Uterine artery embolization as a method of treating uterine fibroids
Treatment methods for uterine fibroids include the use of various conventional treatments for uterine fibroids. While natural fibroid treatment options can be very effective and do not carry the significant expense or side effects associated with conventional methods, in some casesconventional methods, including surgery, are necessary and uterine artery embolization (UAE) is one of the conventional ways to do it.
Uterine fibroids treatment across the UAE
This is a fairly new method of treating fibroids, although UAE, also known as UFE (uterine fibroid embolization), has been used since the 1970s to treat and stop bleeding that might result after giving birth or after undergoing a pelvic surgical procedure.
It only began to be used as a treatment for uterine fibroids in the 1990s, when it was approved as a safe method of treating fibroids in 1995. This means that although it is considered a safe method, the long-term effects are still are unknown compared to surgical ones. procedures such as myomectomy or hysterectomy.
This procedure is performed by a interventional radiologist (IR) and not a gynecologist and technically speaking, surgical removal of uterine fibroids is not considered surgery because nothing is cut from the body during the procedure. Because it is not surgery and because gynecologists do not perform this procedure, your gynecologist may not mention this procedure to you. If he doesn’t mention this treatment option, ask him about it and why he didn’t mention it.
Uterine artery embolization procedure
While it is still unknown why fibroid tumors develop, one thing is known. They need a robust blood supply to keep growing. The logic with a UAE is that if the blood supply is cut off or reduced to the tumors, they should start to disintegrate.
Once the blood supply is cut off or reduced, fibroids can shrink and even die. Without a blood supply to help them grow, fibroid tumors should begin to disintegrate or generally become harmless.
Although fibroid tumors will disintegrate, the uterus will not be affected. This is probably because the uterine muscle requires some blood supply, but not as much as the amount that tumors require to grow. The UAE keeps some blood flowing to the uterine area, but this reduced blood flow, while sufficient for the uterus and surrounding organs, is apparently not sufficient for fibroids.
To perform the procedure, the patient will be placed under local anesthesia or conscious sedation and a thin tube will be inserted near the groin into the large arteries near the groin that supply blood to the uterus and other nearby organs as well as the uterine fibroids.
Since most women have two uterine arteries, you should expect two puncture wounds to reduce blood flow to this area.
Then, a dye is first injected into the arteries to help the IR perform this procedure, as the dye will show up on the X-ray machine and help guide the IR through the procedure.
Once the catheter is in the uterine artery, the IR releases small particles known as polyvinyl alcohol (PVA) into the bloodstream which are then guided by the blood to the area where the IR wants them to settle. Once the PVAs get attached, they will start to slow down the blood supply to the uterus. This procedure is then repeated for the second uterine artery. The procedure should only take 30 to 45 minutes from start to finish.
While not considered a surgical procedure, it is still invasive, but it is still safer than surgical removal of uterine fibroids, such as myomectomy or hysterectomy, and recovery time is usually less than the aforementioned procedures. You should be able to return to work in a week or so.
UAEs are considered an outpatient procedure, which means that after the procedure is done, the patient can be sent home. But for some patients who experience severe cramping after the procedure, an overnight hospital stay may be required.
Another benefit of this procedure is that the uterus remains intact unlike a complete hysterectomy.
What you can expect after the procedure
1. After the procedure, you may experience mild abdominal pain and require hospitalization only in some cases when the pain is significant. You will be given pain medicine, as well as medicine to help treat nausea and help you sleep.
2. Follow up with your gynecologist and IR will be required.
3. Physical activity is prohibited for at least two weeks.
4. In the weeks and months following the procedure, brown or pink discharge resulting from a disintegrating tumor or tumors is commonly reported.
5. Some women may experience post-embolization syndrome, which is like a fever, but can also be like menopause, causing cramps, mood swings, hot flashes, nausea, severe pelvic pain, etc. This condition is thought to be the result of the breakdown of tissue in fibroid tumors. Hospitalization may be necessary. Treatment for pain and nausea may also be necessary. With treatment, these symptoms should go away in a week or two.
6. The results of the procedure can be immediate, but you can realistically expect improvement in the various symptoms of uterine fibroids within 3 months, including a reduction in heavy bleeding caused by fibroid tumors.
7. Your period may only return after a maximum of five months when your body returns to normal.
UAE and Pregnancy
Although the uterus remains intact and many women can have successful pregnancies after this procedure, if you plan to become pregnant after the procedure, UAEs are generally not recommended.
Doctors consider an abdominal myomectomy the best option for women who still want to get pregnant after having the procedure, as there are years of evidence to support myomectomy and not much evidence to support the long-term effects of an UAE. since it is a relatively new procedure. If you still want to maintain your fertility but the number, size, or position of the tumors will lead to a failed myomectomy, an UAE may be recommended.
Are you a suitable candidate for a UAE?
Only if you can answer yes to the following questions;
1. Do you have significant symptoms of uterine fibroids, including heavy bleeding?
2. Do you have children in the past or can you live with the risk of infertility that can result from the UAE?
3. Do you need a hysterectomy or myomectomy?
When is a UAE not recommended?
1. Some types and sizes of fibroids may not respond successfully to a UAE. While all sizes of tumors may still make you eligible for this procedure, very large tumors, such as those comparable to a 20-week pregnancy, will generally not shrink after the procedure compared to small tumors that start to be reduced immediately after the procedure.
Types of tumors, such as pedunculated and submucosal tumors, may not be successfully treated by an UAE because they grow outside the uterus (pedunculated which is attached to the uterus via a stalk) or grow within the uterine wall (submucosal). Although they can be detached from the uterus after the procedure, their location makes it impossible to expel them from the body.
2. If you are using hormone therapy as a treatment method for uterine fibroids, it may cause a failed UAE procedure.
3. If you are pregnant.
4. If you have tumors that do not cause you any problems.
5. If you have pelvic cancer.
6. If you are allergic to the dye used during the procedure.
7. If you have an infection etc.
UAE Risks and Complications
1. There is always a risk of infection that can lead to death, but in most cases, when infection becomes a problem, a hysterectomy is usually required immediately, but this is rare.
2. An allergic reaction or rash may develop.
3. Tumors may not shrink.
4. Bleeding and developing blood clots in the legs is also another risk.
5. ovarian failure can happen. Although the uterus is not affected by reduced blood flow, ovarian failure can occur when some of the PVA particles block blood flow to the ovaries. This risk is one reason that UAEs are generally not recommended for women who still want to become pregnant after the procedure.
6. Premature menopause is also another risk although it is not a very significant risk.