the fibroids shrink, thus relieving symptoms. It is done in a hospital, and typically involves staying overnight after the procedure.
You will most likely be asked not to eat or drink anything after midnight the night before. Tell your doctor about any supplements or medications you take daily, and ask if you should take them the day of the procedure.
You will be sedated for the embolization. The best way to access the uterine arteries is through the femoral artery. This is located at the crease at the top of your leg, near your pelvis. A local anesthetic is applied and a needle is inserted into the artery for placement of the catheter. The catheter is then threaded through this artery and into the uterine artery on the opposite side of the pelvis.
An arteriogram is performed to get a view of the arteries. This involves an X-ray of your pelvis while a contrast dye is injected into the arteries. The resulting image (the arteriogram) gives your doctor a map of your pelvic blood supply and flow.
After this is done, microscopic particles of polyvinyl alcohol (PVA) are injected into the uterine arteries. These particles stay in the arteries and cannot travel to other organs. They wedge into the arteries and slowly block the blood flow to the fibroids. Once the arteries are completely blocked, the embolization can be stopped. Both uterine arteries are embolized to ensure that fibroids will not have any blood supply.
Another arteriogram is performed to confirm that the embolization is complete.
Parts of the uterus will still have normal blood flow. However, because fibroids are so vascular, the particles of PVA are drawn to the fibroids, blocking blood flow in these areas.
The entire procedure takes approximately 60 to 90 minutes.
After the embolization, you will have to lie flat for a few hours to help prevent clotting in the femoral artery. According to the Mayo Clinic, pain is a common side effect and is thought to be a result of stopping blood flow to the fibroids. The pain is typically worst in the 24 hours directly after the procedure. You will be given pain medication intravenously.
Post-embolization syndrome is also common. This can include a low-grade fever, fatigue, nausea, and vomiting. It typically resolves on its own, but you will be monitored for infection while you are in the hospital. You might also have vaginal discharge after the procedure, which is normal.
Most women are able to leave the hospital the day after the procedure. You will likely be given a prescription for pain medication and instructions on observing symptoms of infection.
A follow-up visit with your doctor is important within four weeks of the embolization. This visit is to ensure you are recovering well and to make sure there is no infection.
You might have ultrasound or other imaging tests at intervals throughout the year after the procedure to monitor the shrinkage of your fibroids.
Major complications are rare, but there are risks to UAE, including:
- puncture of other organs during the procedure
- radiation exposure from X-ray imaging
- scar tissue
- possible problems with future pregnancies
Talk with your doctor about any concerns you have, and how the procedure may impact your health.