Uterine Fibroid Embolization (UFE), also known as Uterine Artery Embolization (UAE), is a minimally invasive treatment for symptomatic uterine fibroids. This non-surgical procedure shrinks fibroids by intentionally blocking their blood supply, causing them to die off over time while preserving the uterus. This article explains the nature of uterine fibroids, details the embolization mechanism, outlines candidate eligibility, and describes the expected recovery process.
Context: What Are Uterine Fibroids?
Uterine fibroids, medically termed leiomyomas or myomas, are non-cancerous growths that develop from the muscle tissue of the uterus. They are common, with many individuals developing them by age 50, though they often do not cause symptoms. Fibroids vary widely in size, from microscopic to masses large enough to alter the shape of the uterus.
When fibroids cause problems, symptoms are directly related to their size and location. Common complaints include heavy and prolonged menstrual bleeding, which can lead to anemia and fatigue. Fibroids can also cause pelvic pressure or pain, lower back discomfort, and frequent urination due to bladder compression.
The severity of these symptoms determines the necessity of treatment. Fibroids that grow on the outer surface (subserosal) or within the uterine wall (intramural) often cause pressure. Those protruding into the uterine cavity (submucosal) are more likely to cause heavy bleeding.
How Fibroid Embolization Works
Uterine Fibroid Embolization is a catheter-based procedure performed by an interventional radiologist. The process begins with a local anesthetic applied to a small incision site, typically in the groin over the femoral artery or sometimes the wrist. A catheter is then inserted into the artery through this entry point.
The radiologist uses fluoroscopy, a specialized X-ray technique providing real-time moving images, to guide the catheter. The catheter is threaded through the blood vessels until it reaches the uterine arteries, which supply blood flow to the uterus and the fibroids. A contrast dye is injected to highlight the vessels and confirm the catheter’s precise location.
Once positioned, tiny embolic agents are injected into the uterine arteries. These medical-grade particles, often the size of sand grains, travel through the arteries and lodge in the smaller blood vessels feeding the fibroids. This action blocks the flow of blood, a process known as ischemia.
The cessation of blood supply causes the fibroid tissue, which has a higher blood demand than the surrounding healthy uterine muscle, to shrink and soften. The procedure is repeated for the arteries on both sides of the uterus to ensure all fibroids are treated. The catheter is then removed, and a bandage is placed over the puncture site.
Determining Patient Eligibility
The decision to proceed with UFE involves a thorough evaluation of the patient’s health, symptoms, and reproductive goals. Ideal candidates are individuals with symptomatic fibroids, such as those experiencing heavy bleeding or pelvic pressure, who seek a non-surgical alternative to a hysterectomy. UFE can treat multiple fibroids of various sizes simultaneously.
Certain conditions act as contraindications that may make a patient ineligible. Absolute contraindications include current pregnancy and active pelvic infection, as the procedure carries risks. Severe kidney disease is also a concern due to the use of contrast dye during the imaging phase.
Specific fibroid types, such as those that grow on a single, narrow stalk (pedunculated fibroids) or those where malignancy is a concern, require careful consideration. Patients must discuss their plans for future fertility with their gynecologist and interventional radiologist. While UFE preserves the uterus, its impact on future pregnancy outcomes must be weighed against other treatment options.
The Recovery Process
Following UFE, patients are monitored in a recovery area, and an overnight hospital stay is common to manage immediate post-procedure symptoms. The most immediate effect is pelvic pain and cramping, which is expected as the fibroids begin to lose their blood supply. This pain is often described as intense menstrual cramping and is managed with strong prescription medication.
Some patients may experience post-embolization syndrome, which includes a low-grade fever, fatigue, and nausea. These flu-like symptoms are a normal reaction to the dying fibroid tissue and typically resolve within a week to ten days. Patients are advised to take one to two weeks off work for adequate rest and recovery.
Most individuals can return to light activities within one week, but strenuous exercise and heavy lifting should be avoided for a longer period. Symptom improvement begins quickly, with a noticeable reduction in heavy menstrual bleeding often occurring with the first period after the procedure. Maximum fibroid shrinkage and relief from bulk-related symptoms, such as pelvic pressure, typically become apparent over the following three to six months.