Uterine Fibroid Embolization (UFE) FAQ

What is UFE

 

What does UFE stand for?

UFE, sometimes pronounced ‘you-fee,’ stands for Uterine Fibroid Embolization.

 

 

What is uterine fibroid embolization (UFE)?

 

Uterine fibroid embolization is (UFE) is a minimally-invasive image-guided procedure that is used to treat uterine fibroids. The procedure involves the injection of micro sized beads into the arteries that feed the fibroids. When injected, the beads block blood flow to the fibroids, causing the fibroids to ‘starve’ and shrink.¹

 

In medicine, the term ‘embolization’ generally means to block or obstruct a blood vessel.

 

 

When was UFE first used?

 

UFE was first described in 1995 in a case series of 16 women.² Uterine fibroid embolization has since been established as a safe and effective alternative to surgery for the treatment of symptomatic uterine fibroids.³

 

 

Who performs uterine fibroid embolization?

 

Uterine fibroid embolization is performed by an interventional radiologist (IR). An IR specializes in vascular anatomy and minimally-invasive image-guided procedures.

 

 

 

Efficacy of Uterine Fibroid Embolization

 

How successful is uterine fibroid embolization?

 

The main goal of fibroid treatment is to alleviate fibroid symptoms like heavy bleeding and pelvic pain. Several clinical studies have established that uterine fibroid embolization is as effective at alleviating fibroid symptoms as hysterectomy or myomectomy surgery.³

 

In these studies, treatment success is measured by asking women whether or not they are satisfied with treatment or by asking them about their experiences with fibroid symptoms. Two years after uterine fibroid embolization, around 85% of women report that they are satisfied with the procedure or remain free of fibroid symptoms. A similar percentage of women report that they are still happy with their results 5 years after treatment.³

 

 

How long does uterine fibroid embolization last?

 

For the majority of cases (~65%), uterine fibroid embolization lasts indefinitely.⁴ However, clinical studies have shown that some women require an additional procedure (reintervention) following UFE. According to the highest quality clinical data, about 20% of women elect for reintervention within 2 years of their UFE, increasing to 25-30% at 5 years.³

 

Reintervention is often caused by the development of entirely new fibroids, or regrowth of existing fibroids that were only partially occluded during the first UFE procedure.⁵

 

 

How many times can you have UFE done?

 

In general, there is no limit to the number of times you can have a UFE procedure.

 

 

How often do women who have UFE end up with hysterectomy?

 

About 25-30% of women choose to undergo a second procedure within 5 years of having a UFE procedure.³ Ultimately, the decision to have a hysterectomy falls on the patient. If fibroid symptoms return after UFE, it is possible to have a second UFE procedure and continue to avoid hysterectomy.⁵

 

Safety of Uterine Fibroid Embolization

 

How safe is uterine fibroid embolization?

 

Uterine fibroid embolization is a safe minimally-invasive procedure. Typically, the safety of a procedure is measured by tracking intra-procedural complications (also called adverse events) and side effects (also called post-procedural complications) in clinical studies.

 

Intraprocedural complications of uterine fibroid embolization include hematoma, blood clot, nausea during the procedure, uterine artery dissection, uterine artery spasms, and artery perforation among others. Intraprocedural complications are uncommon in uterine fibroid embolization. The highest quality clinical studies have demonstrated that these complications occur at a rate of 0% to 9%,³ and most complications can be managed during the procedure without long-term health consequences.

 

 

What are the side effects of uterine fibroid embolization?

 

The most common side effects of uterine fibroid embolization include:

 

  • Postembolization syndrome (pain, nausea, mild fever, flu-like symptoms)

  • Hot flashes

  • Vaginal discharge

  • Fibroid expulsion

  • Hematoma formation (bruising)

 

These side effects tend to resolve on their own within the first 30 days following the procedure.

 

Less common side effects include UTI, urinary retention, urinary incontinence, thrombosis, thigh paresthesia, infection, and temporary amenorrhea (absence of menstruation).⁶⁻⁷

 

The UFE Procedure

 

How is uterine fibroid embolization performed?

 

Uterine fibroid embolization is a minimally-invasive image-guided procedure. The procedure begins with a tiny puncture in the upper thigh or the forearm that allows your interventional radiologist to insert small tubes (called catheters) and wires into your artery. Using real-time fluoroscopic (x-ray) imaging, the interventional radiologist guides a catheter to the arteries that feed your fibroids. With the catheter in place, the interventional radiologist injects micro-sized beads through the catheter to stop blood flow to the fibroids. When the interventional radiologist sees that blood flow to the fibroids has stopped, the catheter is removed from the body and the tiny puncture is sealed.

 

Watch this short animated video to see how uterine fibroid embolization is performed.

