There’s generally no specific preparation needed. Your doctor might advise you to stop certain medications, like blood thinners, a few days before. You might also be asked to refrain from eating or drinking anything after midnight before the procedure. Blood tests may be required.
No, UFE is not surgery, and it doesn’t involve incisions. There won’t be any visible scars resulting from UFE.
Most patients can return to work within a week, with some possibly needing 10-14 days. This recovery time is much shorter compared to procedures like hysterectomy or myomectomy, which may take 4-6 weeks.
When can I resume normal activities?
Patients are typically advised to wait ideally for 1 month after UFE before resuming sexual intercourse.
Does the size and number of fibroids matter for UFE?
The procedure usually takes 1 to 2 hours, depending on the size of the fibroids and the vascular anatomy.
The first menstruation post-UFE might be painful with blood clot release, but things should normalize afterward. The bleeding volume tends to decrease, and your menstrual cycle becomes more regular.
Yes, a myomectomy may not remove all fibroids, UFE is a viable and effective option for treating any remaining fibroids after the myomectomy. UFE is a global treatment and will treat all the fibroids in the uterus
Fibroids can impact fertility based on their size and location. Submucosal fibroids, which are on the inner walls of the uterus, can alter the shape of the uterine cavity, making it harder for sperm or an embryo to move properly. They can also change the shape of the cervix and block the fallopian tubes, both of which can affect fertility.
Yes, it’s normal to experience pelvic cramps after UFE. The most intense pain usually occurs within the first 12-24 hours. This pain is a sign that the treatment is working, as UFE cuts off the blood supply to the fibroids, causing them to die. The dying fibroids send pain signals to the body. Although the worst pain eases after the first day, it can continue for about a week.
Dr. Mohan has conducted extensive research on the topic of pain control following UFE. He conducted a double blinded randomized clinical trial (which is considered the highest level of clinical research design) on a new pain control method using steroids injected directly into the arteries during UFE, which was effective in controlling post procedural pain (Add link to RCT paper).
At FII, we use a unique pain management regimen, which is based on Dr. Mohan’s research and other proven methods. During UFE, you’ll receive a single dose of dexamethasone injection into your uterine arteries. Then, after the procedure, you’ll get a nerve block to manage pain, which is called the superior hypogastric plexus block. This involves injecting long-acting local anesthetics around the nerve carrying pain signals from the uterus, which can block pain for up to 20 hours. Additionally, you’ll receive other pain medications to take regularly for a week and have a 24-hour contact number for the clinical team. This comprehensive approach ensures a smooth recovery after your UFE.
The superior hypogastric plexus is a group of nerves that carries pain signals from the uterus and other pelvic organs. This group of nerves is situated in front of your lowest vertebra. Right after the procedure, your doctor inserts a tiny needle right next to this group of nerves using X-ray guidance. After confirming the correct location, he will then inject a long acting local anesthetic medicine. This medicine can block this nerve (make it numb) for up to 20 hours. This will block any pain signal from the uterus for that duration. This is a very effective method for pain control following UFE, especially because the most severe pain after UFE is experienced in the first 12 hours.
Following a Uterine Fibroid Embolization (UFE) procedure, you’ll likely experience cramping in your lower abdomen for the first 24 hours, resembling menstrual cramps. This discomfort is a positive sign that the treatment is working and will gradually improve over time.
Special pain control measures, (Add RCT paper link) including a nerve block, can help to prevent the immediate pain effectively. Post-procedure cramps may persist for a couple of days but can be well controlled with prescribed pain medication. By the next morning, you’ll be able to get out of bed, walk around, and attend to your daily needs, aiding a quicker recovery compared to surgery.
In the first two weeks after the procedure, you’re allowed to shower, but activities like bathing, swimming, intercourse, and gym workouts are restricted. Throughout the initial week, you may continue to experience milder cramping, and any discomfort can be eased with the prescribed medications.
A small percentage of patients may encounter post-embolization syndrome, characterized by low-grade fever, pain, and nausea. Increased fluid intake can help manage symptoms, and this syndrome typically lasts only a few days, diminishing by the end of the first week.
Most patients are back at work after the first week, experiencing some light discharge or occasional cramping but feeling progressively better, stronger, and more energetic each day. For some, return to work may take 10-14 days. By the two-week point, you should feel like yourself again and can resume normal activities. The average UFE recovery time is 5-7 days, significantly quicker than the healing time required for a hysterectomy or myomectomy, which typically takes 6-8 weeks.
Uterine fibroids are non-cancerous. They are benign growths in the wall of the uterus, and they do not increase your risk of uterine cancer.
Uterine fibroids are benign growth in the wall of the uterus. They are very common and in some people can cause symptoms such as heavy bleeding, pelvic pain and frequent urination among others that can affect your quality of life.
Adenomyosis is a condition where the cells lining the inner cavity (endometrium) of the uterus grow into the muscle wall of the uterus. During each menstrual cycle, these displaced cells of the uterine lining continue to perform its usual functions and thicken, break down, and bleed within the muscle wall.
This can result in an enlarged and tender uterus, heavy menstrual bleeding, and painful periods.
