FAQ's For Uterine Fibroid Embolization

Getting rid of these benign tumors?

If you are led to believe by your doctor that hysterectomy is the only solution, maybe it’s time you changed your doctor. Studies suggest that 80% of the hysterectomies done are unwarranted. Fibroids and the hormonal imbalance are as it is causing enough havoc to your emotions and a doctor who is too quick to suggest a hysterectomy doesn’t seem to be making things better.
Your treatment option should be zeroed in after carefully evaluating various factors such as its symptoms and severity, the type, size and number of fibroids, its location, your age and child bearing potential. Uterine fibroid embolisation (UFE, also known as uterine artery embolisation) has been gaining popularity and acceptance as a safe and effective alternative to hysterectomy surgery for treating fibroids. Read on to understand more about this much sought after procedure and when & why you should consider it as an option for treating your fibroids.

1) What is Uterine Fibroid Embolisation?

Uterine fibroid embolisation, also called UFE, is a minimally-invasive, uterus-sparing procedure that shrinks fibroids by cutting off their blood supply. A small catheter is inserted through a tiny nick in the upper thigh into the blood vessels near the fibroids and tiny particles are injected through the catheter to block blood flow to the fibroids.

2) How do I know if I am a candidate for uterine fibroid embolisation?

Whether or not a patient is a candidate for UFE depends on the exact size, number and location of the fibroids as well as the patient’s symptoms. A detailed medical history and pelvic MRI are necessary prior to making a final determination. The ideal candidate is a patient who no longer desires fertility, has multiple small to medium size fibroids and whose primary clinical symptom is heavy menstrual bleeding (menorrhagia).

3) If I would like to maintain fertility, could I still be a candidate for UFE?

The ideal candidate for uterine fibroid embolization has no desire for future fertility. While there have been multiple anecdotal reports of normal pregnancies following uterine fibroid embolization in the medical literature, it is currently unknown whether there is any increase risk of infertility or pregnancy following this procedure. Therefore, UFE is generally not recommended in patients who still desire fertility unless: The patient has failed other treatment options such as myomectomy and the only other option is hysterectomy; Due to the size, number, and/or locationof the fibroids, there is a relatively high risk of a myomectomy resulting in a hysterectomy or causing significant scarring within the uterus, thus eliminating or significantly decreasing the patient’s fertility.

4) How long will it take for my symptoms to resolve following UFE?

Most patients notice a difference in heavy menstrual bleeding (menorrhagia) by their next cycle. Bulk related symptoms including pelvic pain, pressure, frequent urination and constipation may take up to 3-5 months to notice a significant difference. How quickly your symptoms resolve depends largely upon the exact size number and location and your fibroids. A patient’s symptoms may continue to improve for up to 18 to 24 months after the procedure although most patients experience maximum benefit within one year.

Most women notice a lighter flow right away. Some women, however, may not notice a significant decrease in menstrual bleeding until after their first few periods following UFE

5) Will my heavy periods go away after the procedure? How successful is UFE in controlling symptoms caused by fibroids?

Heavy menstrual bleeding (menorrhagia) is controlled in 85 to 95 percent of patients after their procedure. Bulk related symptoms such as pelvic pain, pelvic pressure, frequent urination, constipation, back pain and painful intercourse are controlled in 80 to 95 percent of patients undergoing UFE. Careful pre-procedure planning and evaluation are vital to increasing the chance of a successful outcome.

6) Will UFE affect my Sexual Response?

Most patients report either no change or improvement in their sexual desire and response after UFE. Those women with dyspareunia (pain during intercourse) caused by fibroids usually improve. Concerns about effects of UFE on sexuality should be discussed with your Interventional Radiologist during the initial consultation.

7) How soon can I have sex post procedure?

Patients may generally resume sex and other normal activities in about a week. Because UFE usually does not affect the ovaries, most women will not experience the hormonal changes or depressions that are common with hysterectomy/removal of the ovaries. Women near the age of menopause, however, may be more likely to start menopause after UFE.

8) Are there any types of fibroids that cannot be treated with UFE ?

