Uterine Fibroids

Uterine Artery Embolization

Uterine artery embolization (uterine fibroid embolization) is a nonsurgical treatment alternative that can substantially shrink fibroids and reduce symptoms. Although a relatively new treatment for fibroids, it has been used for years to control dangerously heavy bleeding after childbirth.

How It Works

Embolization plugs up arteries supplying blood to the fibroids. The fibroids shrink, reducing symptoms but leaving the uterus intact and functioning. Embolization is done by an interventional radiologist in an outpatient procedure. The patient is conscious but sedated and feels no pain during the procedure.

What to Expect

The interventional radiologist makes a small, quarter-inch incision in the groin and inserts a catheter into the main leg artery. Local anesthesia is used to block pain. Using a moving X-ray (fluoroscopy), the physician carefully guides the catheter through the artery to the uterus. An arteriogram (a series of images taken while radiographic dye is injected) is done to provide a road map of the blood supply to the uterus and fibroids. Then, tiny plastic spheres, about the size of sand grains, are injected through the catheter. The particles lodge in tiny branches of the uterine artery that supplies blood to the fibroids. The procedure is repeated on the artery that supplies the other side of the uterus.

The patient stays in the hospital overnight and resumes normal activity in about a week. Pain and cramping caused by the procedure are controlled with medication and anti-inflammatory drugs and usually subside in a few days. A pelvic ultrasound or MRI is taken six months after the embolization to confirm the fibroids have shrunk.

Results

Studies have shown that six months after embolization, fibroids have shrunk about 50 percent. On average, the size of the uterus is reduced about 40 percent. Because there are enough unplugged blood vessels left, the uterus does not die. Some women have even become pregnant, although studies looking at the procedure's effect on fertility have not been completed. Physicians caution women not to assume they will be able to conceive after the procedure.

Regarding fibroids regrowing after treatment, long-term follow-up studies are limited. Most reports indicate that the treatment results are long lasting in approximately 90 percent of women, while one out of 10 women experience symptom recurrence due to regrowth of the treated fibroids or because of new fibroids.

Risks

Whether embolization affects the menstrual cycle is not known. Most women who have embolization have decreased bleeding with normal menstrual cycles. A few women near menopause stopped menstruating after the procedure, but it is uncertain whether the embolization played any role in the decreased ovarian function. It is possible that the procedure can cause premature menopause or loss of menstrual cycle in a few patients.

Serious complications, including injury to the uterus from decreased blood supply, are rare, occurring in fewer than 1 percent of patients. A hysterectomy may be required if the uterus is not getting enough blood.