What are Fibroids?

Fibroids are common, benign (not cancer) growths in the uterus. About 2-4 of every 10 women have them but most do not notice them and they don’t cause any issues. Other peoples’ fibroids get large and cause problems such as heavy bleeding, pain, constipation, and frequently having to urinate.

Uterine Fibroid Embolization (UFE)

Uterine fibroid embolization is a minimally invasive solution for fibroids causing problems. This is an outpatient procedure where some of the blood supply to the uterus and fibroids is blocked off with tiny permanent beads, causing them to shrink. This is done through a pinhole in the wrist or top of the leg, so no incision or stitches. It does take time for the fibroids to shrink, so most women start to notice improvement in their symptoms after a few weeks and get the full effect of the procedure by 3-6 months.

Other options for treating fibroids include medications and surgery. The medications can help but tend not to be as effective. The main surgical options include myomectomy (cutting out the fibroids) or hysterectomy (cutting out the whole uterus). The advantage of these is there’s less of a chance of fibroids coming back and causing problems again compared to embolization. The disadvantage is that they are more invasive with longer recovery.

Other options for fibroids include ablation where a skinny wand is inserted into the fibroid and energy is used to destroy it and make it shrink. This can also be done from the outside with focused ultrasound energy. These are less well studied treatment options but may be right for certain people.

What is Adenomyosis?

Adenomyosis is when the lining of the uterus grows into the middle, muscular part of the uterus. It is not cancer but can cause similar problems as fibroids such as heavy periods and pain. Uterine fibroid embolization can also help adenomyosis but is not quite as effective as performing the procedure for fibroids. The surgical alternative is hysterectomy.

What are the risks and recovery of UFE?

The procedure is generally safe with less risks than surgery. It does cause a few days of cramping pain and nausea that tends to be worst the evening or day after the procedure and get better afterwards. Because of this, I also “block” the nerves going to the uterus to help with this pain. I also send people home with plenty of medications to help keep them comfortable as they recover. My patients also have my cell phone number if they get into any trouble. Usually people are back at work in a few days or the next week.

Other risks are quite rare such as problems from the beads going somewhere unintended, forming blood clots in the legs, infection, and chronic vaginal discharge. Often women will have intermittent spotting after this procedure and can even pass pieces of their fibroids. This tends to stop on its own within a few weeks to months.

Does UFE affect menstruation or future pregnancy?

For women less than 45 years old, it is rare for this procedure to permanently affect menstruation. Periods may be irregular for a couple or few months afterwards. For women who are 45 or older, there is a 20-40% chance of no longer having periods.

The effect on future pregnancy is a bit debated. Initially there was evidence that it may increase the miscarriage rate in the first trimester, so women were advised not to get UFE unless they were done having children. There has since been quite a bit of research suggesting that UFE may not have much of an effect on future pregnancy as we originally thought. I usually tell people who are still thinking about getting pregnant to consider myomectomy with their gynecologist first. If that is not possible, it is probably safe to do the UFE.