Uterine Fibroid Embolization (UFE) is a non-surgical, minimally invasive procedure that helps reduce or eliminate symptoms caused by fibroids. Fibroids are growths in the uterus, and UFE works by cutting off their blood supply, causing them to shrink and eventually die.
This page explores common questions regarding the UFE procedure.
During the Uterine Fibroid Embolization procedure, your doctor uses real-time ultrasound and x-ray imaging (fluoroscopy) to access the artery supplying blood to the fibroids. Tiny particles, similar in size to sand, are then injected into the artery, blocking the blood flow to the fibroids. Without blood, the fibroids’ cells die, leading to a reduction in size. Over time, symptoms associated with fibroids decrease. Research indicates that approximately 90% of women who undergo UFE experience significant improvement or complete resolution of their symptoms. Interventional Radiologists have successfully performed Uterine Fibroid Embolization for over 20 years.
Fibroids are growths in the uterus that need a blood supply to survive and grow. In the UFE procedure, we intentionally block this blood supply, causing the fibroids to die. Initially, they become softer and turn into a liquid, eventually shrinking in size. On average, there’s about a 40% reduction in fibroid volume three months after UFE, increasing to 65% by six months. This usually leads to both significant symptom relief (around 90%) and a decrease in the size of the fibroids.
During the UFE procedure, which lasts less than an hour, patients are asleep and receive conscious sedation, similar to a colonoscopy. A local anesthetic is applied in the groin/thigh area or the wrist area, a small needle is inserted, and a catheter is guided under X-ray to the blood vessel that supplies of the uterus. Tiny particles are then injected into the fibroid vessels. These particles flow with the blood and when they reach the tiny vessels supplying the fibroids, they block cut off the blood nourishing the fibroids.
Note that women without symptoms don’t require fibroid treatment. Treatment is typically recommended for those experiencing symptoms.
According to studies, about 90% of women who undergo this procedure typically find significant or complete relief from issues like heavy bleeding, pain, or symptoms related to bulkiness. In simpler terms, most women feel much better after the treatment. For the remaining 10%, there might be slight improvement or no change, but it’s rare for things to get worse. Importantly, this procedure is effective even if you have many fibroids or particularly large ones. It has been shown to work well in those situations too.
Uterine Fibroid Embolization (UFE) is a great choice for women with fibroids who prefer to avoid surgery and long recovery times. Unlike surgery, UFE doesn’t involve hospitalization, stitches, or scarring, and it preserves your uterus.
Here are the key benefits of UFE:
In terms of risks, uterine fibroid embolization (UFE) is generally safer than surgical options for treating fibroids. Here are the main risks associated with the procedure:
During a Uterine Fibroid Embolization (UFE) procedure, you’ll enter a room equipped with specialized tools, including an interventional radiology table, X-ray machine, television-like monitor, ultrasound machine, and thin catheters resembling small wires.
Upon entering, you’ll move from your stretcher to the interventional radiology table, with an X-ray machine positioned above you. Monitoring devices will track your vital signs, such as blood pressure, oxygen levels, heart rate, and breathing throughout the procedure.
You’ll receive anxiety-relieving and pain-preventing medications through an IV, placing you in a state known as “twilight.” This might make you feel so comfortable that you fall asleep, but some patients might remain awake. In certain cases, your doctor may have discussed the use of general anesthesia with you beforehand.
Your wrist or groin area will be cleaned, and your body will be covered to maintain cleanliness. The artery in your wrist or groin will be accessed with a needle, similar to IV placement. Local pain medicine will be injected, causing a momentary sting or burn that will fade as the area becomes numb. An ultrasound guides the needle into the artery, and a small incision may be made at the needle site.
A catheter, a thin plastic tube thinner than a pencil lead, is placed into the accessed artery. The X-ray machine captures images as the catheter is positioned, with these images displayed on the monitor. The interventional radiologist uses these visuals to guide the catheter to the blood vessel supplying your fibroids. X-ray dye is often injected to highlight vessels on the screen, potentially causing a brief warm sensation.
You have arteries on both sides supplying the fibroids. When the catheter is in the artery on either side, small particles are injected. Contrast is used to confirm that the blood supply to the fibroid has ceased. The catheter is then directed to the other artery, and the process is repeated. You shouldn’t feel anything during particle injections, but a few may experience cramps toward the end of the procedure. Pain medication is injected to alleviate this discomfort.
