This leaflet tells you about having fibroid embolisation. It explains what is involved and what the possible risks are. It is not meant to replace informed discussion between you and your doctor, but can act as a starting point for such discussions. If you have any questions about the procedure please ask the doctor who has referred you or contact Professorial Clinics - Vascular and Endovascular Surgery
What is Uterine fibroid/ Uterine artery - embolisation?
Fibroid embolisation is a relatively new way of treating fibroids by blocking the arteries that feed the fibroids (uterine arteries), making the fibroids shrink. It is an effective alternative to an operation. This procedure can also be used for unexplained high volume bleeding in a non fibroid uterus.
Why do you need fibroid embolisation?
Your gynaecologist will have told you about fibroids and discussed treatment options with you. Previously, most fibroids have been treated by an operation to remove the fibroids individually (myomectomy) or by removing the womb (hysterectomy). In your case, it has been decided that embolisation is a suitable treatment option.
Are there any risks?
Fibroid embolisation is a safe procedure, but as with any medical procedure there are some risks and complications that can arise.
- Occasionally a small bruise may develop in your groin at the needle entry site.
- Very occasionally the procedure is not as effective as we would like it to be. This is sometimes due to a different blood supply to the fibroids. If this occurs your doctor will explain the options for further treatment.
- Most patients feel some pain afterwards, which ranges from very mild to severe crampy, period-like pain. It is generally worst in the first 12 hours, and is controlled by painkillers.
- Most patients get a slight fever after the procedure. This is a good sign as it means that the fibroid is breaking down. The painkillers help control this fever.
- Vaginal discharge can occur afterwards and may be bloody, due to the fibroid breaking down. This can persist for up to two weeks or can be intermittent for several months. If the discharge becomes offensive, and if associated with a fever, there is the possibility of infection and you should ask to see your-gynaecologist urgently.
- The most serious complication of fibroid embolisation is infection. This happens to perhaps one in every two hundred women. Severe pain, pelvic tenderness and a high temperature can occur. Lesser degrees of infection can be treated with antibiotics, or a dilatation and curettage (D&C) - a minor surgical procedure to remove uterine products. In severe cases an operation to remove the womb may be necessary but this is extremely rare.
There is a 2–4% chance that the procedure will lead to premature menopause. This occurs usually in women who are 45 years or older. Most women find it takes about six to nine months to resume a regular menstrual cycle.
What about pregnancy?
If you desire to become pregnant after this procedure you should mention this to the doctor at your appointment. Pregnancy is considered high risk after this procedure, but steps can be taken to try to reduce the risks if known in advance.
Are you required to make any special preparations?
- You will be required to stay in hospital as an inpatient overnight.
- You will be asked not to eat for six hours before the procedure.
- A urinary catheter may be placed into your bladder by a nurse.
- You need to have a small needle put into a vein in your arm for medications as needed.
A specially trained team lead by your vascular surgeon will handle your case and will include Anesthesia, nursing, Cath lab specialists.
What happens during fibroid embolisation?
- The procedure will take place in the X-ray department and you will lie flat on your back.
- You may have monitoring devices attached to your chest and finger and may be given oxygen.
- Your groin will be swabbed with antiseptic and you will be covered with sterile drapes.
- Local anaesthetic will be injected in the skin in your groin and a needle will be inserted into the artery. Sometimes both groins are used. A fine plastic tube called a catheter is placed into the artery.
- The vascular surgeon will use X-ray equipment to guide the catheter into the arteries, which are feeding the fibroids. A special dye, called a contrast agent, is injected down the catheter into these uterine arteries, and this may give you a hot feeling in the pelvis.
- Fluid containing thousands of tiny particles is injected through the catheter into these arteries to block them. The catheter is removed and pressure applied to the groin to stop bleeding.
Will it hurt?
When the local anaesthetic is injected, it will sting for a short while, but this soon wears off. You may develop cramp-like pelvic pain toward the end of the procedure, but this is treated with intravenous painkillers. This pain can last for a few days, up to two weeks, but should be treated well by oral painkillers.
How long does the procedure take?
Every patient is different, and it is not always easy to predict; however, expect to be in the radiology department for about two hours.
What happens afterwards?
- You will be taken back to your ward. Nursing staff will carry out routine observations including pulse and blood pressure and will also check the treatment site.
- You will stay in bed for at least four hours.
- You will be kept in hospital overnight and discharged the next day.
- Once at home, you should refrain from strenuous exercise for about a week.
- One to two weeks off work is advised.
- Once you feel well you may have normal sexual relationships.
Continue to use your usual contraception, including the pill.
What are the results of embolisation?
The vast majority of women are pleased with the results, reporting a significant improvement in their quality of life. By one year, most fibroids shrink to about half their size resulting in significant improvement in both heavy prolonged periods and symptoms relating to pressure. Once fibroids have been treated like this, they do not generally grow back again. Some women, who could not become pregnant before the procedure because of their fibroids, have become pregnant afterwards.
Finally
Some of your questions should have been answered by this article, but remember that this is only a starting point for discussion about your treatment with the doctors looking after you. Make sure you are satisfied that you have received enough information about the procedure.
If there is anything else you would like to know please do not hesitate to ask. You can contact us either in person or on the telephone on the following number below:
+919311003130 (2000-2200 hrs only)
digvijay@professordigvijay.com