Uterine Fibroid Embolization: A Safe and Effective Alternative to Surgery
By Alicia Armeli

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If you’ve been diagnosed with uterine fibroids, you’re not alone. The National Institutes of Health concluded that the majority of American women will develop uterine fibroids at some point in their lives.1 With symptoms such as urinary incontinence, painful intercourse, and heavy periods that can lead to iron-deficiency anemia, fibroids take a toll both physically and mentally.

A hysterectomy, or the surgical removal of the uterus, was at one time the go-to treatment for fibroids. But now women have other less-invasive options to choose from—options like uterine fibroid embolization (UFE), which can offer dramatic relief while still sparing the uterus.

“Uterine fibroid embolization is for those women who would like a definitive treatment for all their fibroids but would like to avoid an operation,” says Dr. James Spies MD MPH, Professor, Chairman and Chief of Service of the Department of Radiology at Georgetown University School of Medicine.

With its launch dating back to 1995, UFE may be considered a relatively novel procedure. But previous to this, the basic technique of uterine artery embolization had been safely and successfully used to stop heavy bleeding after childbirth.2

During UFE, a catheter is routed through a small incision in the upper thigh. Using special imaging equipment, the catheter is guided through the femoral artery in the leg and into the uterine arteries. Small particles are then injected in the uterine arteries to block the blood flow that feeds the fibroids, causing them to shrink and die.3

And the success rate for UFE is noteworthy. “It depends upon the symptoms but between 85 and 90 percent of women will have their menstrual bleeding substantially improved typically three months after the procedure.” Dr. Spies explains.  “The other symptoms may get better sooner. Pressure, pain, discomfort, bloating, urinary frequency—often within several weeks to a few months will have improved. About 90 percent of women overall by three to six months will have their symptoms improved significantly—meaning moderately improved to completely resolved.”

Although UFE was once thought to only be effective with small to medium fibroids, recent research has shown that it can provide relief for large fibroids as well. Earlier this year, a study published in Cardiovascular and Interventional Radiology observed the results UFE had on two groups of women, those with small fibroids of less than 10 centimeters in diameter and those with large fibroids of greater than 10 centimeters in diameter. After the surgery, follow up reports showed both groups having similar improvement in quality of life scores. The authors of the study also found there weren’t significant differences in treatment effectiveness or post-op complications between the two groups.4

UFE success rates are high but there are times when it doesn’t work. In some instances UFE is unable to destroy the fibroids completely “due to anatomic variation or other issues,” Dr. Spies explains. “If you completely kill the fibroid it will not grow back. However, if you only kill 80, 90, or 95 percent of the fibroid, the portion that remains living or viable could grow back.” There are also fibroids too difficult to target. “Very small fibroids or ones on the outside of the uterus are a little more difficult to treat. In that case you might not kill the fibroid at all.” At times like these, subsequent treatments or other procedures may be warranted.5

As with any procedure, complications associated with UFE are possible but these are less in comparison to surgical procedures like myomectomy and hysterectomy. “It’s very unlikely to damage other structures, whereas with surgery that can happen,” says Dr. Spies. “Uterine fibroid embolization is for women who are looking for short-term recovery, would like to retain their uterus, and would like to have the symptoms go away. And it works very well in this circumstance.”

ABOUT THE AUTHOR   Alicia Armeli has a Master of Science in Nutrition and Whole Foods Dietetics (MSN/DPD) and is a registered dietitian nutritionist, a certified dietitian, and a holistic life coach. In addition to writing, she enjoys singing, traveling abroad and volunteering with her local animal shelter.

ABOUT THE DOCTOR   James Spies is the Chairman, Chief of Service, and a Professor of the Department of Radiology at Georgetown University School of Medicine. He is an interventional radiologist whose primary clinical and research interest is in uterine embolization for fibroids. His specialty is in radiology and his special interests include uterine artery embolization and gynecologic intervention.

REFERENCES

  1. National Institutes of Health. (2013). Uterine Fibroids. Retrieved April 28, 2015, from http://report.nih.gov/nihfactsheets/viewfactsheet.aspx?csid=50/
  1. Society of Interventional Radiology. (2015). Highly Effective, Widely Available, Interventional Radiology Treatment Often Replaces Need For Hysterectomy. Retrieved April 28, 2015, from http://www.sirweb.org/patients/uterine-fibroids/
  1. King, R., & Overton, C. (2011). Management of fibroids should be tailored to the patient. The Practitioner, 255(1738): 19-23, 2-3.
  1. Bérczi, V., Valcseva,, Kozics,D., Kalina, I., Kaposi, P., Sziller, P.,  Várbíró, S., Botos, E. M. (2015). Safety and effectiveness of UFE in fibroids larger than 10 cm. CardioVascular and Interventional Radiology. doi:10.1007/s00270-014-1045-4
  1. Gupta, J. K., Sinha, A., Lumsden, M. A., & Hickey, M. (2014). Uterine artery embolization for symptomatic uterine fibroids. Cochrane Database of Systematic Reviews. doi:10.1002/14651858.CD005073.pub4.