What Is Uterine Fibroid Embolization and When Is It Appropriate?

If you have heavy menstrual bleeding, unpredictable menstrual periods and/or severe menstrual pain, it’s possible that the cause could be fibroids.Fibroids are benign (non-cancerous) tumors that can develop within the uterus. These growths are very common in women of reproductive age. Although fibroids don’t always cause symptoms, you’ll notice it if they do. You may experience:

• Heavy menstrual flow 
• Passing of blood clots during menstrual periods 
• Severe pain or cramping during menstrual periods 
• Unpredictable menstrual periods 
• Pelvic pressure 
• Urinary frequency or urgency 
• Pain during intercourse 
• Bloating 
• Constipation 
• Back pain 

If your menstrual periods cause discomfort that decreases your quality of life, seek help from your OB/GYN or primary care provider. They’ll ask you about your medical history, perform a pelvic exam and send you for an ultrasound.If your ultrasound results show that you have fibroids, different treatment options are available:

• Hormonal medications. You may be able to manage your symptoms with medication, but it isn’t effective for everyone, and you may not want to take medications containing hormones. 
• Surgical options. Your provider may recommend different surgical procedures, including hysterectomy, but you may not want your uterus removed if you’re of childbearing age, and you might not want to undergo surgery if there are alternatives. 
• Minimally invasive procedures. You may be a candidate for uterine fibroid embolization. The procedure cuts off blood flow to symptomatic fibroids, causing them to shrink, which decreases the symptoms you experience. 

Interventional radiologists are specialized doctors who diagnose and treat medical conditions with minimally invasive procedures. They’ll make a small incision in your groin or wrist and insert a thin catheter into a blood vessel. With the help of fluoroscopy (which uses X-ray images to create real-time video footage), the interventional radiologist can see within your body. This allows them to thread their catheter through your blood vessels until it reaches the site that needs treatment. After the procedure, they remove the catheter and close the incision.You may not have heard of interventional radiology before, because only a small percentage of people need the minimally invasive procedures that they perform. Interventional radiologists often don’t see their patients long-term. Usually, you’ll only have an initial visit, a procedure and a follow-up appointment.

Uterine fibroid embolization is an effective minimally invasive treatment for fibroids that cause painful, disruptive symptoms. The procedure targets blood flow to the fibroids, which shrink when they’re no longer being supplied with blood.During the procedure, an interventional radiologist inserts a catheter through a small incision in your groin or wrist, then uses fluoroscopy (real-time X-ray images) to direct the catheter to the blood vessels that are supplying your fibroids with blood. The interventional radiologist injects tiny gelatinous particles into those blood vessels, to block off the fibroids’ blood supply. Without oxygen and nutrients, your fibroids should start to shrivel up. All of your fibroids are treated during the procedure. Then, the catheter is removed, and your incision is closed.

Sometimes, providers mention uterine artery embolization when they’re planning to treat fibroids. Uterine fibroid embolization is a type of uterine artery embolization, but uterine artery embolization is used to treat a number of conditions, including trauma and hemorrhage.Uterine artery embolization can also be used to treat adenomyosis, a painful condition that arises when the uterine lining grows into the walls of the uterus. Some women seek uterine artery embolization as a possible alternative to hysterectomy, the gold standard of treatment for adenomyosis. It’s organ-preserving, with less scarring at the entry site and a significantly shorter recovery time.Uterine fibroid embolization is only used to treat fibroids, not adenomyosis or other conditions.

Before your procedure, you’ll receive an epidural anesthesia, which blocks pain signals, and you’ll be heavily sedated, which will keep you comfortable. Uterine fibroid embolization typically lasts from one to three hours, including the epidural and sedation.You’ll go home after spending one night in the hospital. At home, you’ll be restricted from lifting anything heavier than 10 or 15 pounds for the first week after your procedure, to ensure proper healing.

Your fibroids should begin to shrink after the procedure. It’s common for them to reduce in size by 50% during the three to six months after uterine fibroid embolization. You should also notice your pain and other symptoms decrease during the same time frame.When you get your menstrual period for the first time after the procedure, you should experience less pain and a lighter menstrual flow. The clinical success rate of uterine fibroid embolization is greater than 95%, especially for controlling bleeding.Three months after your uterine fibroid embolization, you’ll follow up with your interventional radiologist. Patients usually have very positive feedback to report. They say things like: “I can finally leave my house when I have my menstrual period, without worrying about bleeding, cramping or pain,” or “Why didn’t I know about this procedure before?”When appropriate, uterine fibroid embolization can help improve your quality of life.If you have symptomatic fibroids, ask your OB/GYN or primary care provider to refer you to an interventional radiologist, or request an appointment.