At a glance
- Anaesthetic
- Sedation; you stay awake
- Where
- St George’s Hospital, Strowan
Your consultant will explain the anaesthetic, how long it takes and the recovery for your treatment.
On this page
Who it may help
UFE may suit women who:
- have fibroids that cause symptoms, such as heavy bleeding, pelvic pressure or bloating
- want to keep their uterus
- would rather not have surgery
- want a shorter recovery
- may not be suitable for surgery
Not everyone is suitable. Your imaging, symptoms, medical history and plans for future pregnancy are reviewed before treatment is recommended. UFE is not done during pregnancy; see UFE and pregnancy below.
Uterine fibroids and their symptoms
Fibroids can cause heavy bleeding, pelvic pressure, bloating, period pain and discomfort. For some women, symptoms are mild and monitored over time. For others, fibroids interfere with daily activities, work, exercise and quality of life.
Uterine fibroids are benign (non-cancerous) growths in or on the wall of the uterus (womb). They range from less than 2.5 centimetres to more than 15 centimetres across. Women of African descent and those with a family history of fibroids are more likely to develop them. Many fibroids cause no symptoms and are found only during a routine pelvic examination or scan. If you do have symptoms, they may include:
- heavy, prolonged periods, sometimes with clots
- anaemia (tiredness from a low red blood cell count)
- pain or pressure in the pelvis, lower back or the back of the legs
- pain during sex
- needing to pass urine often
- constipation or bloating
- a swollen abdomen
Non-surgical fibroid treatment options
There are several ways to treat fibroids, depending on your symptoms and clinical findings.
Medication may suit women with heavy bleeding, cramps or pain. Hormonal and non-hormonal medicines can help control symptoms, although they do not usually shrink or remove fibroids permanently.
Uterine fibroid embolisation (UFE) is a minimally invasive, image-guided procedure performed by an interventional radiologist. Tiny particles are injected into the arteries supplying the fibroids to reduce their blood flow. Over time the fibroids shrink, and symptoms usually improve.
MRI-guided focused ultrasound (MRgFUS) uses focused ultrasound waves to heat and destroy fibroid tissue without incisions or a hospital stay. It suits only carefully selected patients, depending on the size, number and location of their fibroids, and is not widely available in New Zealand.
For mild symptoms, monitoring may be recommended, with regular scans and symptom reviews to check whether the fibroids are changing.
Uterine fibroid embolisation
UFE is one of the main minimally invasive treatments for fibroids. Imaging guidance lets the interventional radiologist target the blood vessels supplying the fibroids.
The procedure is done through a small puncture in the skin rather than a surgical incision, so there is usually less disruption to surrounding tissue than with open surgery. It aims to improve symptoms, reduce fibroid size where possible and preserve the uterus, usually with less time off than surgery.
How UFE is performed
UFE is performed by an interventional radiologist (IR), a doctor who uses X-rays and other imaging to see inside the body and treat conditions without open surgery.
- You are given sedation but stay awake.
- The IR inserts a catheter (a thin, hollow tube) into an artery at the top of your thigh or in your wrist.
- Using X-ray imaging, the IR guides the catheter to one of the uterine arteries.
- Tiny beads, each about the size of a grain of sand, are injected through the catheter into the vessels feeding the fibroids. They block the blood flow, so the fibroids shrink.
- The same is repeated in the uterine artery on the other side.
The beads are made of a material the body tolerates well, and they stay where they are placed.
UFE compared with hysterectomy
Compared with a hysterectomy, UFE usually means a shorter stay in hospital and a quicker return to work and normal activities, and it keeps the uterus. Your consultant can go through the evidence on recovery and complications and how it applies to you.
After UFE
After UFE, the fibroids shrink, scar and pull back into the wall of the uterus. Some women have a vaginal discharge for a while, which can include fibroid tissue being passed.
Risks of UFE
Serious complications are uncommon, but UFE does carry risks. The most commonly reported are:
- periods stopping for a while (temporary amenorrhoea)
- a short-term allergic reaction or rash
- vaginal discharge or infection
- particles reaching healthy tissue they were not meant for (non-target embolisation)
- passing fibroid tissue
- post-embolisation syndrome: a low-grade fever, pain, tiredness, nausea and vomiting in the days after treatment
Your consultant will go through the risks that apply to you before you decide.
UFE and pregnancy
You should not have this procedure if you are pregnant. The effects of UFE on the ability to become pregnant, to carry a baby to term, and on the baby’s development have not been established.
Women can become pregnant after UFE and have successful pregnancies, but studies have not fully established its effect on fertility and pregnancy. If you are planning a pregnancy, talk this through with your doctor before choosing a fibroid treatment.
Choosing the right fibroid treatment
The most suitable treatment depends on your situation. Fibroids vary in size, number and location, and these affect which options may be appropriate.
Care begins with a review of your symptoms and imaging, to decide whether monitoring, medication, UFE or another option should be considered. Follow-up after treatment checks how your symptoms are improving over time.