Should I Have Uterine Fibroid Embolization for Uterine Fibroids?

Introduction

This is a general overview of issues that are important as you decide how to treat uterine fibroids. This information will help you understand your choices, whether you share in the decision-making process or rely on your doctor's recommendation.

Key points in making your decision

Consider the following when making your decision:

Uterine fibroid embolization (UFE) (or uterine artery embolization) shrinks or destroys a uterine fibroid by injecting tiny particles into arteries, closing off the blood supply to the fibroid.
UFE does not always cure fibroids. In one study, nearly 1 in 5 women who had UFE had a repeat UFE or a hysterectomy within 3½ years.¹
If you have severe fibroid symptoms that have not improved with other treatments and you have no childbearing plans, then UFE may be a good treatment option in place of fibroid surgery.
Although pregnancy is possible after uterine fibroid embolization, you cannot count on it. Pregnancy after UFE may be higher-risk than normal. UFE also has a risk of damage to an ovary or the uterus, which would make pregnancy very unlikely.
If you are approaching menopause, consider that fibroids usually improve on their own after menopause. (For short-term relief of severe symptoms, you can consider hormone therapy with gonadotropin-releasing hormone analogue [GnRH-a] therapy.)

Medical Information

What are uterine fibroids?

Uterine fibroids are noncancerous growths in the uterus. Fibroids can grow on the inside of the uterus , within the muscle wall of the uterus , or on the outer surface of the uterus . Fibroids can change the shape of the uterus as they grow. This can cause pregnancy problems. Over time, the size, shape, location, and symptoms of fibroids may change.

The cause of uterine fibroids is not known. But after fibroids develop, the hormones estrogen and progesterone appear to influence their growth. A woman's body produces the highest levels of these hormones during her childbearing years. After menopause, when hormone levels decline, fibroids often shrink or disappear.

Fibroids are also called myomas, leiomyomas, and fibromas.

What are the symptoms of uterine fibroids?

As women age, they are more likely to have uterine fibroids, especially from their 30s and 40s until menopause. About 80% of women have uterine fibroids by the time they reach age 50. Most have mild or no symptoms.² But fibroids can cause serious problems that need treatment.

Uterine fibroids usually need treatment when they cause:

Anemia from heavy fibroid bleeding.
Ongoing low back pain or a feeling of pressure in the lower abdomen (pelvic pressure).
Blockage of the urinary tract or bowels.

Fibroid problems that need treatment—but not with uterine fibroid embolization—include:

Infertility caused by fibroids that change the shape of the uterus or the location of the fallopian tubes.
Complications during pregnancy, such as miscarriage or premature labor.
Infection, if the tissue of a large fibroid dies.

What is uterine fibroid embolization?

Uterine fibroid embolization (UFE) is a nonsurgical procedure that blocks blood flow to fibroids in the uterus. Fibroids treated with UFE shrink by half or more. Normal uterine tissue usually remains unharmed, because it is supplied by other arteries.³

During UFE, a thin, flexible tube called a catheter is threaded into a blood vessel in the upper thigh (femoral artery). A substance called contrast material is then injected into the catheter. The radiologist uses real-time X-ray on a video screen (fluoroscopy) to see the arteries and guides the catheter to the arteries that supply blood to the fibroid. A solution of polyvinyl alcohol (PVA) particles is injected into those uterine arteries through the catheter. These particles build up in the targeted arteries and block blood flow.

UFE is a fibroid treatment for women who have no childbearing plans. This is because some women have developed ovary damage, early menopause, or infertility after UFE.⁴ This procedure must be performed by a highly experienced interventional radiologist, because it carries risks of serious complications.

When is uterine fibroid embolization an option for the treatment of uterine fibroids?

Uterine fibroid embolization is used to control heavy, prolonged menstrual bleeding when:

Bleeding has not responded to other treatments.
You have no future childbearing plans.
You prefer not to have a hysterectomy to control bleeding. (On rare occasions, emergency hysterectomy is needed to treat UFE complications.)
Other medical problems, such as severe lung or liver disease, make it dangerous for you to have general anesthesia for a hysterectomy.

How effective is uterine fibroid embolization for the treatment of uterine fibroids?

