Uterine fibroid embolization (UFE) is a minimally invasive procedure used to treat symptomatic uterine fibroids, non-cancerous growths within the muscular wall of the uterus. These common tumors can cause disruptive symptoms such as heavy menstrual bleeding, pelvic pain, and pressure on the bladder or bowel. Performed by an interventional radiologist, UFE is designed to shrink the fibroids while fully preserving the uterus.
Understanding UFE: Mechanism and Purpose
Uterine fibroid embolization is an image-guided procedure that targets the blood supply nourishing the fibroids. The radiologist makes a tiny puncture, usually in the groin or wrist, to access an artery. A thin catheter is then navigated into the uterine arteries, the main vessels supplying blood to the uterus and the fibroids.
The procedure relies on injecting specialized microparticles, known as embolic agents, directly into the blood vessels feeding the tumors. These microscopic particles lodge in the arteries surrounding the fibroids, blocking blood flow in a process called ischemia.
By intentionally cutting off the blood supply, UFE deprives the fibroid tumors of the oxygen and nutrients they need to survive and grow. This lack of blood flow causes the fibroid tissue to die and shrink significantly over the following weeks and months. The primary purpose is to alleviate symptoms like heavy bleeding and pelvic discomfort by reducing the size of the fibroids.
UFE is a uterine-sparing treatment, unlike surgical interventions. Unlike a myomectomy, which surgically removes individual fibroids, UFE treats all fibroids present in the uterus simultaneously. This comprehensive approach is attractive for women who wish to avoid major surgery and retain their reproductive organs.
The Patient Journey: Pre-Procedure and Recovery
The process begins with a thorough consultation and pre-procedure evaluation to confirm candidacy. This includes advanced imaging, such as an MRI scan, to map the fibroids’ size, location, and number. Patients are instructed to fast for several hours before the procedure and may need to temporarily stop taking certain medications, like blood thinners.
On the day of the procedure, a local anesthetic is used at the access site, and patients receive conscious sedation to remain relaxed and comfortable. General anesthesia is not required, avoiding recovery time and risks. The UFE procedure usually takes between one and two hours, after which the patient is moved to a recovery area for monitoring.
Following embolization, patients commonly experience post-embolization syndrome. This includes pelvic pain and cramping, similar to severe menstrual cramps, along with possible nausea and a low-grade fever. These temporary discomforts are managed in the hospital setting with prescribed pain and anti-nausea medications.
While some patients may be discharged the same day, an overnight stay is common for adequate pain management and monitoring. Recovery at home is shorter than for open surgery, with most women returning to work and light activities within one to two weeks. Patients are advised to avoid heavy lifting, baths, and strenuous exercise for a short period to aid healing.
Expected Outcomes and Treatment Alternatives
UFE is known for its high success rate in providing relief from fibroid symptoms. Clinical data shows the procedure relieves symptoms such as heavy menstrual bleeding and pelvic pressure in 85% to 92% of patients. Fibroid volume reduction is measurable, with tumors typically shrinking by 40% to 75% within the first six months following the procedure.
Patients should be aware of potential complications, which are rare but possible. These include a low risk of infection and the possibility of premature menopause in women over 45. Although the uterus is preserved, the effect of UFE on future fertility is still being studied, and women planning future pregnancies should discuss these risks with their physician.
When considering treatment, UFE is weighed against surgical alternatives, primarily myomectomy and hysterectomy. Myomectomy involves surgical removal of fibroids while leaving the uterus intact, but it is more invasive and carries a risk of recurrence. Hysterectomy, the removal of the entire uterus, is a permanent cure but is major surgery with a longer recovery.
UFE provides a balance between these options, offering a non-surgical, minimally invasive path to significant symptom relief and fibroid shrinkage. Its advantage lies in the preservation of the uterus, shorter recovery time, and lower complication rates compared to major surgery.