Fibroid embolization is performed by an interventional radiologist, a physician who is specially trained to perform this and other minimally-invasive procedures.

The interventional radiologist makes a small nick in the skin (less than one-quarter of an inch) in the groin to access the femoral artery, and inserts a tiny tube (catheter--like a piece of spaghetti) into the artery. Local anesthesia is used so the needle puncture is not painful. The catheter is guided through artery to the uterus while the interventional radiologist guides the process of the procedure using a moving X-ray (flouroscopy).
 

The interventional radiologist injects tiny plastic particles the size of grains of sand into the artery that is supplying blood to the fibroid tumor. This cuts off the blood flow and causes the tumor (or tumors) to shrink. The artery on the other side of the uterus is then treated. The skin puncture where the catheter was inserted is cleaned and covered with a bandage.

Fibroid embolization usually requires a hospital stay of one night. Pain-killing medications and drugs that control swelling typically are prescribed following the procedure to treat cramping and pain. Fever sometimes occurs after embolization and is usually treated with acetaminophen. Many women resume light activities in a few days and the majority of women are able to return to normal activities within one week.

While embolization to treat uterine fibroids has been performed since 1995, embolization of arteries in the uterus is not new. It has been used successfully by interventional radiologists for more than 20 years to treat heavy bleeding after childbirth. UFE is now available at hospitals and medical centers across the country. To find a site near you, visit our Doctor Finder section.

Expected Results

Fibroid embolization usually requires a hospital stay of one night. Pain-killing medications and drugs that control swelling typically are prescribed following the procedure to treat cramping and pain. Many women resume light activities in a few days and the majority of women are able to return to normal activities within seven to 10 days.

• On average, 90 percent of women who had the procedure experience significant or total relief of heavy bleeding. The procedure is about 85 percent effective for pain.
  
• The procedure is effective for multiple fibroids and large fibroids.
  
• Recurrence of treated fibroids is very rare. Short and mid-term data show UFE to be very effective with a very low rate of recurrence. Long-term (10 year) data is ongoing and not yet available, but in one study in which patients were followed for six years, no fibroid that had been embolized regrew.
  

FDA Approval

The FDA does not regulate the practice of medicine, but it does approve devices and medications. All devices, equipment and medications used for fibroid embolization are approved by the FDA for use in people.

Many women wonder about the safety of leaving plastic particles in the body. It is reassuring to know that the particles most commonly used in UFE have been available with FDA approval for over 20 years. During that time, they have been used in thousands of patients without long-term complications.

Fertility

There have been numerous reports of pregnancies following uterine fibroid embolization, however prospective studies are needed to determine the effects of uterine fibroid embolization (UFE) on the ability of a woman to have children. One study comparing the fertility of women who had uterine fibroid embolization with those who had myomectomy showed similar numbers of successful pregnancies.11 However, this study has not yet been confirmed by other investigators.

Less than 2 percent of patients have entered menopause as a result of UFE. This is more likely to occur if the woman is in her mid-forties or older and is already nearing menopause

Side Effects/Complications

Fibroid embolization is considered to be very safe, however, there are some associated risks, as there are wtih almost any medical procedure. Most women experience moderate to severe pain and cramping in the first several hours following the procedure. Some experience nausea and fever. These symptoms can be controlled with appropriate medications. A small number of patients have experienced infection, which usually can be controlled with antibiotics. It also has been reported that there is a 1 percent chance of injury to the uterus, potentially leading to hysterectomy. These complication rates are lower than those of hysterectomy and myomectomy.

A small number of patients have entered into menopuase after embolization. This is more likely to occur if the woman is in her mid-forties or older, and is already nearing menopause.

Myomectomy and hysterectomy also carry risks, including infection and bleeding leading to transfusion. Patients who undergo myomectomy may develop adhesions causing tissue and organs in the abdomen to fuse together, which can lead to infertility. In addition, the recovery time is much longer for abdominal myomectomy, generally one to two months.

You should talk to your doctor about possible risks of any procedure you may choose.

Insurance

Most insurance companies pay for fibroid embolization. You will want to talk with your interventional radiologist about this before your procedure. You can also check out a list of carriers on the SIR web site.