Most fibroids can be successfully treated using uterine fibroid embolisation. Moderate-to-large pedunculated fibroids (those that hang from the uterus by a stalk) are the only types of fibroids that are generally not treated with UFE.
This is because there is a small chance of the stalk breaking after the fibroid loses its blood supply after which the fibroid may fall into the pelvis and cause additional problems. Patients with these types of fibroids can be considered as candidates for joint procedures using a combination of uterine fibroid embolisation and laparoscopic myomectomy.

9) Can fibroids be completely removed after the procedure?

Fibroids begin to shrink post procedure and die over time. They shrink primarily in the first six months, but they may continue to shrink for up to a year. Although fibroids never completely go away, they usually become small enough to relieve most symptoms including heavy bleeding, pressure,frequent urination and pain.

10) Do fibroids grow back after UFE?

A successful UFE procedure treats all fibroids that are present on the day of the procedure, regardless of size, number, or location. Once fibroids infarct they are dead and do not regrow. If, however, a fibroid’s blood supply is not completely eliminated, it could continue to grow and cause symptoms.
For women who have initially responded to UFE there are few reported recurrences of fibroids. Once menopause is reached there is usually no further
growth of fibroids.
By comparison, approximately 30 percent of patients have a recurrence of fibroids after myomectomy.

11) How long does the UFE procedure take?

The fibroid embolisation procedure usually takes approximately one hour to perform. During the procedure, you will be awake but given IV medication to make you sleepy.

12) Is UFE Painful?

The uterine fibroid embolization procedure itself is painless. The only pain encountered by the patient is the local anesthetic shot at the puncture site near the right hip (like a shot at the dentist’s office). The procedure does not require general anesthesia (or for the patient to be put completely to sleep).
Immediately following the procedure, however, a majority of patients develop pain as part of the post-embolization syndrome. This pain begins immediately after the procedure, increases for 8 to 12 hours, and usually improves significantly by the following morning.

13) What other symptoms I might experience post procedure?

Other symptoms which may be encountered as part of the post embolisation syndrome include nausea or vomiting, low-grade fevers, a lack of energy, and vaginal discharge. The morning after the procedure, the symptoms usually improve to a point were they can be easily controlled with oral medications provided for the patient at the time of discharge to take home.

14) How long do I stay at the hospital after the procedure?

After the procedure , patient is maintained at the healthcare unit for 2-3 days to rule out complications. Some providers observe only overnight stays before discharging the patient.

15) What type of follow-up is required after the UFE procedure

After the procedure, patients are asked for routine follow-up in seven to 10 days. One must continue routine gynecologic exam once in 2-3 months.
MRI is recommended in six to nine months to assess the results of embolization and to insure that the blood supply to the fibroids is eliminated.

16) Is UFE a safe procedure?

UFE has been performed safely in thousands of women worldwide. While no procedure is without risk, fibroid embolization has been shown to have a lower major complication rate than traditional surgical treatment options such as myomectomy.
The two most serious potential complications are infection and ovarian failure leading to premature menopause. Infections are extremely uncommon and can usually be treated with oral or IV antibiotics. Rarely (much less than 1 percent), a severe infection can develop and may require the patient to undergo a hysterectomy.
Ovarian failure leading to premature menopause is also relatively uncommon occurring in 1 to 2 percent of most patients and 2 to 4 percent of women nearing menopause.

17) What is the success rate of UFE?

According to the combined results of major studies of UFE, the average success rate is approximately 94 percent. A successful procedure significantly reduces or eliminates uterine fibroid symptoms and requires no further treatment with surgery or other options.

18) What happens to the fibroids after embolisation?

After losing their blood supply, the fibroids shrink an average of 50 percent in size and also change in composition. They change from a heavy muscular tissue to a much lighter spongy, scar-like tissue that no longer has a blood supply. Small fibroids are very rarely completely re-absorbed or disappear.

19) What happens to the normal uterine tissue after uterine fibroid embolisation?

After UFE, the fibroids shrink and die while the normal uterus and uterine tissue lives. It is thought that the normal uterine tissue survives due to its ability to recruit new blood supply from other areas of the pelvis, while the fibroids rely solely on blood supply from the uterine arteries.

20) Can UFE be performed regardless of the number and size of the fibroids?

UFE can be performed irrespective of the number and size of fibroids , there is no set limit involved.