Birth control pills do not increase your risk of having fibroids. Some of the earlier studies have suggested that pills may have a protective effect against the development of fibroids. But these were case control studies and the findings were not confirmed.
https://pubmed.ncbi.nlm.nih.gov/10453838/
Treatment of large fibroids with UFE is an area that Dr. Mohan has expertise in and he has conducted clinical research on this topic. He has presented his findings on this topic at international meetings. (Click to read abstract 1, abstract 2).
When UFE initially introduced (25 years ago), large fibroids, or fibroids which are larger than 10 cm in diameter were considered to be a relative contraindication to UFE. However, since then several clinical studies have demonstrated that UFE is safe and effective for large fibroids. In our experience, large fibroids can be safely treated with UFE with excellent results, which are similar to that of small fibroids. With UFE there are no there are no size or quantity restrictions when it comes to fibroids. UFE can treat any size fibroids and any number of fibroids. On the other hand, fibroids larger than 10 cm are not typically removed using laparoscopic surgery (key hole) and they need conventional open surgery. (Click to read paper 1, paper 2, paper 3, paper 4).
Fibroids only need treatment if they are not causing you any symptoms. They are very common benign growths in the uterus and many women do not realize that they have fibroids.
It is true that UFE can be lead to accelerate the menopause:
UFE do not accelerate menopause normally. However, approximately 2% of patients enter menopause after UFE. It should be noted that the vast majority of these women are over 45 years old. A much smaller percentage of women enter menopause after UFE between the ages of 40 and 45.
How often and how should we monitor the fibroids once they are diagnosed?
It is not necessary to do routine monitoring for fibroids unless you have symptoms.
Fortunately, Uterine artery embolization (UAE) (same procedure as uterine fibroid embolization), is an effective non-surgical treatment option for adenomyosis. Several studies have confirmed the safety and efficacy of this procedure for the treatment of adenomyosis. A systematic review, which is an analysis of all the prior research on this topic in 2017 that looked at 30 clinical studies on this topic with over 1,000 patients, showed that UAE provides significant symptom relief from adenomyosis in the short term (<12 months) for 90% of patients as well as long-term (>12 months) relief of symptoms in up to 75% patients. (Click to read paper).
UFE is a treatment which treats all the fibroids while preserving the uterus. Since the uterus is preserved, there is a small chance that over the years new fibroids can form in the uterus. These new fibroids take many years to grow and many cases are not symptomatic. In rare cases where they are causing you symptoms, the procedure can be repeated. Firboids can also recur after myomectomy. The risk of them coming back is higher for myomectomy than UFE, because unlike UFE, myomectomy does not remove all the fibroids, small or inaccessible fibroids are left behind and these can grow with time.
Foods to Help Prevent or Shrink Fibroids
There isn’t a single diet that can magically prevent or treat fibroids, but some studies suggest that certain foods may help reduce the risk. Adjusting your diet might also help minimize symptoms by lowering hormone levels that fuel fibroids.
Beneficial Foods for Fibroids
Foods to Avoid
Exercise and Healthy Lifestyle Tips
Pairing a healthy diet with regular physical activity can further reduce fibroid symptoms. Daily activities like walking can help by boosting endorphins, which are natural painkillers, and improving overall mental health. Exercise also helps in maintaining a healthy weight, which can lower estrogen levels. Adopting a healthy lifestyle with balanced diet and exercise is key to managing fibroids effectively.
Lupron is a GnRH agonist, which blocks the production of estrogen from ovaries. It puts you in a state of temporary menopause. It can cause many side effects including hot flashes, headache, weight gain, vaginitis, decreased sex drive, depression and mood swings.
Lupron can shrink the fibroids as it blocks the estrogen, however, when the drug is stopped, the fibroids can regrow.
Adenomyosis is a condition where the tissue lining the uterus grows into the muscular wall of the uterus. This can cause pain, heavy periods, and discomfort and significantly affect the quality of life of affected women. Adenomyosis is common, especially among women in their 30s and 40s who have had children. While exact numbers vary, it’s estimated that around 20-30% of women of reproductive age may have this condition.
Symptoms:
The most common symptoms of adenomyosis include:
Diagnosis:
Traditionally, the diagnosis of adenomyosis was often made form pathologic analysis of uterus from hysterectomy. Often patients were misdiagnosed with fibroids and their hysterectomy specimens showed adenomyosis as the real culprit. Today, magnetic resonance imaging (MRI) is considered the best test (gold standard) for diagnosing adenomyosis.
Almost all of the insurance providers cover UFE for symptomatic fibroids.
Yes, UFE is a global treatment and it treats all the fibroids that are present in the uterus.
No, there is no blood loss during UFE proceudre.
Dr. Mohan will be personally performing your procedure at Florida Interventional Institute.
Dr Mohan has a great bedside manner and quiet confidence about him that puts you at ease. I first met him when he performed microwave ablation on my husband’s liver as part of his cancer treatment. One year later Dr Mohan did ablation laser therapy on my varicose veins.
Dr. Mohan makes the most complicated and complex surgeries easy and fun for the patient. He is very caring and has impeccable “Bedside Manners” which is most comforting for an afraid patient. Can’t wait to visit him again. Thanks.
Dr. Mohamed Saved my life! The care leading up till I got accepted for my liver transplant was nothing but the best and most professional and at times difficult. Being the cancer had to be controlled and not spread through out it was just that… he controlled it, got rid of it, explained every procedure thoroughly.
