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Fibroid embolisation

What is fibroid embolisation and how does it work?

Fibroid embolisation is a procedure that has been performed worldwide for over 20 years. The procedure is conducted in an angiography suite (“cath lab”) at Intra, which is in the Mercy Hospital at 98 Mountain Road, Epsom in Auckland. Your interventional radiologist will be assisted by nurses and other highly trained staff.

UFEM 2 Small particles are used to block the blood vessels supplying the fibroids. It is a minimally invasive procedure performed by an interventional radiologist requiring only a tiny nick in the skin in the groin, with most patients able to go home the day after the procedure.

You will be given medication before the procedure to help relax and control pain, but you will remain awake during the procedure.

Under x-ray guidance a small flexible plastic tube called a catheter is feed into the artery in the groin and then into the artery supplying the fibroids.

Particles smaller than a grain of sand are injected into the artery, blocking the blood vessels supplying the fibroids. It doesn’t matter how many fibroids are in the uterus because all of them are treated at the same time.

Without blood supply the fibroids die off and then shrink, on average by 40 - 50%, over a 3 to 6 month period. The majority of patients have a significant improvement in their symptoms, both for heavy bleeding (80 - 90%) and pelvic pressure (80-90%) after 4 to 6 weeks.

The particles used to block the blood vessels are made from plastic type materials that are biocompatable (don’t react with the body) and are smaller than a grain of sand. These particles have been used for over 40 years in a wide variety of procedures with no significant side effects from the material reported. In total no more than a teaspoon of particles is usually required to complete the procedure. There are two main types of particles made from Polyvinyl alcohol or PVA and tris-acryl gelatin spheres called ‘Embospheres”.

How should I prepare for my procedure?

There is very little preparation involved to get ready for the procedure:

Where possible we ask women to stop taking their hormone medication two to four weeks before the procedure as it is felt this improves the chance of having a good outcome.

On the day of your procedure:

Fasting: You must not have anything to eat 4 hours before the procedure.. You may continue to have some clear fluids.
Allergies or previous reactions to contrast (x-ray dye): Please inform your doctor, and Intra staff at the time of booking your procedure, if you have any known history of allergies, particularly allergies to x-ray contrast and seafood.
Diabetes: If you are diabetic, you should tell the Intra staff at the time of booking. You may need to discuss your insulin dose with the Radiologist.

Other usual medications: Continue these unless advised otherwise by your specialist. If you are taking any “blood thinners”, you should make this known to the Intra staff at the time of booking. It is likely that you will need to stop this medication up to 5 days before your procedure.

You may bring your favourite music on an iPod or smart phone as this can be played during the procedure.

On the day of your procedure, please make your way to Stella Maris where they will be expecting you. You will be admitted to this ward and transferred to Intra for your procedure.

Are my fibroids suitable for embolisation?

Almost all fibroids are suitable for embolisation.
Where possible all patients have an MRI scan of the pelvis that helps to show the fibroids in detail.
In a small number of patients the MRI scan shows no blood supply to the fibroid or a fibroid on a thin stalk called a ‘pedunculated fibroid’ and these may be better treated with a surgical operation such as myomectomy.

What happens after the procedure?

Following your procedure, you will be transported to a hospital ward for recovery, where you will stay for one to two days. You will be looked after by both your gynaecologist and interventional radiologist.

You will receive discharge instructions from your doctor and be given medications to keep you comfortable on leaving the hospital. You will be told who to contact in case of an emergency after your procedure. This is especially important if you are experiencing fever, pelvic pain, or vaginal discharge that is increasing over time.

On returning home, you may experience some cramping, similar to menstrual period cramping, that lasts a few days after the procedure. Most women are able to return to light activity within a few days and are usually back to work and normal activity within 10 to 21 days.

You will be asked to see your interventional radiologist after two weeks and then to see your gynaecologist at six to eight weeks to ensure you are recovering well. For most women whose symptoms resolve there is no need to have a repeat scan. For some women a further scan can be organised to assess the change in the fibroids if symptoms have not improved as much as expected.

One of the benefits of fibroid embolisation is the quicker recovery when compared with surgery. Most patients can return to normal activities after one to two weeks and return to work in one to three weeks.

A number of studies have shown that after twelve months 80 – 90% of women who have had fibroid embolisation would recommend the procedure to a friend.

Is fibroid embolisation safe? What are the risks?

Embolisation of the uterus has been performed for over 20 years with a large number of recent studies showing fibroid embolisation to be very safe and effective.

Risks

The main risks that patients need to be aware of include a small risk of requiring hysterectomy (1-2%) if infection occurs.
Some women enter menopause early (3-4%), although this is more likely to occur in women over 45.
A small number of women may require a second procedure under anaesthetic to help treat post procedure symptoms (3-4%).

Will my fertility be affected?

While many studies have shown women can have successful pregnancies following fibroid embolisation, the full effect of fibroid embolisation on fertility and pregnancy is still being studied in detail.
Currently where fibroids are suitable for myomectomy, without a significant risk of hysterectomy, this procedure is recommended for patients hoping to preserve fertility.
In patients where myomectomy would result in a high risk of hysterectomy, fibroid embolisation is reasonable to perform to preserve fertility. Similar to myomectomy, patients are advised to avoid becoming pregnant for 6 months following embolisation.