Uterine fibroids treatment methods include the use of various conventional treatments for uterine fibroids. While natural fibroid treatment options can be very effective and comes without the significant expense and side effects associated with conventional methods, in some cases, conventional methods including surgery is necessary and uterine artery embolization (UAE) is one of the conventional ways to get this done.
This is a fairly new method for the treatment of fibroids although UAE also known as uterine fibroid embolization (UFE) has been used since the ‘70s to treat and stop hemorrhaging that could result after giving birth or after undergoing a pelvic surgical procedure.
It only started being used as a uterine fibroids treatment in the ‘90s when it was approved as a safe method for fibroid treatment in 1995. This means that although it is considered a safe method, the long term effects are still unknown when compared to surgical procedures such as the myomectomy or the hysterectomy.
This procedure is performed by an interventional radiologist (IR) and not a gynecologist and technically speaking, it is not considered surgery for the surgical removal of uterine fibroids because nothing is cut from the body during the procedure. Because it is not surgery and because gynecologists do not perform this procedure, your gynecologist may not mention this procedure to you. If he or she does not mention this treatment option, ask him or her about it and why they did not mention it.
Uterine Artery Embolization Procedure
While it remains fairly unknown why fibroid tumors develop, one thing is known. They need a robust blood supply to continue to grow. The logic with a UAE is that if the blood supply is cut off or reduced to the tumors, they should start to disintegrate.
Once the blood supply is cut off or reduced, the fibroids may shrink and even die. With no blood supply to help them grow, the fibroid tumors should start to disintegrate or generally become harmless.
While the fibroid tumors will disintegrate, the uterus remains unaffected. This is probably because the uterine muscle requires some blood supply but not as much as the amount that the tumors require to grow. The UAE does keep some blood flowing to the uterus area but this reduced blood flow while enough for the uterus and surrounding organs, is apparently not enough for fibroids.
To perform the procedure, the patient will be placed under local anesthesia or conscious sedation and a thin tube will be inserted close to your groin into the large arteries that are close to your groin that supply blood to the uterus and other organs in the vicinity as well as to the uterine fibroids.
Since most women have two uterine arteries, you should expect two puncture wounds to be performed to reduce the blood flow to this area.
A dye is then injected into the arteries first in order to help the IR perform this procedure as the dye will show up on the x-ray machine and will help guide the IR during the procedure.
Once the catheter is in the uterine artery, the IR releases small particles known as polyvinyl alcohol (PVA) into the blood stream which are then guided by the blood to the area that the IR wants them to settle. Once the PVA attach themselves, they will start to slow down the blood supply to the uterus. This procedure is then repeated for the second uterine artery. The procedure should last only 30 to 45 minutes from start to finish.
While not considered a surgical procedure, it is still invasive but it is still safer than surgical removal of uterine fibroids methods such as the myomectomy or the hysterectomy and the recovery time is usually less than the aforementioned procedures. You should be able to return to work in about a week or so.
The UAE is considered an outpatient procedure which means that after the procedure is performed, the patient can be sent home. But for some patients who experience bad cramps after the procedure, an overnight hospital stay may be required.
Another of the benefits of this procedure is that the uterus remains intact unlike a full hysterectomy.
What You Can Expect After the Procedure
1. After the procedure, mild abdominal pain may be experienced and require hospitalization in only a few cases when the pain is significant. You will be given pain medication as well as medication to help treat nausea and to help you sleep.
2. A follow-up will be required with your gynecologist as well as with your IR.
3. Physical activity is prohibited for at least two weeks.
4. A brown or pink discharge resulting from a disintegrating tumor or tumors is commonly reported in the weeks and months after the procedure.
5. Post embolization syndrome may be experienced by some women which is like a fever but can also be like menopause resulting in cramping, mood swings, hot flashes, nausea, severe pelvic pain, etc. This condition is thought to be the offshoot of disintegrating tissue in the fibroid tumor(s). Hospitalization may be required. The treatment for pain and nausea may also be required. With treatment, these symptoms should go away within a week or two.
6. The results of the procedure may be immediate but realistically, you can expect an improvement in your various uterine fibroids symptoms within 3 months including a reduction in heavy bleeding caused by fibroid tumors.
7. Your period may only return after a maximum of about five months when your body returns to normal.
Although the uterus remains intact and many women may go on to have successful pregnancies after this procedure, if you are planning to get pregnant after the procedure, the UAE will not usually be recommended.
Doctors feel that an abdominal myomectomy is the best option for women who still want to get pregnant after having the procedure as there is years of evidence to back up the myomectomy and not a lot of supporting evidence into the long term effects of a UAE since it is a relatively new procedure. If you still want to maintain your fertility but the number, size or position of the tumors will lead to an unsuccessful myomectomy, a UAE may be recommended.
Are You a Suitable Candidate for a UAE?
Only if you can answer the following questions in the affirmative;
1. Do you have significant symptoms of uterine fibroids including heaving bleeding?
2. Is child bearing in the past for you or can you live with the risk of infertility that may result from the UAE?
3. Do you require a hysterectomy or a myomectomy?
When is a UAE Not Recommended
1. Some types and sizes of fibroids may not respond successfully to a UAE. While all sizes of tumors may still make you eligible for this procedure, very large tumors such as those comparable to a 20 week pregnancy will not usually shrink after the procedure compared to small tumors that start to shrink immediately after the procedure.
Types of tumors such as pedunculated and submucosal tumors may not be successfully treated by a UAE because they either grow outside the uterus (pedunculated that are attached to the uterus through a stalk) or grow within the uterine wall (submucosal). While they may detach from the uterus after the procedure, their location makes it impossible for them to be expelled from the body.
2. If you are using hormone therapy as a uterine fibroids treatment method, it can cause an unsuccessful UAE procedure.
3. If you are pregnant.
4. If you have tumors that are not causing you any problems.
5. If you have pelvic cancer.
6. If you are allergic to the dye used during the procedure.
7. If you have an infection, etc.
UAE Risks and Complications
1. There is always a risk of infection that may lead to death but in most cases when infection becomes an issue, a hysterectomy is usually required immediately but this is a rare occurrence.
2. An allergic reaction or rash may develop.
3. The tumors may not shrink.
4. Bleeding and the development of blood clots in the legs is also another risk.
5. Ovarian failure may occur. Though the uterus is not affected by the reduced blood flow, ovarian failure may result when some of the PVA particles block the flow of blood to the ovaries. This risk is one of the reasons that UAE is not usually recommended for women who still have a desire to get pregnant after the procedure.
6. Premature menopause is also another risk although this is not a very significant risk.
UAE is definitely a viable uterine fibroids treatment method if you are considering other surgical removal of uterine fibroids methods such as a hysterectomy or myomectomy. It is also much safer than these two surgical procedures so that is a plus.