Uterine Fibroid Embolization
If you have uterine fibroids, you may want to know more about a procedure called embolization. It's a minimally invasive procedure that temporarily stops blood flow to certain organs or tissues and is often used to treat women diagnosed with uterine fibroids.
During embolization, arteries leading to the uterus are blocked, killing benign fibroid tumors growing within it.
Radiologists at Yale Medicine have extensive experience performing embolizations. If you have fibroids, we can help you understand your various treatment options. Our radiologists work closely with gynecologists to ensure you have the information you need to decide the best treatment option for you, says Jeffrey Pollak, MD, a Yale Medicine radiologist. At Yale Medicine, we offer uterine fibroid embolization; the treatment is well accepted but not widely available in other locations.
What type of patients can be helped by uterine fibroid embolization?
Uterine fibroids can cause heavy bleeding, pain, urinary frequency and bloating during and in between menstrual periods. Women with fibroids may consider several treatment options:
- Prescription hormone therapy
- Surgery to remove just the fibroids or the entire uterus
- Fibroid embolization
Embolization may be a good choice for women who don’t want to have any more children, but who also don’t want an invasive surgery such as a hysterectomy. It's important to know that it may be harder to become pregnant after embolization, and there may also be a slightly increased risk of miscarriage if you do become pregnant.
Fibroids are often diagnosed by a gynecologist, who may refer a patient to a radiologist to discuss embolization. A magnetic resonance imaging (MRI) scan of the patient’s pelvis can help the radiologist rule out other potential causes of the symptoms and determine whether the patient is a good candidate for embolization.
At Yale Medicine, doctors discuss the pros and cons of each treatment option with you before deciding on a course of action.
How does uterine fibroid embolization work?
The day of the procedure, the patient arrives at the hospital and changes into a gown. Because the procedure involves X-ray exposure and would be dangerous to a fetus, a pregnancy test is administered to make sure that you are not expecting. Next, you are given a sedative as well as antibiotics intravenously to safeguard you against infection.
Embolization is performed through a tiny needle puncture in the skin. This can be done near the groin (on the bikini line) or on the wrist, depending on the preference of the patient and the doctor.
First, a local anesthetic is applied to either the groin or the wrist. A thin needle—like those used to draw blood—is inserted into an artery. The needle is then swapped out for a tiny plastic tube, which injects dye into the bloodstream. The patient is placed under an X-ray machine where the dye “glows” to show the path of the artery and the blood flowing to the uterus. Once the doctor confirms that the tube is in an artery feeding the uterus and its fibroids, tiny pieces of plastic or gelatin are injected through it.
“I describe them as the fake snow in a snow globe, only smaller and medical grade,” Dr. Pollak says. These particles enter the bloodstream and block the flow of blood and oxygen to the uterus. This blockage is typically only temporary—the blood vessels open back up after a few hours—but the fibroids usually die off before blood flow is restored. The procedure typically takes about one hour.
What is recovery from uterine fibroid embolization like?
You can stand up and walk within a few hours after the procedure if it's done through the groin or bikini line. If the procedure is done through the wrist, you can walk immediately. Afterward, it’s normal to have at least moderate pain that then recedes over the next few days. This is due to the lack of blood flow. Patients are given morphine while they recover during one night in the hospital and a prescription painkiller to take once they go home.
It’s also normal to have bloody or mucous-like discharge for a few days or weeks. It is common to discharge tiny bits of tissue as dead fibroids break down and slough off.
Most fibroids stay attached to the uterine wall after they die, but they stop causing symptoms and shrink over time. Most women who have fibroid embolization return to regular activities within a few days, although they may feel tired for a few weeks.
What are the benefits of uterine fibroid embolization?
Embolization is a safe and minimally invasive procedure that requires just a small puncture wound in the skin. Recovery from embolization is much faster than invasive surgery because there is no incision to heal or stitches to be removed. The risk of bleeding and complications is lower than with invasive surgery.
What are the risks of uterine fibroid embolization?
During embolization, blood supply to the uterus is cut off for a short time. That means there is a very small risk that the uterus will become damaged and unable to recover. Infection can also develop in or around dead fibroid tissue after embolization.
In those cases, a hysterectomy may have to be performed. The overall risk of needing a hysterectomy after embolization is about 1 percent, Dr. Pollack says. There is also a small chance that a patient will stop menstruating, either temporarily or permanently, which would also affect fertility.
For women under 45, this risk is less than 1 to 2 percent, he says. But if a woman wants to have children in the future, she may consider a myomectomy—surgical removal of the fibroids (but not the uterus)—instead.
How effective is uterine fibroid embolization?
More than 85 to 90 percent of women treated with embolization feel better, at least for a few years, but within five years, 20 to 25 percent of them experience a recurrence in their symptoms, Dr. Pollack says.
The size and location of a woman’s fibroids may also affect how well embolization will work. Weigh the risks and benefits of each treatment option before deciding on a procedure, taking into account your individual diagnosis and risk factors as well as your symptoms, age and future fertility concerns.
What makes Yale Medicine’s approach to uterine fibroid embolization unique?
Yale Medicine has some of the most highly skilled interventional radiologists in the country and has been recognized as a center of excellence for embolization. Yale Medicine Radiology & Biomedical Imaging employs cutting-edge technologies to diagnose and treat uterine fibroids.
Plus, Yale Medicine physicians work closely with referring gynecologists to determine whether surgery or embolization are appropriate treatment options for each patient.
Fibroid embolization is a widely accepted treatment alternative to invasive surgery, but it's not available at every hospital. “Not enough women in this country are offered this option,” says Dr. Pollak, “so Yale Medicine doctors are proud to offer it at Yale New Haven Health.”