Uterine fibroid embolization

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Uterine fibroid embolization (a procedure known as uterine artery embolization) is a fundamentally new approach to uterine fibroid treatment. Embolization is a minimally invasive mean of blocking the arteries that supply blood to uterine fibroids.

This is a procedure that involves using angiographic techniques (similar to those used in heart catheterization) and involves placing catheters in the uterine arteries. Small particles are injected into the arteries feeding the fibroids, blocking them. This technique is essentially the same as that used to control bleeding that occurs after birth or pelvic fracture bleeding caused by malignant tumors.

The procedure was first used in France as a way to reduce the amount of blood lost during myomectomy. It was thus found that in some cases (the patients who had embolization done, awaiting surgery) many symptoms have disappeared and surgery was not required. Blocking the blood supply caused degeneration of fibroids and their symptoms diminish. Thus this technique has become a stand-alone treatment for symptomatic fibroids.


1. Overview
2. Procedure
3. Side effects
4. Complications
5. Risks and benefits


The procedure is usually done after hospitalization. The patient will be anesthetized locally and will not feel any inconvenience. Uterine arteries are accessed through the femoral artery using a catheter. The first catheter will advance through the aorta vein, the uterine artery on the opposite side of the puncture. Then a second arterial catheter will be placed in the femoral artery, opposite to the other uterine artery. Before embolization an arteriogram is done to give an indication of the blood vessels that supply the uterus and fibroids.

According to the information that will be obtained after arteriogram, polyvinyl alcohol particles (X-ray investigations guided) will be injected slowly. These particles are about the size of grains of sand. Because fibroids are highly vascular, the particles will go directly to uterine fibroids. Particles can’t travel in other parts of the body’s blood vessels. Within minutes the arteries are blocked.

Embolization process is repeated until the blood flow to the fibroids is blocked completely. The process will continue in the other blood vessels. After uterine fibroids embolization, another arteriogram will be done to confirm the completion and accuracy of the procedure. Arterial blood flow will be present in a certain measure in normal areas of the uterus, but blood flow to the fibroids, will be blocked. The procedure takes between an hour and an hour and a half.

Side effects

Most patients will experience moderate to severe pain, a few hours after the procedure. In addition to that, might occur nausea and fever (these should be controlled with medication usually administered intravenously through a pump that allows self-administration of medication). After an initial period of bed rest (about 6-8 hours), women who have mild to moderate symptoms will be discharged from hospital unit. However, most patients will remain hospitalized overnight in hospital under close supervision of doctors and health professionals.

In some cases may occur cramps and pain in the uterus a few days after surgery (in this case it is necessary to prescribe painkillers to relieve them) that will persist for several days. Most patients will feel tired and may have periodically fever or nausea. All these signs and symptoms may be controlled with medication. Most women can return to normal activities and work daily 7-14 days after the procedure, without feeling any discomfort.


Complications may intervene in approximately 3% of patients. Serious complications are possible, including uterine lesions as a result of poor blood circulation or infection. Fortunately, these situations are quite rare and by hysterectomy can be treated problems and unpleasant situations occurring in less than 1% of patients. According to some specialists, there are no other long-term drawbacks, though in this aspect there are many questions about possible side effects resulting from the procedure. X-rays are used to guide during the procedure and this raises doubts about the potential long-term effects. From a study in which they measured X-ray exposure during uterine fibroids embolization proved that their level was below the presumed cause for negative effects on patient’s health or on future pregnancies.

Pregnancy after uterine artery embolization

Uterine artery blockage effect that can have on a woman’s ability to become pregnant or to carry a pregnancy to term is uncertain. Most women who have undergone the procedure became pregnant and had children by different modes (normal, cesarean). Even women who have undergone this procedure for other reasons (bleeding after childbirth, for example) became pregnant. However most of the women (who have been treated for uterine fibroids) were not interested to become pregnant.

