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Interventional Radiology: Uterine Artery Embolization to Treat Fibroids (5688)

Interventional Radiology: Uterine Artery Embolization to Treat Fibroids (5688) - Clinical Hub, Patient Education, Health and Nutrition Facts For You, Radiology - Invasive Procedures

5688







Uterine Artery Embolization to Treat Fibroids

What are fibroids?

A fibroid is made up of benign (non-cancerous) growth of smooth muscle within the uterus.
About 30% of U.S. women over the age of 35 have fibroids. About 10 – 20% of these women
have symptoms due to their fibroids. The symptoms caused by the fibroids depend upon their
size and location.

ξ Submucosal – A fibroid that is under the inner lining of the uterus can often result in
very heavy menstrual bleeding.
ξ Intramural – A fibroid within the wall of the uterus is the most common and results in
an increase in the size of the uterus. Symptoms can include heavy menstrual bleeding
and pelvic pain. This type of fibroid can cause bulk symptoms by pushing on the organs
around it. Bulk symptoms include frequent urination (pushing on the bladder),
constipation (pressing on the lower bowel), or lower back pain (pressure on the lower
back).
ξ Subserosal – A fibroid under the outer lining of the uterus can also cause bulk
symptoms.
























Are fibroids causing your symptoms?

The key is to be certain that heavy menstrual bleeding and other symptoms are related to fibroids
and not due to other causes. You should be sure to see your doctor, and have your symptoms
checked. This will include a review of your health history, a physical exam including a pelvic
exam, a Pap smear, and a blood test to check for anemia and other problems. Your doctor often
will schedule an ultrasound exam (a test using sound waves) to look at the size of the uterus and
for any fibroids. A Magnetic Resonance Image (MRI) of the pelvis may also be done to check
the uterus, ovaries, bladder, and lower bowel.

What options are available for fibroids?

In the past, the treatment for fibroids has been a hysterectomy. Today, instead of surgery,
doctors may choose to do a Uterine Artery Embolization (UAE). This treatment blocks the
blood supply to the fibroid, causing it to shrink so that the symptoms go away or lessen. At the
same time, it saves the uterus.

Once your doctor decides that fibroids are the cause of your symptoms, you have many choices
for treatment. As you decide, keep in mind certain goals:

 Do you wish to keep your uterus?
 Do you wish to have children?
 Are you a few years away from menopause (perimenopausal)?

Options

1. Watch and wait until menopause begins. Fibroids are hormone sensitive. At
menopause, estrogen levels begin to drop, and fibroids get smaller. If you are in
perimenopause, this may be an option, although you may suffer with symptoms in the
meantime.
2. Hormone therapy. Progesterone or GnRH agonists (gonadotrophin releasing hormone
agonists such as Lupron®) can shrink the size of the uterus. The size of the fibroid will
also shrink. This can improve the symptoms. The side effects of GnRH agonists are hot
flashes and osteoporosis. It is best if GnRH agonists are only used for six months.
3. Myomectomy (surgery to remove only the fibroid) is an option for a woman who wishes
to become pregnant in the future.
4. Hysterectomy. This would remove the uterus and the symptoms of the fibroids.
5. Uterine artery embolization (UAE)

Are you a candidate for Uterine Artery Embolization?

If you wish to keep your uterus, then UAE may be a good option. If you wish to bear children,
you should know that there is a 4 – 20% chance of damage to your ovaries.



What is the success rate?

The success rate for reduced pain, bleeding, or bulk symptoms is about 85%.

What will happen before the UAE?

You will see an Interventional Radiologist (a radiology doctor who performs UAE) and a Nurse
Practitioner in the IR (Interventional Radiology) clinic before your treatment. The nurse
practitioner will take your health history and review your physical exam. The doctor will review
your ultrasound or MRI. Both will talk with you about the procedure. If you have not had an
MRI of the pelvis, one may be ordered. Once this is done and reviewed, we will review your
case again to be sure that fibroids are the cause of your symptoms. At this point, if you are a
candidate for UAE and you would like to proceed, you will be scheduled for UAE. You will
need to spend a night in the hospital after your UAE. Plan to be off work for at least a week.


How is the Uterine Artery Embolization done?

