Uterine fibroid embolization (UFE), also known as uterine artery embolization (UAE), is a minimally invasive procedure to treat fibroids. Uterine fibroids are noncancerous growths that form on the uterus. They can be asymptomatic or symptomatic. If symptomatic, they can cause vaginal bleeding, pelvic pain, lower back pain, pain during sexual intercourse, and constipation, and may interfere with fertility. In this case, surgery may be needed to relieve symptoms.
During the procedure, the blood supply to the fibroids is cut off by inserting small plastic or gelatin particles through a catheter inserted into the uterine artery, which supplies blood to the uterus and the fibroids. This will cause the fibroids to shrink, reducing symptoms. UFE is typically performed with a local anaesthetic, meaning you will remain awake (although sedated) during surgery.
Who is a candidate?
Patients who suffer from uterine fibroids that do not plan to have children in the future, but would like to avoid surgery are good candidates for UFE. Those who may be poor surgical candidates for other reasons such as obesity, bleeding disorders, or anemia should also consider UFE a possible treatment for uterine fibroids.
Who is not a candidate?
Patients who wish to have children in the future should not consider UFE their best option, as the effects of UFE on fertility and future pregnancies is not known. UFE may interfere with the ability to conceive.
A preoperative assessment discussing treatment, anesthesia, and hospital stay should be scheduled in order to prepare mentally for the procedure. Any blood thinners such as aspirin and other pain relievers should be discontinued 7 days before the procedure to reduce the risk of excessive bleeding. If you can, quit smoking, as this will also reduce your risk of abnormal bleeding.
After the procedure, you will be instructed to lie flat for 4-6 hours to prevent blood from pooling at the surgery site, and have a urinary catheter inserted. You may either go home the same day or stay in the hospital overnight. Moderate to severe abdominal and pelvic cramps may occur in the first 24 hours, and may last for up to 2 weeks. Pain from cramping can be relieved with prescribed pain medication. Post-embolization syndrome, consisting of low-grade fever, pain, fatigue, nausea and vomiting, may occur anywhere in the first 48 hours post-procedure. These symptoms typically will resolve on their own within a week. For many women, they can return to work and normal activities in 7-10 days after the procedure, though total absence of pain without medication may take longer.
In the next few weeks to a month, monitor yourself for signs of infection. Watery or mucus like vaginal discharge may occur after treatment, and remnants of fibroids may pass through your vagina. Follow up with your physician to ensure no infection develops and recovery is proceeding normally.
Although UFE is a relatively low-risk and minimally invasive procedure, general risks include infection, excessive bleeding, injury to an artery or to the uterus, possible problems with future pregnancy, problems with ovarian function, and/or premature menopause (lack of menstrual periods). As with any surgery performed under local anesthesia, there are risks of anesthesia-related complications or allergic reactions to surgical medications. Recurrence of uterine fibroids may occur in some cases. Having uterine fibroids shrunk via UFE can also lead to delayed diagnosis of a rare type of cancer that occurs in fibroids, called leiomyosarcoma.
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