Uterine artery embolization is a minimally invasive treatment for uterine fibroids, noncancerous growths in the uterus. In uterine artery embolization — also called uterine fibroid embolization — a doctor uses a slender, flexible tube (catheter) to inject small particles (embolic agents) into the uterine arteries, which supply blood to your fibroids and uterus. The goal is to block the fibroid blood vessels, starving the fibroids and causing them to shrink and die.
Uterine fibroids can cause severe symptoms in some women, including heavy menstrual bleeding, pelvic pain and swelling of the abdomen. Uterine artery embolization destroys fibroid tissue and eases these symptoms. And it provides an alternative to surgery to remove fibroids (myomectomy).
You might choose uterine artery embolization if you're premenopausal and:
Rarely, major complications occur in women undergoing uterine artery embolization. The risk of complications from uterine artery embolization is about the same as those for surgical treatment of fibroids. These may include:
Possible problems in future pregnancies. Many women have healthy pregnancies after having uterine artery embolization. However, some evidence suggests pregnancy complications, including abnormalities of the placenta attaching to the uterus, may be increased after the procedure.
If you want to have children, talk to your doctor about the risks of surgery and how uterine artery embolization might affect your fertility and future pregnancy.
Avoid uterine artery embolization if you:
Most fibroid sizes and locations can be treated with uterine artery embolization. However, extremely large fibroids can be so big that they cause complications and require another method to remove them.
Some fibroids that are primarily inside the uterus (pedunculated submucosal) may be expelled vaginally following the procedure. Finally, if the fibroids have already lost their blood supply (degenerated), uterine artery embolization won't provide any benefit.
Discuss the benefits and risks of uterine artery embolization with your obstetrician-gynecologist or an interventional radiologist ― a doctor who uses imaging techniques to guide procedures that would be impossible with conventional surgery.
Uterine artery embolization usually is performed by an interventional radiologist or a specialist in obstetrics and gynecology who has training in uterine artery embolization.
On the evening before the procedure, don't eat or drink after midnight or after whatever time your doctor advised. If you're taking medications, ask your doctor if you should stop taking them before or after the procedure.
To see your uterus and blood vessels, the radiologist uses a fluoroscope. This device is a pulsed X-ray beam that produces moving images of internal structures and displays them on a computer monitor.
In the radiology procedure room, you'll have an intravenous (IV) line placed in one of your veins to give you fluids, anesthetics, antibiotics and pain medications.
The procedure includes:
Blood vessel mapping and injection. An injected contrast fluid, usually containing iodine, flows into the uterine artery and its branches and makes them visible on the fluoroscope's monitor. The fibroids "light up" more brightly than other uterine tissue.
The radiologist identifies the right area of the uterine artery and then injects the blood vessel with tiny particles made of plastic or gelatin. The particles are carried by the blood flow to block the fibroid vessels.
After injecting more contrast into the uterine artery, the doctor checks additional images to make sure that blood is no longer reaching the fibroids. The same steps are then repeated in the second uterine artery.
In the recovery room, your care team monitors your condition and gives you medication to control any nausea and pain. When the effects of the anesthesia fade, they take you to your hospital room for overnight observation.
Observation. Post-embolization syndrome — characterized by low-grade fever, pain, fatigue, nausea and vomiting — is frequent after uterine artery embolization.
Post-embolization syndrome symptoms peak about 48 hours after the procedure and usually resolve on their own within a week. Ongoing symptoms that don't gradually improve should be evaluated for more-serious conditions, such as an infection.
By the next day, your urinary catheter is removed, and you're encouraged to walk around. Recovery is generally rapid, and complications are rare.
Most women return home the day after the procedure with a prescription for oral pain medication. Pain usually ends within a day or two, but in some women it may last up to a few weeks.
Monitor your recovery for:
You may have a magnetic resonance imaging (MRI) exam over the next year to monitor shrinkage or other changes in the fibroids or your uterus. Doctors usually schedule the first exam three months after the procedure.
Uterine artery embolization typically provides significant relief of symptoms. It also affects your menstrual period and it may have an impact on fertility.
Menstruation. Your menstrual period may continue on its normal schedule. If you miss any periods, they will probably resume within a few months.
A small number of women enter menopause after the procedure. The risk appears highest among women age 45 and older.
Impact on fertility. Although the risk of entering menopause after the procedure is low, subtle ovarian damage may make getting pregnant more difficult. There also may be an increased risk of pregnancy complications, especially involving abnormal placement or attachment of the placenta. Despite these risks, many women have had successful pregnancies after uterine artery embolization.
But, more long-term, larger studies are needed to determine the impact of uterine artery embolization on fertility and pregnancy — and the risks of uterine artery embolization must also be compared with the risks of surgery.
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