 

 

How does uterine fibroid embolization work?

 

Uterine fibroids rely on a continuous supply of blood from the uterine arteries to maintain their size and continue to grow. Uterine fibroid embolization works by blocking (embolizing) the arteries that feed the fibroids with micro-sized particles. By limiting or completely eliminating the fibroids’ blood supply, the fibroids shrink over time.¹

 

 

How long does the uterine fibroid embolization procedure take?

 

On average, the uterine fibroid embolization procedure takes about an hour from start to finish, but may be as quick as 30 minutes or take as long as 2 hours.⁶⁻⁸

If the procedure is done in an outpatient setting (i.e. if the patient is discharged on the same day as the procedure), typically the patient will spend at least 6 hours in recovery after UFE so OR staff can monitor post-op pain and nausea. Depending on the interventional radiologist that performs the procedures, patients may be kept overnight to administer IV fluids and monitor post-op recovery.

 

 

Where do they cut for UFE?

 

There are no major incisions involved in the UFE procedure. Only one tiny puncture is made in the upper thigh or in the forearm when performing UFE. This tiny puncture allows the interventional radiologist to access your fibroids through your arteries and deliver therapy.

Why is UFE painful afterwards?

 

UFE works by inducing ischemia (blockage of blood flow) to the fibroids and depriving the fibroids of blood, oxygen, and nutrients. Although ischemia is the goal of the UFE procedure, ischemia also activates pain signals that respond to oxygen deficiency. This is thought to cause cramping pain at or around the site of treatment for a few days after the UFE procedure. Cramping pain after UFE typically lasts for 3-4 days, and less frequent cramping can happen for up to 2 weeks following the procedure.

 

How long to monitor pain onsite after UFE?

 

The decision of how long to monitor patients onsite after UFE is usually made by the interventional radiologist that performs the procedure. Some patients have the procedure in the morning and are home in the afternoon after 6-8 hours of onsite recovery. Other interventional radiologists keep their patients overnight for pain control, nausea control, and IV fluids.

What to Expect After UFE

 

What happens to fibroids after UFE?

 

After UFE, the blood vessels feeding the fibroids are occluded, causing the fibroids to receive less blood than they need. An insufficient supply of blood leads to an ischemic reaction in the fibroids (injury from lack of oxygen), which causes them to undergo necrosis (death of cells) and shrink.¹

 

How much do fibroids shrink after UFE?

 

Fibroids shrink by 40% to 75% in the first 6 months after UFE, and continue to shrink over longer periods of time. This reduction in fibroid size causes the uterus to shrink by 26% to 59%,³ which is why UFE is effective in alleviating fibroid symptoms.

 

 

How long does it take for fibroids to shrink after UFE?

 

Fibroids begin to shrink immediately after the UFE procedure, and continue to shrink throughout the next year. Many women note improvement in their bleeding symptoms immediately following the procedure, but it can take up to 3 months for fibroids to shrink enough for women to notice major symptom improvements.

 

In one notable UFE study, 200 women were asked about their symptoms 3 months after treatment. 87% of the women described improvement in their bleeding symptoms, and 93% described improvement in pelvic pain and pelvic pressure symptoms.⁹

 

 

 

UFE Post-Op Care

What is the recovery time for uterine fibroid embolization?

 

Multiple studies looked at how long it takes women to make a full recovery after uterine fibroid embolization. In most studies, recovery time averages between 9 and 12 days,⁸⁻¹² but exact recovery time will vary from person to person. In general, women undergoing uterine fibroid embolization should plan for 1 to 2 weeks of recovery before returning to normal activities like work and exercise.

 

 

How do you know if you have an infection in your uterus after UFE?

 

If you’ve recently had a UFE procedure: fevers, chills, and a foul-smelling vaginal discharge might indicate that you have an infection in your uterus. If you’re experiencing these symptoms, we recommend that you seek immediate medical attention.

 

 

How to treat an infection after UFE?

 

An infection from a recent UFE procedure is usually treated with oral antibiotics. A really severe infection may require hospitalization for IV administered fluids and antibiotics. If you suspect that you have an infection from UFE, we recommend that you seek immediate medical attention.

 

 

How soon can a person have sex after a UFE procedure?

Patients are advised to wait at least 1 week after their UFE procedure to have sex.

 

 

How long do you bleed after uterine fibroid embolization?

 

Bleeding after uterine fibroid embolization varies from person to person. Some women experience no extra bleeding outside of their normal menstrual cycle. For women that experienced heavy bleeding with their fibroids, cycles should become increasingly lighter in the months following the UFE procedure as the fibroids shrink. If UFE is successful, women will re-establish a new baseline cycle after 4-6 months, which should be much lighter and closer to their normal cycle before fibroids.

