Uterine fibroids are common non-cancerous growths that develop in the uterus, affecting many women. These growths can lead to a range of disruptive symptoms, impacting daily life and well-being. For those seeking alternatives to traditional surgery, Uterine Fibroid Embolization (UFE) offers a minimally invasive treatment option. This article explores the characteristics that make someone a suitable candidate for UFE.
Understanding Uterine Fibroids and UFE
Uterine fibroids, also known as leiomyomas, are growths composed of muscle and connective tissue that form in or on the wall of the uterus. They are almost always benign, meaning non-cancerous. While many women with fibroids experience no symptoms, others can suffer from heavy menstrual bleeding, pelvic pain or pressure, frequent urination, painful intercourse, lower back pain, or a feeling of fullness in the lower abdomen.
Uterine Fibroid Embolization (UFE), also called Uterine Artery Embolization (UAE), is a minimally invasive procedure performed by an interventional radiologist. During UFE, tiny particles, approximately the size of grains of sand, are injected into the uterine arteries that supply blood to the fibroids. This action blocks the blood flow, effectively depriving the fibroids of nutrients and oxygen, causing them to shrink and die over time. UFE serves as an alternative to surgical options such as hysterectomy (removal of the uterus) or myomectomy (surgical removal of fibroids), offering a less invasive approach with a typically shorter recovery period.
Criteria for UFE Candidacy
Patients experiencing significant symptoms directly attributable to their fibroids are generally considered good candidates for UFE. UFE aims to alleviate these disruptive symptoms and improve overall quality of life.
Many women who desire to avoid a hysterectomy and wish to preserve their uterus find UFE to be an appealing option. This procedure allows for uterine preservation, which is a significant factor for those who prefer to retain their reproductive organs or avoid the psychological impact of a hysterectomy.
Most types of fibroids, including intramural (within the uterine wall), submucosal (just under the uterine lining), and subserosal (just under the outer uterine surface), are generally suitable for UFE. While pedunculated fibroids, which grow on a stalk, were historically viewed with more caution, recent research indicates that UFE can be safe and effective for these types as well, especially if the stalk is sufficiently wide. The size of a fibroid alone does not necessarily exclude it from UFE, although very large fibroids may require special consideration.
UFE is generally suitable for women of reproductive age. While some research suggests UFE may preserve or even enhance fertility when infertility is directly caused by fibroids, women actively planning future pregnancies should have a thorough discussion with a specialist about the potential risks and alternatives, such as myomectomy, as UFE can affect fertility and pregnancy outcomes in some cases.
Factors Affecting UFE Suitability
Uterine Fibroid Embolization is typically not recommended for fibroids that are not causing any symptoms, as its primary purpose is to alleviate them. If there is any suspicion of uterine cancer or sarcoma, UFE is not appropriate because it does not allow for tissue biopsy to confirm or rule out malignancy.
Active pelvic infection is another condition that contraindicates UFE; any existing infection must be treated and resolved before the procedure can be considered. Furthermore, UFE is absolutely contraindicated during pregnancy due to potential risks to both the mother and the developing fetus. Patients with severe kidney disease may also not be suitable candidates, as the contrast dye used during the procedure could pose a problem for their kidneys.
Certain fibroid characteristics or locations can also affect UFE suitability. While UFE can be effective for a wide range of fibroid sizes, extremely large fibroids (e.g., greater than 10-12 cm or a uterus size larger than a 20-week pregnancy) might require special consideration or alternative treatments. Pedunculated fibroids with very thin stalks might carry a slightly increased risk of detachment and subsequent infection, though modern techniques and careful patient selection can mitigate this risk. Fibroids that receive their primary blood supply from the ovarian artery rather than the uterine artery may also be less responsive to UFE.
For women desiring future pregnancy, UFE may not always be the optimal choice. While successful pregnancies have occurred after UFE, there can be an increased risk of complications such as miscarriage, preterm birth, or placental abnormalities compared to other fibroid treatments like myomectomy. Therefore, a thorough discussion of reproductive goals and all available options is important for these patients.
Consulting a Specialist
Determining whether Uterine Fibroid Embolization is the right treatment requires a comprehensive evaluation by a qualified healthcare professional. It is important to consult with an interventional radiologist, a gynecologist, or a fibroid specialist who can assess individual circumstances.
During this consultation, the specialist will review your complete medical history, conduct a physical examination, and perform imaging tests such as an MRI or ultrasound to accurately assess the number, size, and location of your fibroids. The ultimate decision on UFE candidacy is personalized, taking into account your symptoms, fibroid characteristics, overall health status, and future goals, including any desire for pregnancy.