Frequently Asked Questions

What are fibroids?
Uterine fibroids, also known as leiomyomata, are benign growths in the uterus. Fibroids are one of the most common causes of chronic abnormal uterine bleeding.

How common are fibroids?
Up to 40% of women of menstrual age have uterine fibroids.

What are the symptoms?
Fibroids may produce chronic bleeding, pelvic pain, abdominal fullness, frequent urination and infertility.

What are the treatments?
Traditionally, the symptoms of fibroids have been treated by several different means, including hysterectomy, surgical or laporoscopic fibroid removal, cryotherapy or hormone therapy. More recently, an established technique known as uterine artery embolization (UAE) which has been used for years to treat acute uterine bleeding, has been applied to chronic uterine bleeding associated with fibroids.

What is Uterine Artery Embolization (UAE)?
UAE is a technique performed by specialized interventional physicians under local anesthesia. A small catheter is inserted into a blood vessel in your groin and threaded into the arteries to your uterus. Small particles are injected through the catheter to decrease blood flow to the fibroids, which usually causes them to shrink. In most patients, bleeding and pressure-related symptoms are significantly reduced.

How do I know if I'm a candidate for UAE?
One or more of the following symptoms are indications for UAE:

  1. Heavy menstrual bleeding with or without anemia (92% of patients).
  2. Pain in pelvis, back, flank or legs caused by bulk effect of fibroids (79% of patients).
  3. Urinary frequency or other bladder symptoms caused by compression of the bladder by fibroids or compression of the ureters, which can cause hydronephrosis.
  4. Pain or discomfort during sexual activity.

Will I be able to have children following this procedure?
Women wishing to maintain fertility may be treated with UAE if:

  1. They have failed all medical therapy: hormonal therapy such as birth control pills, estrogen replacement, or
  2. Their only remaining options are radical myomectomy or hysterectomy due to size, number and/or location of their fibroids.
There have been four pregnancies documented with women who have had UAE that were successful.

What is needed in preparation for UAE?
A referral from your gynecologist is needed along with the following:

  1. A pelvic exam within one year.
  2. A PAP test within one year.
  3. A pelvic MRI within 3 months, which we will assist in scheduling.
  4. Bloodwork, which will be drawn on the day of the procedure.

Is this procedure painful?
The most common side effect is pelvic pain, which is controlled during and immediately after the procedure using effective intravenous. Moderate pain typically continues for 3-5 days after the procedure. Nausea and fever are also common. These symptoms are controlled with intravenous and oral medications.

What will I receive for pain control?

  1. Patient Controlled Analgesia (PCA): Intravenous pain medications are given at specified intervals by the patient when needed.
Additional medications for nausea are given. The patient is discharged with prescriptions for pain medications, non-steroidal anti-inflammatories and in some cases antibiotics.

Will I stay in the hospital after the procedure?
After the out-patient procedure each patient is admitted to a patient care unit for post procedure care for an overnight stay. The patient is discharged the next morning with discharge instructions, take home information and pain medications.

What symptoms will I experience after I get home?
The following will probably be present:

  1. Vaginal discharge (gray or brown).
  2. Pelvic pain and/or low back discomfort.
  3. Nausea may be experienced.
  4. Possible symptoms of Post Embolization Syndrome (PES), which are fever, severe abdominal pain, nausea and vomiting.

What is Post Embolization Syndrome?
About 40% of women experience PES. It is a result of tissue necrosis from the infarcted myomata. PES is characterized by pain, fever, high white blood cell count, nausea and vomiting. This should be followed closely to distinguish it from a complicating infection.

When can I return to work?
Patients may return to normal activity immediately after discharge if symptoms allow. No heavy lifting for 7 days.

What are some of the late complications that have been reported?
A small percentage of women may have late complications weeks after their initial symptoms have passed. This is an example of 2:

  1. Expelled fibroids can occur 2-8 months post procedure. There can be prolonged pelvic pain followed by tissue or whole fibroids passing into the vagina. About 5% of patients experience this. This may also be accompanied by a fever.
  2. Occasionally women can go into menopause. This is more common in women in their late 40's. More typically, if the patient experiences a cessation of a period, it will recur after a couple of months.

What is the follow-up care for UAE?
Gynecological exams will be done within 2 weeks of the procedure and at regular intervals as determined by your gynecologist. Clinical improvement in abnormal bleeding and in pelvic pain and/or pressure will be evaluated.

An MRI will be scheduled at 3 months and 12 months post procedure, plus a clinic visit with the radiologist. These will provide measurements of the uterus, fibroids and calculate uterine volume and volume of the dominant fibroid.

How long has UAE been done?
UAE has been done since 1979 to help control uterine hemorrhaging and was first done in 1991 for the treatment of uterine fibroids. In 1996 it was offered as a primary therapy for uterine fibroids. Our Doctors have been performing this procedure since 1998, but have extensive experience with pelvic embolization.

What are the documented results of UAE?
Most patients' conditions have improved with:

  1. 89% of patients noted improvement in menorrhagia.
  2. 96% of patients with symptoms of pelvic pain and/or pressure noted improvement.
  3. 95% of patients expressed some degree of satisfaction with the outcome.
  4. The average reduction in the size of the dominant fibroid was 50%.

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