Another unclear issue is the effect of this procedure on the menstrual cycle. The overwhelming majority of women who have had uterine fibroids embolization have reported a decrease in the amount of menses during normal menstrual cycles. In some cases, patients have found that menstrual periods have stopped after the procedure. It is uncertain whether these cases are the result of low ovarian function following surgery. Because of this the specialists recommend further studies.

In conclusion, based on rather limited data it appears that this procedure may cause premature menopause in a small number of patients.

Possible outcomes

Considering that over 3000 patients worldwide have undergone this procedure, initial results suggest that symptoms have improved in 90% of cases, which is a considerably percent. Most women have rated this procedure as tolerable. In three months fibroids volume will be reduced to 50% and total uterine volume will decrease by about 35%.

Risks and benefits


Uterine embolization, done under local anesthesia, is much less invasive than open surgery for their removal or the entire uterus. Patients can resume their normal activities a few weeks earlier than for hysterectomy. Blood loss occurring during embolization of uterine fibroids is minimal, the recovery time is shorter, while the general anesthesia is not required.

On the other hand, most women who have been treated by this method were found the complete disappearance or significant symptoms. This is true for those who were complaining the heavy bleeding and pelvic pain or pressure.

Long-term studies that follow patients, for many years, demonstrated that treated fibroids rarely grow or recur after uterine fibroid embolization. This is because all fibroids present in the uterus, even in the early stages, which were too small to be visualized after imaging investigations are treated during the procedure. Uterine fibroid embolization is a permanent treatment option compared to other therapies – such as the hormonal (if hormonal treatment is stopped, fibrous tumors will grow back, usually). Regeneration is another problem that was treated with laser treatment for uterine fibroids.


Any procedure that involves placing a catheter inside a blood vessel requires the occurrence of certain risks. These include blood vessel injuries, bruises and puncture site infection. When the technique is performed by an interventional radiologist with experience, the likelihood that any of these events take place during uterine fibroid embolization is rarely seen.

Any procedure where the skin is penetrated carries the risk of infection. Possibility of developing an infection that requires antibiotic treatment appears to be less than 1%., There is always the likelihood that embolization agent to be placed in the wrong place and deprive normal tissue of oxygen.

Occasionally, patients may have an allergic reaction to the contrast substance used during X-ray radiography during uterine fibroid embolization. These episodes range from mild itching to severe reactions that can affect the respiratory system or blood pressure. Therefore, patients should be closely monitored during the procedure so that any allergic reaction can be immediately detected and treated.

Approximately 2-3% of women will remove small pieces of fibrous tissue after uterine fibroid embolization. This occurs when the uterine fibroid tissue located near the uterus lining dies and partially detaches. Women with this problem may require doctor implementation procedure involving dilatation and curettage to ensure that all tissue is removed and any possible bleeding and infection won’t occur.

For most women with fibroids, normal menstrual cycles resumed after the procedure. About 5% of women, menopause occurs early after uterine fibroid embolization. It was found that the phenomenon occurs more frequently in women aged over 45 years. Although uterine fibroid embolization goal is to cure fibroids that cause symptoms without surgery involved, some women may be required hysterectomy because of persistent infections or events. Probability of hysterectomy after embolization of uterine fibroids is below 1%.

Women are exposed to X rays during embolization procedure, but exposure levels are below those that may cause negative effects on the patient or next pregnancies. So far, the doctors can’t say what effect can have uterine fibroid embolization on fertility. Because of this uncertainty, doctors recommend that a woman who wants to have more children to consider surgical removal of tumors than embolization procedure. If this is not possible, then uterine fibroid embolization is the best option.

It is not possible to predict whether the uterine wall will be weakened in any way of the uterine fibroid embolization procedure, a situation that could be a problem during birth and labor. To avoid these situations it is advisable to use contraception for six months after the procedure and to ask for cesarean section, in order not to risk breaking of the uterus during labor’s contractions.



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