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Uterine Fibroid Embolisation

Overview

Fibroids are benign (non-cancerous) growths that develop in the muscle wall of the uterus. Between 20-40% of women over the age of 35 have fibroids, but they do not always cause symptoms. Fibroids vary in size but can grow to be very large, up to the size of a 5 or 6 month pregnancy. They typically improve after the menopause. Fibroids are also called by other terms including leiomyoma and myoma.

Most fibroids do not cause symptoms and do not need treatment. Symptoms depend on the number, size and location of fibroids, and UFEM 1they may cause;
  • Heavy, prolonged menstrual periods that can cause anaemia
  • Pelvic pain
  • Pelvic pressure or heaviness often described as ‘bloating’ of the abdomen
  • Bladder and bowel pressure resulting in the need to constantly pass urine or causing constipation.
  • Infertility
Fibroids are typically multiple and are described by their location as shown on the diagram to the right.

For symptomatic fibroids there are three main types of treatment:
  • Medical therapy - using drugs to control symptoms including hormonal treatments;
  • Surgical therapy - there are a growing number of surgical options available including endometrial ablation and hysteroscopic resection; myomectomy – laparoscopic (‘key hole’) and abdominal (‘open’); and hysterectomy,
  • Embolisation, which is minimally invasive using a catheter under x-ray guidance to to block the blood vessels supplying the fibroids with small particles.Without a supply of blood, the fibroid die off and shrink by an average of 40 - 50% over a 3 to 6 month period.
A gynaecologist and intervetional radiologist should be able to talk through these treatment options in more detail.
 

What is fibroid embolisation and how does it work?

Fibroid embolisation is a procedure that has been performed worldwide for over 20 years. The procedure is conducted in an angiography suite (“cath lab”) at Mercy Angiography, which is in the Mercy Hospital at 98 Mountain Road, Epsom in Auckland. Your interventional radiologist will be assisted by nurses and other highly trained staff.
 
UFEM 2Small particles are used to block the blood vessels supplying the fibroids. It is a minimally invasive procedure performed by an interventional radiologist requiring only a tiny nick in the skin in the groin, with most patients able to go home the day after the procedure.

You will be given medication before the procedure to help relax and control pain, but you will remain awake during the procedure.
 
Under x-ray guidance a small flexible plastic tube called a catheter is feed into the artery in the groin and then into the artery supplying the fibroids.

Particles smaller than a grain of sand are injected into the artery, blocking the blood vessels supplying the fibroids. It doesn’t matter how many fibroids are in the uterus because all of them are treated at the same time.   

Without blood supply the fibroids die off and then shrink, on average by 40 - 50%, over a 3 to 6 month period. The majority of patients have a significant improvement in their symptoms, both for heavy bleeding (80 - 90%) and pelvic pressure (80-90%) after 4 to 6 weeks.

The particles used to block the blood vessels are made from plastic type materials that are biocompatable (don’t react with the body) and are smaller than a grain of sand. These particles have been used for over 40 years in a wide variety of procedures with no significant side effects from the material reported. In total no more than a teaspoon of particles is usually required to complete the procedure. There are two main types of particles made from Polyvinyl alcohol or PVA and tris-acryl gelatin spheres called ‘Embospheres”. 
 
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How should I prepare for my procedure?

The is very little preparation involved to get ready for the procedure:
  • Women who have a Mirena coil in to have it removed  2 to 4 weeks before the procedure date.
  • Also, where possible we ask women to stop taking their hormone medication 2 to 4 weeks before the procedure as it is felt this improves the chance of having a good outcome.
On the day of your procedure:
  • Fasting: You may eat until 2 hours before admission then you should not have anything to eat. You may continue to drink clear fluids.
  • Allergies or previous reactions to contrast (x-ray dye): Please inform your doctor, and Mercy Angiography staff at the time of booking your procedure, if you have any known history of allergies, particularly allergies to x-ray contrast and seafood.
You may bring a favourite music CD as this can be played during the procedure.

On the day of your procedure, please make your way to the Mercy Hospital Reception where they will be expecting you. You will be admitted to a hospital ward and transferred to Mercy Angiography for your procedure.

For directions to the Mercy Hospital, click here.
 
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Are my fibroids suitable for embolisation?

  • Almost all fibroids are suitable for embolisation.
  • Where possible all patients have an MRI scan of the pelvis that helps to show the fibroids in detail.
  • In a small number of patients the MRI scan shows no blood supply to the fibroid or a fibroid on a thin stalk called a ‘pedunculated fibroid’ and these may be better treated with a surgical operation such as myomectomy.
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What happens after the procedure?

Following your procedure, you will be transported to a hospital ward for recovery, where you will stay for 1 to 2 days. You will be looked after by both your Gynaecologist and Interventional Radiologist.

You will receive discharge instructions from your doctor and be given medications to keep you comfortable on leaving the hospital. You will be told who to contact in case of an emergency after your procedure. This is especially important if you are experiencing fever, pelvic pain, or vaginal discharge that is increasing over time.
 
On returning home, you may experience some cramping, similar to menstrual period cramping, that lasts a few days after the procedure.
Most women are able to return to light activity within a few days and are usually back to work and normal activity within 10 to 21 days.
 
You will be asked to see your Interventional Radiologist after 2 weeks and then to see your Gynaecologist at 6 to 8 weeks to ensure you are recovering well. For most women whose symtpoms resolve there is no need to have a repeat scan. For some women a further scan can be organised to assess the change in the fibroids if symptoms have not improved as much as expected.

One of the benefits of fibroid embolisation is the quicker recovery when compared with surgery. Most patients can return to normal activities after 1 to 2 weeks and return to work in 1 to 3 weeks.

A number of studies have shown that after 12 months 80 – 90% of women who have had fibroid embolisation would recommend the procedure to a friend. 
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Is fibroid embolisation safe? What are the risks?

Embolisation of the uterus has been performed for over 20 years with a large number of recent studies showing fibroid embolisation to be very safe and effective.

Risks
  • The main risks that patients need to be aware of include a small risk of requiring hysterectomy (1-2%) if infection occurs.
  • Some women enter menopause early (3-4%), although this is more likely to occur in women over 45.
  • A small number of women may require a second procedure under anaesthetic to help treat post procedure symptoms (3-4%).
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Will my fertility be affected?

  • While many studies have shown women can have successful pregnancies following fibroid embolisation, the full effect of fibroid embolisation on fertility and pregnancy is still being studied in detail.
  • Currently where fibroids are suitable formyomectomy, without a significant risk of hysterectomy, this procedure is recommended for patients hoping to preserve fertility.
  • In patients where myomectomy would result in a high risk of  hysterectomy, fibroid embolisation is reasonable to perform to preserve fertility. Similar to myomectomy, patients are advised to avoid becoming pregnant for 6 months following embolisation.
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