Fibroids are benign non-cancerous growths within the uterus. They are often a common cause of heavy menstrual bleeding, pelvic pain, anemia, bloated abdomen, constipation, pain during intercourse and a frequent need to urinate. African-American women and those with a family history of fibroids are more likely to develop fibroids.
Uterine Fibroid Embolization (UFE) is a minimally invasive procedure that blocks the blood supply to fibroids causing them to shrink. Most UFE procedures are performed in the angiography suite under mild-moderate sedation and local anesthesia. The interventional radiologist inserts a thin tube through the artery at the top of the thigh and uses X-Ray (fluoroscopy) to guide it to the uterine artery. X-Ray dye is injected into the uterine arteries to identify the catheter position and once this is confirmed tiny particles are injected into the blood vessels which block the flow to the fibroids and causes them to shrink. The procedure usually takes between 60-90 minutes. After the procedure patients are monitored for several hours to ensure a comfortable recovery and may stay overnight in the hospital.
UFE allows the patient to recover quickly and return to a normal work routine within a week compared to a hysterectomy where there is typically a 6 week recovery period.
Preparing for Uterine Fibroid Embolization:
- A representative will call you prior to your procedure to review instructions and complete registration.
- You will be asked to complete a pelvic MRI scan prior to your procedure to determine the anatomy of the uterus and the vascularity of the fibroids.
- Your procedure may require an overnight hospital stay to monitor any discomfort and check for bleeding. If so, hospital registration may be required to complete the registration process.
- You will need to arrange for a driver to take you home.
- Make sure to let your doctor know if you are taking blood thinners (Aspirin, Lovenox, Plavix, Heparin, or Coumadin). You may be asked to stop taking these medications prior to your procedure.
- Do not eat or drink anything for 12 hours prior to your procedure
- The procedure itself is not painful however light sedation medications will be administered through an IV in order to prevent any discomfort.
- A catheter may be placed in your bladder to make you comfortable with urination during and after the procedure.
- A small catheter is placed into the artery in the leg and advanced into the uterine arteries under X-Ray guidance. An arteriogram (injection of contrast dye) into the arteries is performed to provide a roadmap of the blood supply to the uterus.
- Both uterine arteries are embolized during the procedure in order to ensure the entire blood supply to the fibroids is blocked.
- Your procedure may require an overnight hospital stay for observation.
- After the procedure you may experience mild pain/cramping in the pelvic area, nausea or low grade fever.
- You may begin to eat a regular diet once you are able to tolerate food.
- Patients are typically discharged home after one night in the hospital and a follow up appointment is scheduled at that time.
- You may resume your normal activites after 48 hours and return to work within 1 week.
If you develop fever or severe pain contact our office at 352-333-7847 (7VIP) or call your referring physician. After hours or on weekends, go to the nearest emergency room or call North Florida Regional Medical Center at 352-333-4000 and ask for the Interventional Radiologist on call.
Frequently Asked Questions
Q. Is the UFE procedure painful?
A. Not Usually. You may experience pelvic pain, similar to menstrual cramping but sometimes described as “heaviness” . This is the body’s reaction to the decreased blood supply to the uterus. In addition, you may experience low energy, intermittent nausea, and possibly fever. This occurs in response to the death of the fibroid tissue. These symptoms typically last a few days and gradually decrease in severity. By the fourth or fifth day after the procedure, most women feel back to normal. Cramping may last a few more days.
Q. How soon can I resume my normal activity?
A. Light at-home activity is recommended for 3-4 days with no prolonged periods of time on your feet. It is recommended that you take a week off from work. You may return to unrestricted activity, including sexual activity and exercise 7 days after the procedure. Travel plans should be limited to short distances for two weeks.
Q. Will I have to observe a special diet?
A. You may resume your usual diet and medications immediately. Drinking plenty of liquids may also be helpful as well to prevent any constipation that may occur with strong pain medicines.
Q. What kind of medication will I need to take?
A. You will be given a prescription for medication to take over the next 7-10 days to help manage pain and nausea that may occur. It is recommended that you take the anti-inflammatory medicine (Toradol) for the next 3 days. If this medicine is not helpful, you may take whatever anti-inflammatory medicine that usually works for you (Ibuprofen, Motrin, Naprosyn, etc.). A stronger pain medication can be taken on an “as needed” basis. Also, a medication for nausea can be taken as needed. If these medications do not seem to be helpful, please call and we can prescribe an alterative.
Summary: Anti-inflammatory e.g. Toradol 10mg three times/day (or your alternative)
Pain relief e.g. Percocet 1-2 tabs every 4-6 hrs as needed
Anti-nausea e.g. Zofran 8mg twice a day as needed
Q. What do I need to know about the puncture site?
A.The catheter site is covered with a small dressing and can be removed in 24 hours. You may shower and wash gently over this area, then apply a band-aid for one more day. After this, you may leave the area uncovered. It is not unusual to notice some discoloration or bruising in this area. If you notice marked swelling or active bleeding, apply direct pressure with your fingers and either call for assistance or go to the nearest emergency room for evaluation. This is very UNCOMMON. A small “knot” may develop under the skin which typically resolves in 2-3 weeks. This is part of the normal healing process. Persistent pain at the puncture site is also uncommon but may be due to irritation of the nerve that lies next to the artery. This also is treated with anti-inflammatory medicine and usually resolves on its own.
Q. What do I do if I have a fever?
A. You may experience a mildly elevated temperature in the few days following the procedure. This can occur in 10-15% of cases but DOES NOT necessarily indicate infection. Motrin or Tylenol may be helpful in relieving this. Persistent, high fever (greater than 101.5), lasting more than 3 days MAY indicate infection and you should immediately call the Vascular & Interventional Physicians (VIP) office (352-333-7847). Infections are more likely to occur several weeks later rather than right after the procedure.
Q. What should I expect regarding menstrual periods/spotting/discharge?
A. A brownish or reddish vaginal discharge or spotting is considered normal following the embolization and may continue for 7-14 days or until your next period. Use of a sanitary napkin is preferred over a tampon in the first week after the procedure. A clear, watery discharge has also been described following the procedure. Of some concern is if a thick or foul-smelling discharge is noted, especially if there is pelvic pain and fever additionally. This may indicate infection and you should immediately contact the Vascular & Interventional Physicians (VIP) office or, if after hours, the Interventional Radiologist on call at North Florida Regional Medical Center (NFRMC). There may be a change in the first menstrual period following UFE, particularly if heavy bleeding was the predominant symptom before UFE. However, some women will not experience any change for 2-3 months until the fibroid has begun to shrink. Likewise, women whose pre-UFE symptoms were more related to pressure on the bladder may not experience improvement for a few months, since it can take time for the fibroid to fully shrink. Do not be discouraged if your symptoms do not improve immediately.
Q. Will I need a check-up?
A. The VIP office staff will call you the day after your discharge to check on your progress and answer any questions. At that time, a one week follow-up appointment will be scheduled to check the small incision site and arrange your 3 month follow-up visit. You should maintain your regular gynecologic care with your gynecologist.