After blocking both arteries with particles, the catheter is removed, and pressure is applied or a device is used to close the vessel. No visible stitches are needed; a dressing covers the tiny cut. Some providers do a nerve block to manage cramps, using a thin needle guided by the X-ray machine. This block can alleviate pain from the uterus for about 8-10 hours.
The entire procedure typically takes 1-3 hours, depending on your specific arterial anatomy and the size of the fibroids.
After a Uterine Fibroid Embolization (UFE) procedure, you may experience cramping in your lower abdomen for the first 24 hours. It’s similar to the cramps you might feel during your regular menstrual cycle, but don’t worry – this discomfort is a sign that the treatment is successful and the fibroids are dying.
If you’re able to drink liquids, have no bleeding from the entry point in your groin, and the oral pain medicine effectively controls your discomfort, you’ll be allowed to go home. You’ll be given painkillers to take for about a week.
You can gradually return to your usual light activities within 48-72 hours, but it’s important not to overexert yourself. Let your pain or discomfort be your guide. Make sure to eat healthy foods, stay hydrated, and consider using heating pads for any lingering discomfort. Taking it easy during this time is key to a smoother recovery.
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 hyperlink to the RCT paper), 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.
For women facing uterine fibroids, many of whom are of child-bearing age, preserving or improving fertility is a crucial consideration when deciding on treatment. Fertility following UFE is a topic of expertise of Dr. Mohan. He has conducted extensive research and published the first systematic review on this topic, which is considered the highest level of scientific evidence. This was published in the premier journal of Interventional Radiology – Journal of Vascular and Interventional Radiology as a featured article. (Click here to read the paper).
While hysterectomy (surgical removal of the uterus) makes fertility impossible, UFE and myomectomy (surgical removal of fibroids) leaves behind the uterus and gives you the option to become pregnant. In UFE, uterus is preserved as the fibroids within the uterus are the target, not the uterus itself. UFE gives you the option to preserve your fertility.
Early research on UFE (about 20 years old) suggested that it reduced the ovarian reserve. Ovarian reserve is an indication of how many good quality eggs you have remaining in the ovary for making babies. However, most of the women in these studies were around 45 years old, an age when the number of good quality eggs is already naturally decreasing, making fertility an issue. Another factor was that during the early days of UFE, smaller particles were used for UFE, which theoretically can cause ovarian damage. Nowadays, larger particles (over 500 microns) are used for UFE, which is safer. So, the idea that UFE harms fertility was based on data from women whose fertility was already low due to their age and from an older UFE technique. In reality, the findings were not accurate.
Patient experiences over the years later confirmed this. As more women chose to have UFE, many of these women went on to have successful pregnancies. Many who had trouble getting pregnant because of fibroids were able to conceive following UFE. This prompted further research on this topic which are summarized below.
Dr. Mohan is a pioneer on this topic and published the first systematic review on fertility following UFE in 2013, which is considered the highest level of research evidence. This study systematically reviewed all the prior research on this topic (21 studies) and showed that the chance of pregnancy for women undergoing UFE was the same as that of the general population, provided that the pregnancy rate was adjusted for the patient’s age. The average pregnancy rate following UFE was similar to the age adjusted pregnancy rates in the general population. (Click here to read the paper).
In another study from the US, researchers examined the impact of UFE on the ovarian reserves. They followed and tested 89 women, aged 23 to 40, for four years after their UFE treatments. The results showed that UFE did not reduce the number of good quality eggs they had. In fact, 32 of the 89 women actually experienced an increase in their ovarian reserve after the procedure. (Click here to read the paper).
In 2017, the journal Radiology published the results of a six-year study in which 359 women with fibroids who could not get pregnant before the procedure participated. During the 6 years after having UFE, 149 women (41.5%) became pregnant at least once, and 131 women gave birth to a total of 150 children. This was the first pregnancy for more than 85% of these women. (Click here to read the paper).
All these studies confirm that it is possible to become pregnant and have children after UFE. However, some studies have noted increased incidence of abortions, preterm delivery, and placental abnormalities in pregnancies following UFE. The rates of such occurrences in the published literature vary, and this is an area which needs further research. However, it should also be noted that myomectomy, which is the surgical alternative treatment for women who wish to become pregnant, is also associated with risks. Since myomectomy leaves a scar in the uterus, there is a small risk of uterine rupture with pregnancy and patients will need C-section for delivery. Myomectomy is also associated with premature birth and placental abnormalities.
In summary, it is possible to become pregnant and have children following UFE. Since the research in this space is still evolving, it is very important that you discuss your desire to preserve fertility with your provider.
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.
