Uterine Fibroids/ Uterine Fibroid Embolisation

Uterine Fibroids/ Uterine Fibroid Embolisation - What it is

Uterine fibroids are benign abnormal growths of the muscle wall of the uterus. They are sometimes referred to by several other names including leiomyoma and fibromyoma. Fibroids develop in up to 70% of women but only a small proportion of women with fibroids develop symptoms. If there are no symptoms there is no need to worry about fibroids.

Uterine Fibroids/ Uterine Fibroid Embolisation - Symptoms

Symptoms usually begin to appear in women in their 30s or 40s although younger women can also develop symptoms from fibroids. Symptoms tend to get improve after menopause, as the reduction in hormone levels reduces blood flow to the fibroids and they shrink.

Approximately 25% of women with fibroids have symptoms. The symptoms depend on the size and location of the fibroids. Common symptoms include:

heavy or prolonged periods (menorrhagia)
anaemia - from prolonged heaving bleeding
painful periods (dysmenorrhea)
urinary incontinence/ urgency - difficulty or need to urinate frequently
infertility or miscarriage
pressure symptoms on the bowel leading to constipation
back pain and sciatica (pain in the lower back and down the leg)
abdominal swelling

Uterine Fibroids/ Uterine Fibroid Embolisation - How to prevent?

Uterine Fibroids/ Uterine Fibroid Embolisation - Causes and Risk Factors

There is a higher incidence in Afro-Caribbean women and those who don't have children. There is also thought to be a genetic connection, as fibroids sometimes run in families. Fibroids are also commoner in obese women.

Uterine Fibroids
Ultrasound images of a uterine fibroid

A) Before Uterine Fibroids B) After

MRI of a large fibroid (a) before and (b) after uterine fibroid embolisation showing a successful treatment

Uterine Fibroids/ Uterine Fibroid Embolisation - Diagnosis

Uterine Fibroids/ Uterine Fibroid Embolisation - Treatments

Uterine Fibroid Embolisation (UFE) is a well-established treatment for uterine fibroids. It is minimally invasive procedure performed by an Interventional Radiologist. The fibroids begin to shrink with reduction in size of the fibroid by at least 50% or more within 3 months of the procedure. In some patients, the fibroids completely disappear altogether. The main advantage of the procedure is it is minimally invasive, performed under local anaesthetic, requires one night hospital stay and allows early return to normal activities.

Other treatments for uterine fibroids include hysteroscopic resection, endometrial ablation, myomectomy, hysterectomy and MR guided focussed ultrasound

Uterine Fibroids/ Uterine Fibroid Embolisation - Preparing for surgery

On the day of the procedure, you will be admitted to a ward. A pregnancy test is routinely performed. It is routine to insert a bladder catheter before the procedure as you will be required to lie flat after the procedure for several hours. The procedure is carried out while you are awake although you may wish to receive some sedation if you feel anxious. The discomfort you will experience from a UFE procedure is similar to the pain you experience during your period and so all patients will have a drip set up attached to the back of your hand so that painkilling medication can be administered. A PCA (patient controlled analgesia) morphine pump will be attached to the drip after the procedure so that you are in complete control of your own pain relief.

At the start of your procedure, your Interventional Radiologist will administer local anaesthetic, a tiny skin puncture is made in the right groin or the wrist and a small tube ( vascular catheter) is guided into the blood vessel of the uterus using x-ray (fluoroscopy) guidance. Some contrast or dye is injected to outline the blood vessels and act as a roadmap and can make you feel warm all over. Tiny sterile plastic particles (polyvinyl alcohol) the size of grains of sand are injected into the blood vessel supplying the fibroid, cutting off the blood flow. The whole procedure takes about one hour. After spending one night in hospital, you will be discharge home the following afternoon.

Angiogram of the (a) left and (b) right uterine arteries during uterine fibroid embolisation procedure.

Uterine Fibroids/ Uterine Fibroid Embolisation - Post-surgery care

Following the UFE, you will be taken back to your room where you will be looked after by nursing staff familiar with embolisation procedures. You will need to lie in bed for a few hours. You will have a morphine pump and given medication for nausea due to the morphine. Most patients will be able to return home the next day and return to normal activities within one to two weeks after the procedure. Before you go home, appointments for an MRI scan and a 3 month follow up clinic appointment with your Interventional Radiology Consultant will be arranged. If you do have any concerns after discharge from hospital, you should get in touch to make an earlier appointment to see the doctor.

Uterine Fibroids/ Uterine Fibroid Embolisation - Other Information

Overview

Article contributed by Vascular and Interventional Radiology, Singapore General Hospital

The information provided is not intended as medical advice. Terms of use. Information provided by SingHealth

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