Uterine Artery Embolization
(Conditions treated: Fibroids; Uterine fibroids; Adenomyosis.)
What are fibroids?
Fibroids are common, benign tumours that grow in the uterus and are found in over 70% of women at some point in their lifetimes. They rarely turn cancerous and are only problematic when they cause symptoms including pain, heavy periods or infertility amongst others.
What causes fibroids?
Their cause is unknown; however, their growth is influenced by hormones, including pregnancy.
Why should I get them treated?
As benign tumours fibroids are extremely unlikely to pose a threat to life and are generally only problematic when they cause troublesome symptoms.
What is uterine fibroid embolization?
In this procedure a doctor accesses one of your arteries in a similar manner to coronary angiograms. A catheter is then directed into the uterine artery feeding the fibroid via x-ray guidance. The artery is and its small branches are blocked by injecting specially designed microparticles. The fibroid is then starved of its blood supply and shrinks over time. A video of the process can be watched here.
How is this different to surgery?
Only a small 3mm skin incision is required to access the artery, much smaller than required for keyhole or open surgery. Recovery is quicker and usually only requires an overnight stay. The procedure is performed under sedation so no general anaesthetic is required. If hysterectomy is the only surgical option, embolization allows women to keep their uterus.
Is the procedure painful and what will my recovery be like?
The procedure itself is performed under sedation and is generally very well tolerated. Pain and nausea can develop afterwards. To prevent severe pain or nausea patients are kept in hospital overnight, with the majority being discharged the following morning. On discharge you will be given a script for pain management. Most women can expect to return to work in approximately 7-10 days, with some being able to return to work earlier.
Is this a new procedure?
Embolization is a well established, and evidence based procedure for treatment of problematic uterine fibroids. Uterine artery embolization to treat uterine bleeding has been performed since the 1970s. The efficacy of uterine artery embolization for treatment of fibroids was first noted in France in 1995. There are multiple well designed studies demonstrating the efficacy of this technique in the medical literature.
We would recommend consulting with a gynaecologist to determine whether your symptoms are attributable to uterine fibroids. If your symptoms are attributable to uterine fibroids you can consult with an interventional radiologist who is best placed to determine whether the procedure would be appropriate for you.
What are my alternatives?
Fibroid embolization is not your only solution and is not necessarily the best solution for every woman. For true informed consent we recommend consulting with a gynaecologist and interventional radiologist before proceeding to treatment.
Your options include a variety of drugs such as the pill, an intrauterine device or surgical procedures including myomectomy or hysterectomy. Your gynaecologist is best qualified to advise you regarding these. Alternatively, a relatively newer technique that uses MRI and ultrasound generated heat called MRgFUS may be considered.
Is there scientific evidence available?
This procedure has a very robust scientific evidence base including several high quality randomized controlled trials acknowledging its efficacy and safety. It is recognized as an appropriate therapy by multiple national health organizations and Specialist Radiology and Gynaecology societies including in Australia, Europe and the United States. Multiple trials have demonstrated the technique’s efficacy and safety. There are over 2000 peer reviewed papers published on the topic of fibroid embolization to date and by some estimates the procedure has been performed over 100,000 times worldwide. It is not considered a new or novel procedure, rather it is a well established technique.
An up to date and informed specialist Gynaecologist or Interventional Radiologist will be able to discuss the evidence with you.
What are the risks and potential complications?
The probability of complications compare favourably with surgical alternatives with some studies suggesting major complications are less common.
Risks include:
Inadvertent damage to artery < 1%
Infection or vaginal expulsion of fibroid < 1%
Difficult to treat pain 1-2% requiring extra drugs or readmission to manage
If you are considering fibroid embolization we recommend discussing the risks and benefits with an interventional radiologist.
