Uterine fibroid tumors are benign growths that develop in the muscular wall of the uterus and may cause problems for some women. Symptoms may include pain and heavy and prolonged menstrual periods leading to anemia, as well as bowel or bladder irritation from direct pressure.
Uterine fibroids may be diagnosed by gynecologic internal pelvic exam and can be confirmed with ultrasound. MRI provides the best anatomic information regarding size, number, location, and type of fibroids. Treatment options for fibroids that cause symptoms include hormonal therapy, myomectomy (surgical resection of visible fibroids), hysterectomy, and uterine artery embolization. Appropriate treatment depends on the size and location of the fibroids, as well as the severity of symptoms.
Dr. Andrew Weber, Retired Raleigh Radiology interventional radiologist, was the first physician in Raleigh to perform uterine artery embolization as a less invasive alternative to surgical hysterectomy in the treatment of symptomatic uterine fibroid disease. All of our interventional radiologists perform Uterine Fibroid Embolization and also have extensive experience treating fibroid disease.
How should I prepare?
Imaging of the uterus by magnetic resonance imaging (MRI) or ultrasound is performed prior to the procedure to determine if fibroid tumors are the cause of your symptoms and to fully assess the size, number and location of the fibroids.
You should report to the radiologist all medications that you are taking, including herbal supplements, and if you have any allergies, especially to local anesthetic medications, general anesthesia or to contrast materials (also known as “dye” or “x-ray dye”).
Your physician may advise you to stop taking aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs) or a blood thinner for a specified period of time before your procedure. Also inform the radiologist about recent illnesses or other medical conditions. You may be instructed not to eat or drink anything after midnight before your procedure. Your doctor will tell you which medications you may take in the morning. You will be given a gown to wear during the procedure. You should plan to stay overnight at the hospital following your procedure.
How does the procedure work?
The procedure involves inserting a catheter through the groin, maneuvering it through the uterine artery, and injecting the embolic agent into the arteries that supply blood to the uterus and fibroids. As the fibroids die and begin to shrink, the uterus fully recovers.
How is the procedure performed?
UFE is an image-guided, minimally invasive procedure that uses a high-definition x-ray camera to guide the interventional radiologist to introduce a catheter into the uterine arteries to deliver the particles. The procedure is typically performed in a cath lab.
You will be positioned on the examining table. You will be connected to monitors that track your heart rate, blood pressure and pulse during the procedure. A nurse or technologist will insert an intravenous (IV) line into a vein in your hand or arm so that sedative medication can be given intravenously. You may also receive general anesthesia. The area of your body where the catheter is to be inserted will be shaved, sterilized and covered with a surgical drape. Our radiologist will numb the area with a local anesthetic. A very small nick is made in the skin at the site. Using x-ray guidance, a catheter is inserted into your femoral artery, which is located in the groin area. A contrast material provides a roadmap for the catheter as it is maneuvered into your uterine arteries. The embolic agent is released into both the right and left uterine arteries by repositioning the same catheter that was originally inserted. Only one small skin puncture is required for the entire procedure. At the end of the procedure, the catheter will be removed and pressure will be applied to stop any bleeding. The opening in the skin is then covered with a dressing. No sutures are needed. Your intravenous line will be removed. You will most likely remain in the hospital overnight so that you may receive pain medications and be observed. This procedure is usually completed within 90 minutes.
What will I experience during and after the procedure?
Devices to monitor your heart rate and blood pressure will be attached to your body. You will feel a slight pin prick when the needle is inserted into your vein for the intravenous line (IV) and when the local anesthetic is injected. The intravenous (IV) sedative will make you feel relaxed and sleepy. You may or may not remain awake, depending on how deeply you are sedated. You may feel slight pressure when the catheter is inserted but no serious discomfort. As the contrast material passes through your body, you may get a warm feeling. While you are in the hospital, your pain will be well-controlled with a narcotic. After staying overnight at the hospital, you should be able to return home the day after the procedure. You may experience pelvic cramps for several days after your UFE, and possibly mild nausea and low-grade fever as well. The cramps are most severe during the first 24 hours after the procedure and will improve rapidly over the next several days. While in the hospital, the discomfort usually is well-controlled with pain medication delivered through your IV.
Once you return home, you will be given prescriptions for pain and other medications to be taken by mouth. You should be able to return to your normal activities within one to two weeks after UFE. Afterward, it is common for menstrual bleeding to be much less during the first cycle and gradually increase to a new level that is usually greatly improved as compared to before the procedure. Occasionally you may miss a cycle or two or even rarely stop having periods altogether. Relief of bulk-related symptoms usually takes two to three weeks to be noticeable and over a period of months the fibroids to continue to shrink and soften. By six months, the process has usually finished and the amount of symptom improvement will stabilize.
Nothing to eat or drink after midnight. If you are on blood pressure medications, you may take your AM dose with a small sip of water, otherwise hold off on taking your other medications. Discontinue taking aspirin, coumadin, or plavix 5 days prior to procedure. Make sure a driver is available post procedure to take you home.
What You Should Know About Fibroids | UFE | Treating Uterine Fibroids: Finding Relief with Uterine Fibroid Embolization | Uterine Fibroid Embolization: Fibroid Relief Doesn’t Have to Mean a Hysterectomy | Fibroid Treatment Options Brochure | Uterine Fibroid Embolization Brochure | UFE Raleighrad Note