Uterine artery embolization is a non-surgical alternative to hysterectomy or myomectomy for troublesome uterine fibroids. By blocking the specific arteries that enrich the tumors and encourage them to grow, the tumors shrink or disappear altogether.
Click here to go to Uterine Artery Embolization - Patient's Story
FOR AN APPOINTMENT, CALL 314-362-2375
What is a uterine fibroid tumor ?
Uterine fibroids -or leiomyomata -are benign growths that arise from the muscular wall of the uterus. In some women, they can cause excessive menstrual bleeding, pain, and a feeling of heaviness in the abdomen. In fact, they may grow so large that a woman appears to be in an advanced state of pregnancy. Fibroids also may exert pressure on the bladder and lead to voiding problems and even incontinence.
How common are uterine fibroid tumors ?
Fibroids are the most common benign tumors in women in the United States today. From 25-40% of women have fibroids and, although only a quarter of the tumors are symptomatic, millions of women continue to live with them because the only alternative is surgery.
Is uterine artery embolization a new procedure ?
The concept was developed in France in the early 1990s and has been adopted worldwide for the treatment of more than 1,000 women with excellent clinical and therapeutic results. In the United States, it is performed routinely at an increasing number of medical facilities, including Washington University Medical Center. The Washington University Comprehensive Fibroid Center, founded by the four physicians listed above, treats women with this common problem by providing all of the treatment options.
What exactly is uterine artery embolization ?
The secret to the success of embolization is that fibroids are highly vascular and dependent on blood supplied by the left and right uterine arteries. In the arteriogram, taken at the beginning of each procedure, these arteries are very visible. Engorged with blood, they become enlarged and take an easy route to the uterus and feed the tumor.
The objective of the procedure, which can take from one to three hours, is to block the blood flow through these arteries. It is necessary to embolize both arteries, as previous experience in which only one artery was blocked resulted in failure.
Through a small incision in the patient's groin, physicians insert a tiny plastic tube, or catheter, which is guided into each uterine artery-one after the other-using the arteriogram as a map. Once the catheter is in place, 350 to 500 micron-size particles of polyvinyl alcohol (the size of grains of sand) are injected through the catheter. These granules immediately block the arteries, obstructing blood flow to the fibroids.
What can I expect ?
The patient must be referred by her gynecologist or if self-referred, be seen by a gynecologist on the team for a physical exam and lab tests to rule out other causes for her symptoms. If uterine fibroid tumors are the cause and embolization is indicated, patients meet with the physician to discuss all aspects of the procedure.
On the day of the embolization, the patient checks in to the hospital early in the morning to undergo any remaining tests. She is instructed not to eat any food after midnight preceding the morning of the embolization. The procedure requires intravenous sedation only, not general anesthesia, so the recovery period is short and without side-effects.
What about recovery ?
In most of these cases, as soon as the fibroids have been embolized, the patient feels crampy abdominal pain, sometimes accompanied by nausea and vomiting-called 'post-embolization syndrome'. This lessens over the next few days. It is usually necessary for the patient to stay overnight in the hospital so that she can be given strong medicines to provide optimum pain control.
During the procedure, the patient receives intravenous medication for pain and relaxation; afterwards, she is placed on a morphine, patient-controlled analgesia (PCA) pump, so that she can determine her own need for pain relief. Gradually, the patient is switched to oral medicines. Ibuprofen and Tylenol® are also added to treat the soreness and fever that usually develop during the first few days after embolization as the fibroids begin to break down. By the third or fourth day after the procedure, the patient can usually return to a modified routine, with most women returning to work within a week.
All of the fibroids are treated at the same time, and as they have been starved for oxygen or nutrients, they begin to shrink. Some fibroids "melt" away entirely, and occasionally some which have grown on a stalk inside the uterine cavity may even be expelled. A follow-up ultrasound at six months shows that, on average, the fibroids have diminished in size by 40 to 50 percent.
What about long term effects and results ?
According to all available reports, approximately 92% of patients have sufficient symptomatic relief from either pain or bleeding so that no further treatment is necessary.
After undergoing uterine artery embolization, a few women in their forties stopped having periods. It is still unclear whether or not embolization effected the early onset of menopause for these women or whether they were already perimenopausal, a fact which became evident only after the abnormal bleeding had disappeared.
Therefore, until embolization's possible effect on fertility is determined, younger women who want to have children should consider myomectomy, unless it is not feasible, instead of embolization. No negative impact from embolization has been found. In fact, in a group of 25 women who had uterine artery embolization for postpartum hemorrhage, each of the six patients who tried to become pregnant afterwards succeeded.
What are the other options ?
One solution for a woman with troublesome uterine fibroids is a hysterectomy, the surgical removal of the uterus. This operation usually entails a week in the hospital, followed by a four- to six-week recuperation. In the past, a hysterectomy was the recommended treatment, particularly for older women who are not concerned about preserving their fertility. In 1995, for example, some 600,000 women underwent a hysterectomy, making it the most commonly performed surgical procedure in women in the U.S. One-third of those procedures was for the treatment of uterine fibroids. The loss of the uterus also means the loss of child-bearing potential and, for some women, a loss of gender identity.
A second surgical option is myomectomy, where only the fibroids are removed. Myomectomy, which spares the uterus, is a better alternative for younger women who may later wish to become pregnant. It is a more time-consuming procedure than a standard hysterectomy, even longer if the procedure is done laparoscopically, since the physicians painstakingly remove the individual fibroids. Not only does myomectomy carry the risks of any surgical procedure, there are other disadvantages as well: Small fibroids may be left behind only to enlarge later, or brand new fibroids may grow. Most frustrating of all is the chance that the key fibroid, which is causing most of the problems, may be left untreated