 

 

How long do cramps last after uterine fibroid embolization?

 

Cramping pain after uterine fibroid embolization typically lasts for 3-4 days. Additional, less frequent cramping can happen for up to 2 weeks following the procedure. Over the counter NSAIDS like ibuprofen are usually enough to manage cramping pain.

 

 

What kind of over the counter medication can I take after having a UFE?

 

Many doctors will prescribe post-procedural NSAIDS like ibuprofen that patients are required to take for the first 5 days following uterine fibroid embolization. Patients are also advised to take Tylenol for fevers and ibuprofen to help with cramping.

 

 

How to stay comfortable after UFE?

 

Patients are advised to keep their activity light while they recover from a UFE procedure, but not to spend too much time in bed either. Ibuprofen may be prescribed for the first 5 days after UFE to help with cramping pain and general discomfort. Narcotics are also prescribed to help with episodes of more intense pain. If narcotics are taken, over the counter stool softener is recommended to prevent constipation (side effect of narcotics).

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References

[1] Khan, A. T., Shehmar, M., Gupta, J. K., & Gupta, J. (2014). Uterine fibroids: current perspectives. International Journal of Women’s Health, 6, 95–114.

[2] Ravina JH, Herbreteau D, Ciraru-Vigneron N, Bouret JM, Houdart E, Aymard A, et al. Arterial embolisation to treat uterine myomata. Lancet 1995;346:671-2.

[3] Gupta et al. (2014). Uterine artery embolization for symptomatic uterine fibroids (Review). Cochrane Library, (5).

[4] de Bruijn, A. M., Ankum, W. M., Reekers, J. A., Birnie, E., van der Kooij, S. M., Volkers, N. A., & Hehenkamp, W. J. K. (2016). Uterine artery embolization vs hysterectomy in the treatment of symptomatic uterine fibroids: 10-year outcomes from the randomized EMMY trial. American Journal of Obstetrics and Gynecology, 215(6), 745.e1-745.e12.

[5] Yousefi, S., Czeyda-Pommersheim, F., White, A. M., Banovac, F., Hahn, W. Y., & Spies, J. B. (2006). Repeat uterine artery embolization: Indications and technical findings. Journal of Vascular and Interventional Radiology, 17(12), 1923–1929.

[6] Hehenkamp, W. J. K., Volkers, N. A., Donderwinkel, P. F. J., De Blok, S., Birnie, E., Ankum, W. M., & Reekers, J. A. (2005). Uterine artery embolization versus hysterectomy in the treatment of symptomatic uterine fibroids (EMMY trial): Peri- and postprocedural results from a randomized controlled trial. American Journal of Obstetrics and Gynecology, 193(5), 1618–1629.

[7] Pinto, I., Chimeno, P., Romo, A., Haya, J., & Cal, M. A. De. (2003). Uterine Fibroids : Uterine Artery Embolization versus Abdominal Hysterectomy for Treatment — A Prospective , Randomized , and Controlled Clinical Trial. Radiology, 226(2), 425–431.

[8] Mara, M., Maskova, J., Fucikova, Z., Kuzel, D., Belsan, T., & Sosna, O. (2008). Midterm clinical and first reproductive results of a randomized controlled trial comparing uterine fibroid embolization and myomectomy. CardioVascular and Interventional Radiology, 31(1), 73–85.

[9] Spies, J. B. (2013). Current evidence on uterine embolization for fibroids. Seminars in Interventional Radiology, 30(4), 340–346

[10] Ruuskanen, A., Hippeläinen, M., Sipola, P., & Manninen, H. (2010). Uterine artery embolisation versus hysterectomy for leiomyomas: Primary and 2-year follow-up results of a randomised prospective clinical trial. European Radiology, 20(10), 2524–2532.

[11] Jun, F., Yamin, L., Xinli, X., Zhe, L., Min, Z., Bo, Z., & Wenli, G. (2012). Uterine artery embolization versus surgery for symptomatic uterine fibroids: A randomized controlled trial and a meta-analysis of the literature. Archives of Gynecology and Obstetrics, 285(5), 1407–1413.

[12] Moss, J. G., Cooper, K. G., Khaund, A., Murray, L. S., Murray, G. D., Wu, O., … Lumsdenf, M. A. (2011). Randomised comparison of uterine artery embolisation (UAE) with surgical treatment in patients with symptomatic uterine fibroids (REST trial): 5-Year results. BJOG: An International Journal of Obstetrics and Gynaecology, 118(8), 936–944.

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

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The Fibroid Specialists of University Vascular are leading providers of uterine fibroid embolization (UFE), the least invasive treatment option for women suffering from uterine fibroids. Our physicians have devoted their expertise to helping women overcome fibroids without hysterectomy or major surgery. 

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