Uterine Fibroid Embolisation or Uterine Artery Embolisation (UAE)

What is fibroid embolisation?

Uterine Fibroids are benign (non-cancerous) growths in the uterus. Fibroid Embolisation is a procedure that involves blocking the blood vessels to the uterus in order to stop the growth of the fibroids. The procedure is performed by a radiologist, rather than a surgeon and is an alternative to an operation. 

Why do I need fibroid embolisation?

Fibroids are common and most do not require treatment. However, if your fibroids are causing discomfort and are thought to be a cause for your symptoms, your gynaecologist will discuss treatment options with you. The treatment is non-surgical and while it aims to reduce the size of the fibroids and the symptoms associated with them, it does not remove the fibroids.

There are alternative treatments available that your doctor should discuss with you such as the use of medication, or surgical procedures – removing the fibroid (myomectomy) or removing the uterus (hysterectomy). During these discussions, remember the choice of treatment (if at all) is up to you. 

Are there reasons I should not have an embolisation?

You should not have an embolisation if

• your fibroids are not causing you any symptoms
• you have a current or have had a recent infection in your cervix, uterus, or fallopian tubes
• there is a chance that a cancer could be causing your symptoms (your gynaecologist will assess this with tests prior to the procedure)
• you could be pregnant
• you feel that you would not want a hysterectomy under any circumstances

Who will be performing the fibroid embolisation?

A trained radiologist will perform the procedure. Radiologists have special expertise in using x-ray equipment to guide the small wires into the correct placement to perform the procedure.

Where will the procedure take place?

The procedure will take place at Mater Medical Imaging (x-ray department) located on the fourth floor of the Mater Adults Hospital.

How do I prepare for fibroid embolisation?

It is recommended to arrange two weeks of leave following the procedure. In preparation for your embolisation, you will have had an ultrasound, blood tests and will meet with the radiologist performing the procedure. On the day, you will be asked to not eat or drink for six hours before the procedure. An IV cannula (‘drip’) will be inserted in your arm to disperse antibiotics. A small tube (catheter) will also be inserted into your bladder to keep it empty during the procedure. Hair may need to be removed from the groin area.

What actually happens during fibroid embolisation?

You will be hooked up to a monitoring device to observe your pulse and blood pressure and be given oxygen through small tubes in your nose. The skin and deeper tissues over the left or right main artery in the groin will be anaesthetised with local anaesthetic and then a needle will be inserted into this artery. A guide wire is then placed through the needle and along the artery before being withdrawn allowing the catheter to be placed over the wire and directed until it reaches the uterine artery.  Using X-ray the radiologist will move the catheter and the guide-wire into the arteries which are feeding the fibroid. X-ray contrast (“dye”) is injected to check the catheter position. Once the fibroid blood supply has been identified, fluid containing thousands of tiny particles is injected through the catheter into these small arteries which nourish the fibroid, blocking them and starving the fibroid of its blood supply.  While arteries on both the left and the right of the uterus require treatment, this can usually be done from either the right or left groin.  At the end of the procedure, the catheter is withdrawn and the radiologist then presses firmly on the puncture site for 10-15 minutes to prevent bleeding.

Will it hurt?

When the local anaesthetic is injected, you may feel a small sting but this soon passes. If you do experience pain during the procedure, pain medication can be administered through the cannula in your arm. Some people also feel an unpleasant warm feeling as the contrast passes around the body. Most patients feel some pain afterwards. This ranges from very mild period-like pain to severe, cramping pain. It is generally worse in the first twelve hours but may be present when you go home. Medication can be administered for this while at hospital, and some patients do take further medication home as well.  Patients also experience a slight fever after the procedure. This is a good sign as it means that the fibroid is breaking down. The pain medication will help control this fever.

How long will it take?

Every patient’s situation is different, and it is not always easy to predict how complex or how straightforward the procedure will be. Most fibroid embolisations take between one or two hours, but can occasionally take longer.  As a guide, expect to be in the x-ray department for about three hours.

What happens afterwards?

Immediately after the procedure you will be taken to the Post Anaesthesia Care Unit ( PACU). An anaesthetist monitors your pain and arrange for more pain relief before you return to the ward. Nurses on the ward will carry out routine observations, such as taking your pulse and blood pressure, to ensure there are no untoward effects. They will also look at the puncture site to ensure there is no bleeding. You will stay at least one night in hospital. A doctor will see you before you go home. Once you are home, you should take things easy for three to four days.

Are there any risks or complications?

Fibroid embolisation is a safe procedure, but there are some risks and complications that can arise, as with any medical treatment:

• Groin bruise (haematoma) where the needle has been inserted, if this becomes a large bruise, then there is the risk of it getting infected and would require treatment with antibiotics or surgery.
• Vaginal discharge (which may be bloody) may occur 24-48 hours afterwards and usually lasts for two weeks. Occasionally it can persist intermittently for several months. If the discharge becomes too much and if it is associated with a high fever and feeling unwell, there is a possibility of infection and you should ask to see your gynaecologist urgently, or present to an Emergency Department.
• Infection may occur in two in every hundred (2%) of women having the procedure. If severe infection has developed, it is generally necessary to have an operation to remove the uterus—a hysterectomy.
• A blood clot may form in the artery or in the pelvic veins.
• Early menopause is uncommon but more likely in women ages 45 years or older.
   

What else may happen after this procedure?

• Some patients may feel tired for up to two weeks following the procedure, though some people feel fit enough to return to work three days later.
• Approximately 8% of women have spontaneously expelled a fibroid, or part of one, usually six weeks to three months afterwards. If this happens, you are likely to feel some period-like pain and have some bleeding and discomfort.
• You need to come back to the Emergency Department or see your GP if bleeding is heavy, if you have severe pain, persistent fever or you feel unwell.
   

What are the results of fibroid embolisation?

Embolisation seems to be successful in resolving symptoms of heavy bleeding, painful periods, and pressure symptoms in approximately 80% of women at follow up between 2 and 5 years. 

What your doctor needs to know

If you have any allergies, you must let your doctor know. If you have previously reacted to intravenous contrast media (the dye used for kidney x-rays and CT scanning), advise your doctor.

Will embolisation affect my chance of pregnancy in the future?

Studies are limited and the effect that embolisation has on fertility is uncertain. Studies suggest that there may be a small reduction in “ovarian reserve” in women who have undergone embolisation. One study showed that fertility rates after embolisation were 50% of those who tried, compared to 78% of those who underwent a myomectomy.

Will my pregnancy be affected if I do get pregnant?

Once again, studies are limited, but it appears that pregnancies after embolisation may have a higher chance of miscarriage, caesarean birth and bleeding after childbirth. It is hard to know if this is related to the embolisation, or the fact that the fibroids have affected the uterus. 

References
Royal College of Obstetricians and Gynaecologists (RCOG). (2013). Uterine Artery Embolisation in the Management of Fibroids. Retrieved from https://www.rcog.org.uk/en/guidelines-research-services/guidelines/uterine-artery-embolisation-in-the-management-of-fibroids/

British Society of Interventional Radiology (2011). Uterine artery embolization (fibroid embolization). Retrieved from https://www.bsir.org/media/resources/BSIR_Patient_Leaflet_-_Uterine_Artery_Embolisation_Fibroid_Embolisation_2.pdf

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