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Uterine Fibroid Embolization

Women now have a non-surgical option for the treatment of symptomatic uterine fibroids. Uterine fibroid embolization (UFE) is a procedure performed by our interventional radiologists at New Hanover Regional Medical Center.

Uterine fibroids are very common. From 20 to 40 percent of women age 35 and older have uterine fibroids of significant size. African-American women are at higher risk for fibroids, and as many as 50 percent have fibroids of a significant size. Approximately 300,000 hysterectomies and 35,000 myomectomies (selective removal of fibroid tumors without removing the whole uterus) are performed each year in the United States for fibroids. In addition, many women receive medical treatment for fibroids and many others suffer symptoms but never undergo treatment. Hence, UFE has the potential to provide women with a non-surgical, uterus-sparing alternative for the treatment of uterine fibroids.

Uterine fibroid embolization is particularly appealing to women who wish to preserve their child-bearing ability. This is not an option after hysterectomy.

Uterine fibroids are the most common tumors of the female genital tract. They are referred to by other names, including myoma or leiomyoma. Fibroids are benign noncancerous growths that develop in the muscular wall of the uterus. While fibroids do not always cause symptoms, their size and location can lead to problems for some women, including pain, heavy vaginal bleeding, and infertility.

Fibroids range greatly in size, from marble-to-basketball in size. In some cases they can enlarge the uterus to such an extent as to cause a woman to look pregnant. They can be confused with other pelvic masses, such as ovarian cysts and tumors. In most cases, there is more than one fibroid in the uterus.

Fibroids can be located in various parts of the uterus. There are three primary types:

Subserosal fibroids, which develop under the outside covering of the uterus and expand outward through the wall, giving the uterus a knobby appearance. They typically do not affect a woman's menstrual flow, but can cause pelvic pain, back pain and generalized pressure. The subserosal fibroid can develop a stalk or stem-like base, making it difficult to distinguish from an ovarian mass. These are called pedunculated fibroids. The correct diagnosis can be made with either ultrasound or MRI.

Intramural fibroids, which develop within the wall of the uterus and expand it, increasing the size of the uterus, and making it feel larger than normal in a gynecologic pelvic exam. These are the most common fibroids. Intramural fibroids can result in heavy menstrual bleeding and pelvic pain, back pain or sense of generalized pelvic pressure.

Submucosal fibroids, which are just under the lining of the uterus. These are the least common fibroids, but they tend to cause the most problems. Even a small submucosal fibroid can cause heavy vaginal bleeding.

Uterine fibroid embolization is performed by our interventional radiologists. They guide catheters (small tubes) through the arteries of the pelvis to the uterus. Various materials can be used to deliberately block the arteries that supply blood to fibroids, causing them to die and shrink.

Procedures performed by interventional radiologists are generally less costly and less traumatic, involve smaller incisions, less pain, shorter hospital stays, and usually avoid general anesthesia. Most patients undergoing UFE go home the same day or after an overnight stay at the hospital. The overall recovery time from UFE is on the order of several days to a week, as opposed to a hospital stay of several days and recuperation of several weeks after a hysterectomy. UFE involves virtually no blood loss or transfusion risks. General anesthesia and surgical incisions are avoided. Symptoms of early menopause are rarely caused by UFE, but are common with the hormonal therapy commonly used to try to shrink fibroids. As opposed to myomectomy, which treats only selected fibroids, all of the fibroids are treated with UFE. Women who wish to preserve the option of having children should opt for UFE.

To determine if a woman is a candidate for UFE, she will have a routine pelvic examination by her gynecologist, who will order lab work and make a referral to one of our interventional radiologists. Diagnostic tests such as ultrasound and MRI may be necessary to fully evaluate the uterus and ovaries and confirm that there are no unsuspected abnormalities which might be responsible for the symptoms.

UFE is a safe and highly effective treatment for women with symptomatic uterine fibroids. Many of the nearly 300,000 women who will undergo hysterectomy this year in the United States are not aware of this alternative. Approximately 25,000 women have chosen UFE since 1996. We have seen a dramatic increase in the number of women choosing UFE at our center and nationwide.

For more information about Uterine Fibroid Embolization, visit the Society for Interventional Radiology UFE website and the U. S. Department of Health and Human Services.