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Select an FAQ....
What causes uterine fibroids?
What are typical symptoms?
Who is most likely to have fibroids?
How are fibroids diagnosed?
What is the expected recovery time of the embolization procedure?
What are the expected results of uterine fibroid embolization?
Will a woman become infertile after the embolization procedure?
What are the possible complications of this procedure?
What causes uterine fibroids?
The exact causes for fibroid development are unclear, but it is thought that there is a genetic predisposition to having fibroids and there is a subsequent susceptibility to developing them from hormonal stimulation.
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What are typical symptoms?
Most fibroids don’t cause symptoms—only 10-20% of women who have fibroids ever require treatment. Depending on location, size, and number of fibroids, a woman might experience the following:
- Heavy, prolonged menstrual periods and unusual monthly bleeding, sometimes with clots, which can lead to anemia.
- Increased menstrual cramping.
- Pelvic pain, pressure or discomfort in the pelvis that is caused by bulk symptoms of the fibroids pressing on nearby structures.
- Pain in the back, flank or legs as the fibroids press on nerves in the pelvis.
- Pain during sexual intercourse.
- Pressure on the urinary bladder, which typically results in increased frequency of urination, including the need to get up at night.
- Pressure on the colon, leading to constipation and bloating.
Abnormally enlarged abdomen.
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Who is most likely to have fibroids?
Although fibroid tumors may be found in women in their 20’s, most women do not begin to have symptoms until they are in their 30’s or 40’s. 20-40% of women ages 35 and older have uterine fibroids of a significant size. African-American women are at a higher risk than the general population for development of fibroids. Fibroids can dramatically increase in size during pregnancy. Fibroids typically decrease in size after menopause, but can grow if estrogen supplements are taken.
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How are fibroids diagnosed?
Doctors can feel many fibroids during a gynecologic pelvic exam. In addition, there are several types of medical imaging exams that can accurately diagnose fibroids. Fibroids are most commonly confirmed by ultrasound. This painless procedure is performed by a specially trained technologist who gently moves an instrument across the outside surface of the abdomen, which transmits sound waves into the pelvis. A picture is displayed on a computer screen showing the uterus and the fibroids. In some cases, more detailed images of the uterus and pelvic organs are obtained using a transvaginal ultrasound probe. Fibroids can also be detected using magnetic resonance imaging (MRI), which is particularly well suited to distinguish fibroids from another common uterine condition, adenomyosis. Pelvic MRI is also quite accurate in detecting submucosal fibroids (a type of fibroids which can cause bleeding) and in distinguishing pedunculated fibroids from other pelvic masses such as ovarian tumors. Diagnostic hysteroscopy is a procedure performed by a gynecologist and can evaluate the presence of submucosal fibroids. A long, thin probe-like instrument is passed through the vagina and cervix into the uterus, where the physician can visually inspect the uterine lining and take biopsy samples of tissue if necessary.
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What is the expected recovery time of the embolization procedure?
Uterine fibroid embolization usually requires a hospital stay of one night, although some women may go home the same day. About six to eight hours of bed rest is typical after the procedure. Pain-reducing medication and drugs that reduce swelling typically are prescribed following the procedure to decrease cramping, which is a common side effect. Fever, an occasional side effect, is treated with Tylenol. Total recovery usually takes one to two weeks, but can take longer.
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What are the expected results of uterine fibroid embolization?
78%-94% of women who have the procedure experience significant or total relief of pain and other symptoms, with the large majority of patients considerably improved. The procedure has been successful even when multiple fibroids are involved. The average reduction in volume of the fibroids is 50% after three months, with a reduction in the overall size of the uterus of about 40%. Most patients have rated the procedure as “very tolerable.” The long-term outcome is not known, as only short-term follow-up is available. It is not yet known if fibroids re-grow, however no recurrences have occurred in women who have been followed for up to six years.
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Will a woman become infertile after the embolization procedure?
The majority of women who have fibroid embolization are beyond desired childbearing years, so few have tried to subsequently become pregnant, making fertility difficult to study. More than a dozen pregnancies have been reported in patients who have undergone fibroid embolization, and patients who have had uterine artery embolization for other reasons, such as bleeding after childbirth or massive pelvic trauma, have become pregnant. Because the embolization procedure rarely also affects one or both ovaries, there are a few reported cases of early menopause after the procedure. There is ongoing research that is studying this issue further.
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What are the possible complications of this procedure?
Uterine fibroid embolization is considered to be very safe, but there are some expected side effects from the procedure. Most patients experience moderate to severe pain and cramping in the first several hours following the procedure, and some experience nausea and fever. These symptoms are usually well controlled with appropriate medications, and most of these symptoms are substantially improved within 24 hours. Complications occur in fewer than 3% of patients, and include uterine infection, uterine infarction, decreased ovarian function, and premature menopause. Hysterectomy to treat these complications occurs in less than 1% of patients.
It is not known what effect, if any, uterine artery embolization has on the menstrual cycle. The majority of women who have had the procedure have had decreased bleeding with normal menstrual cycles. A few women, most of whom are near menopause, have reported that their menstrual periods have stopped after the procedure. Based on this information, it appears that the procedure may cause a loss of menstrual cycles in a very small number of patients. The UFE Comparison Chart lists a comparison of treatment options for uterine fibroids, including known advantages and disadvantages of all procedures.
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