21) Will I experience any hormonal changes after the procedure?

Because UFE usually does not affect the ovaries, most women will not experience the hormonal changes or depressions that are common with hysterectomy/removal of the ovaries. Women near the age of menopause, however, may be more likely to start menopause after UFE.

22) How quickly can I go back to work?

Generally women return to most of their normal activities in about 7 to 10 days. The interventional radiologist will provide you with written post procedure instructions to ensure that you are comfortable in your recovery. Some women recover more quickly than others, and your personal results may vary.
Recovery time for UFE patients is much shorter than hysterectomy or myomectomy , which can lead up to 6 weeks or more. You may resume your usual diet and medications immediately. You are however, recommended to take fluids. Drinking plenty of liquids may be helpful as well to prevent any constipation that may occur due to intake of painkillers. 99% of patients returned to work in less than a week.

23) Will I have to take special diet after UFE procedure?

You may resume your usual diet and medications immediately. You are however, recommended to take fluids. Drinking plenty of liquids may be helpful as well to prevent any constipation that may occur due to intake of painkillers.

24) Who is an Interventional Radiologist?

Interventional Radiologists are specially trained doctors who use their expertise in reading x rays, ultrasound, and other medical images to guide small instruments through blood vessels and other pathways to treat disease without an open surgical incision.

Most procedures performed by Interventional Radiologists are minimally invasive (that is they do not require an open surgical incision) and are performed using imaging guidance (x-ray fluoroscopy, CAT scan, ultrasound, and/or MRI).

The procedures performed by an Interventional Radiologist are typically less invasive and much less costly than traditional surgery. Interventional Radiologists are specially trained in performing these procedures and this training is certified by the Board of Medical Specialties.

While gynecologists are specially trained to performed hysterectomies, myomectomies and other less invasive laparoscopic and hysteroscopic surgical procedures, most of them have not been formally trained and therefore do not possess the skills necessary to perform uterine fibroid embolization.

FAQ's For Biopsy

Preparing for Your Image-Guided Procedure

1) What is an Ultrasound/CT guided biopsy?

A biopsy is a procedure to take a small sample of tissue from a certain place. A very thin biopsy needle is inserted through the skin to the area where the sample needs to be collected.
The ultrasound/CT scan image is used to guide needle to the right place. This collected sample is then sent to Pathology lab for analysis.

2) What are the benefits?

Other tests that you have done like USG, CT, PET-CT, MRI or blood tests have confirmed that there is abnormal tissue in the body.
The doctors need to know what this abnormal tissue is in order to decide most suitable treatment for you. Hence biopsy is needed

3) What are the risks?

Ultrasound/CT-guided biopsy is generally considered safe. There is very small risk of bleeding/infection where needle has been inserted. Other risks vary according to which part of body is being biopsied.

4) Does it hurt?

You will only feel a minor scratch or discomfort during the biopsy, usually when the local anesthetic is injected.

5) Pre procedure investigations needed


6) Pre procedure instructions

  • At least one person should accompany you when you come for procedure.
  • If you are taking blood thinner drugs (antiplatelet drugs or anticoagulant drugs) then inform your doctor beforehand as you may have to stop them for few days (3-5 days) before biopsy.
  • Bring all scan reports and films/CD, laboratory reports while you come for biopsy.
  • Do not eat or drink for 2 hours before biopsy procedure if it is to be done under local anesthesia. Most biopsies are done under local anesthesia unless specified otherwise.
  • If general anesthesia or sedation is required for any of the procedures below: Do not eat or drink anything (including water) for 6 hours before the procedure

7) What happens after the procedure?

After the biopsy you will be taken to our observation area for 2-3 hours and we will screen the area using Ultrasound/CT as and when required. Once the findings are confirmed, you will be discharged from the observation.

8) Regarding Biospy Report

  • Biopsy report is given by pathologist after examining the biopsy sample which is taken out by us.
  • Usually the turnaround time is 3-5 days for biopsy report. At times it varies depending on the type of tumor and type of tests needed.
  • For subtyping of tumor pathologists may need to do further tests on same sample.
  • If the sample is necrotic or acellular/pauci cellular, one may need to undergo repeat biopsy. However this is remote possibility.