Getting ready
When you arrive, you will be taken to the Radiology prep area to have two intravenous (IV) lines
placed and a urinary catheter put in your bladder. You will be given antibiotics and an anti-
nausea drug. When you are in the IR suite, either the right or left groin will be washed with a
sterile soap. Your abdomen and legs will be covered with a sterile drape. A nurse will give you
two IV drugs. One is for anxiety and the other is for pain relief. During the UAE, you will be
drowsy and likely not remember it.

Placing the arterial catheter
The doctor will inject a small amount of medicine into your groin to numb it. This will sting at
first. The doctor will then place a small hollow tube (sheath) through a small incision in your
groin. The tube will be placed into the groin artery. A catheter will be passed through the tube
where it will be guided into the uterine artery.
















Blocking the blood supply
With the catheter in place, the doctor will inject small particles into the left uterine artery until
there is very little blood flow in the artery. This is called the
“embolization” of the uterine artery. At this point, some
women experience some heavy cramping which is normal as
the blood supply is cut off to the fibroid. The catheter will
then be guided into the right uterine artery. Particles will be
injected again to embolize the blood flow to this artery.

Once it is done, the tube will be removed from the groin. A
pressure dressing will be placed on the groin for 15-20
minutes. You will be taken to a nursing unit and watched
overnight. Most often, you will be sent home the next
afternoon.

What can I expect after the UAE?

Most women have some symptoms after UAE. These symptoms include fever, nausea,
vomiting, and mild to severe pelvic pain. The symptoms often begin shortly after the procedure,
and are at their worst about 12 hours later. The pelvic pain may feel like very intense menstrual
cramps. You will have a PCA pump to control the pain at first and then pain pills. The
symptoms can last, to some degree, for a week or two. You will be sent home with a
nonsteroidal anti-inflammatory agent such as ibuprofen that you should take every day as
scheduled. You will also be given stronger pain medication to use for moderate to severe pain.
You will also be given medicine to reduce the nausea or vomiting.

You will be able to leave the hospital once your pain is under control and you can get out of bed,
eat, drink, and take these medicines.

You should not return to work for at least a week after the procedure. You will return to the IR
Clinic in one to two weeks. Depending on how your symptoms are after the procedure, we may
schedule a follow-up MRI of the pelvis in three to six months to measure the shrinkage of the
fibroid. Shrinkage will occur over the next 3 – 12 months.

Are there problems that might happen later?

In a small number of patients with submucosal fibroids, the fibroid tissue may slough off and
enter the inside of the uterus (endometrial cavity). When this happens, labor-like pain may start.
The tissue may be passed through the cervix. However, a larger fibroid may not pass. In this
case, you may need a D&C (dilatation and curettage) to remove this tissue. If this tissue is not
removed, there is a chance that it will become infected and lead to serious problems.






Are there other complications?
1. Groin site hematoma (collection of blood at or near the needle entry site). This often
goes away after a few months as your body will re-absorb the collection of blood.
2. Allergic reaction to the x-ray dye used (contrast reaction)
3. Damage to the kidneys from the x-ray dye (contrast induced renal failure)
4. Early menopause due to accidentally blocking off the blood supply to both ovaries
(ovarian failure)
5. Blood clot in leg due to inactivity (deep venous thrombosis)

When to call Interventional Radiology

You should call the IVR if you:
ξ Have a fever over 100.5 θ F for 2 readings taken 4 hours apart.
ξ Have foul smelling vaginal drainage.
ξ Have labor-like pains.
ξ Have pain that is not controlled.
ξ Cannot keep any food or liquids in you.

Phone numbers

Interventional Radiology Department, Monday - Friday 8:00am to 4:00pm at 608-263-9729
prompt 3 and ask to be connected to the IR Nursing Coordinator.

Weekends, nights or holidays call (608) 262-2122 or toll free at 1-800-323-8942. This will give
you the paging operator. Ask for the Interventional Radiology Resident on call. Give the
operator your name and phone number with the area code. The doctor will call you back.

For further details, go to: http://www.scvir.org/fibroid/index.htm













Your health care team may have given you this information as part of your care. If so, please use it and call if you
have any questions. If this information was not given to you as part of your care, please check with your doctor. This
is not medical advice. This is not to be used for diagnosis or treatment of any medical condition. Because each
person’s health needs are different, you should talk with your doctor or others on your health care team when using
this information. If you have an emergency, please call 911. Copyright ©4/2015. University of Wisconsin Hospitals
and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#5688.