Uterine Fibroid Embolisation

Most fibroids would be suitable for uterine artery embolisation except the very large and very small. A typical woman having this procedure will be in her forties and will have completed her family.

Women with symptoms of heavy menstruation and ‘bulk’ symptoms related to the increased size of the uterus (including pressure on the bladder causing the need to wake at night to urinate, painful intercourse, limiting ability to bend and exercise) and pain (in the case of adenomyosis) with either Uterine Fibroids, Adenomyosis or both conditions.

Uterine artery embolisation usually reduces the fibroids in volume by 40-60%. Studies show 78-94% of women have either total or significant relief of symptoms from heavy bleeding, pain and urinary symptoms.

Uterine artery embolisation is undertaken as a procedure requiring admission to hospital for an overnight stay, typically being discharged home 24-48 hours post procedure. The procedure will be undertaken by our interventional radiologist in the interventional radiology suite at an one of London Gynaecology's preferred hospitals.  The procedure also has a supportive team of an anaesthetist, nurses and radiographers.

Uterine artery embolisation is a minimally invasive procedure (undertaken as a single inpatient episode), which requires a tiny incision of about 2mm in the groin to gain access to the arteries. You will be given analgesia and antibiotics via a cannula (drip). It usually takes 45-90 minutes. The procedure involves the injection of tiny particles which block off the uterine arteries – therefore depriving the fibroids of oxygen and nutrients, causing them to involute. This procedure typically shrinks the fibroids, it does not remove them. Then the x-ray machine allows vision to ensure that the deposition of the particles is correct.

If you choose to have this procedure, your gynaecologist will refer you to an interventional radiologist. You will need to have a consultation, where you can ask questions, and MRI scan, to establish information regarding the symptoms you are experiencing and their impact on your life, as well as the position and size of your fibroids (which will determine the suitability or not for treatment with embolisation).  It is possible for your consultation to be virtual for maximum convenience.

Prior to the procedure you will need to have blood tests, these can be undertaken at the time of the consultation.

Following the procedure you will be required to lie flat for a minimum of four hours. It is not unusual to experience some pain immediately following the procedure. Pain relief will be always available. Recovery will be undertaken in the theatre recovery and subsequently in a private room. Pain can be controlled with analgesia, either intravenous, intra-muscular or oral (or a combination of these). You will be given analgesia to take home if necessary. After the procedure you probably will get a harmless watery, non-offensive, vaginal discharge, which may continue or several weeks following the procedure.

After discharge, appropriate follow up with the radiologist and gynaecologist will be arranged.

Fibroid embolisation is considered to be very safe, though there are some risks associated with this procedure:

1. Most women experience moderate pain in the first few hours after the embolisation, which requires analgesia which is delivered by a patient controlled analgesia mechanism. Some experience nausea and fever.
2. In the months after the procedure there is a small risk of developing an infection which generally can be treated with antibiotics (patients must be vigilant for symptoms and seek prompt appropriate review).
3. It is recognised that a tiny number of these women may require a hysterectomy for extensive infection (considerably less than 1% of those treated with embolisation).
4. Embolisation may result in premature menopause, this is more likely the closer the women are to their “natural” menopause.

Uterine artery embolisation reduces the amount of oxygenated blood getting to the uterus and as such will cause pain at the conclusion of the procedure. The procedure is performed with a consultant anaesthetist and the pain management strategy allows patients to self administer pain relief in the immediate post procedure period with a PCA (patient controlled anaelgesia). Patients require an overnight stay and typically go home on oral analgesia that reduces over a 7-12 day period to zero. There is no surgical wound/scar to heal, which is often cited as desirable compared to open surgical procedures.

Patients often have a slight temperature and some discomfort for several days after leaving hospital, but usually can resume normal activities within a week of the procedure. Some women experience a watery, non-offensive vaginal discharge. Approximately 7% of women may pass degenerating fibroid material over the following weeks or months.

Symptomatic uterine fibroids and adenomyosis are typically managed with options including medications, conventional surgery such as Laparoscopic Myomectomy and uterine artery embolisation. Discussing which option best suits each individual and reviewing this if things change is desirable.