UFE is usually an effective treatment. But in one study, about 1 in 5 women who had UFE needed another UFE or a hysterectomy within the next 3½ years.¹

Shorter-term studies have reported that:³

About 85% of women treated with UFE have said that their fibroid-related symptoms improved.
Uterine fibroid embolization shrinks fibroids an average of 48% to 78%.
After 6 years, uterine fibroids return in 10% to 27% of women treated with UFE.

Although there are reports of pregnancy after uterine fibroid embolization, experts do not yet fully know the risks to pregnancy. There appear to be more pregnancy complications than normal after UFE.⁴

What are the risks of uterine fibroid embolization?

The risk of complications after uterine fibroid embolization is low but includes:⁵

Infection. This is the most serious, potentially life-threatening complication of UFE. See your doctor immediately if you have a high fever and feel ill or notice pus in your vaginal discharge. In rare cases, emergency hysterectomy is needed to treat an infected uterus.
Loss of menstrual periods (amenorrhea).
Premature menopause.
Scar tissue formation (adhesions).

For more information, see the topic Uterine Fibroids.

Your Information

Your choices are:

Have uterine fibroid embolization to treat symptoms caused by uterine fibroids.
Choose a method other than uterine fibroid embolization to treat symptoms caused by uterine fibroids.

The decision about whether to have uterine fibroid embolization takes into account your personal feelings and the medical facts.

**Deciding about uterine fibroid embolization**
Reasons to have uterine fibroid embolization	Reasons not to have uterine fibroid embolization
Heavy vaginal bleeding is causing anemia. Uterine fibroid symptoms are severe and decrease your quality of life. Treatment with medicine has not controlled your symptoms. You have no future childbearing plans. You are many years from menopause, when fibroids likely will improve on their own. You have another condition or disease that would make treatment with medicine or surgery risky. Your symptoms are severe enough to outweigh the risks and discomforts of uterine fibroid embolization. Are there other reasons that you might want to have uterine fibroid embolization?	You are not troubled with heavy menstrual bleeding. Symptoms of uterine fibroids are not severe or do not decrease your quality of life. You have not tried other treatments to control your symptoms. You hope to become pregnant in the future. You are approaching menopause, when fibroids likely will improve on their own. You do not have any other conditions or diseases that would make treatment with medicine or surgery risky. Your symptoms are not severe enough to outweigh the risks and discomforts of uterine fibroid embolization. You prefer to have a hysterectomy or myomectomy. Are there other reasons that you might not want to have uterine fibroid embolization?

These personal stories may help you make your decision.

Wise Health Decision

Use this worksheet to help you make your decision. After completing it, you should have a better idea of how you feel about having uterine fibroid embolization to treat uterine fibroids. Discuss the worksheet with your doctor.

Circle the answer that best applies to you.

I have severe symptoms of uterine fibroids.	Yes	No	Unsure
My symptoms are gradually getting worse.	Yes	No	Unsure
My menstrual bleeding is severe or lasts longer than 7 to 10 days.	Yes	No	Unsure
I have been told that I have anemia caused by heavy menstrual periods.	Yes	No	Unsure
I wish to become pregnant.	Yes	No	Unsure
I am approaching menopause.	Yes	No	Unsure
Treatment with prescription medicines, such as leuprolide (for example, Lupron), has failed to relieve my symptoms.	Yes	No	NA*
I have other medical conditions (such as kidney failure, liver failure, or a bleeding disorder) that would make other treatments risky.	Yes	No	NA
I have had a blood clot in my legs or lungs.	Yes	No	NA

*NA = Not applicable

Use the following space to list any other important concerns you have about this decision.

What is your overall impression?

Your answers in the above worksheet are meant to give you a general idea of where you stand on this decision. You may have one overriding reason to have or not have uterine fibroid embolization.

Check the box below that represents your overall impression about your decision.

Leaning toward having uterine fibroid embolization

Leaning toward NOT having uterine fibroid embolization

Return to the topic Uterine Fibroids.

References

Citations
Edwards RD, et al. (2007). Uterine-artery embolization versus surgery for symptomatic uterine fibroids. New England Journal of Medicine, 356(4): 360–370.
Day Baird D, et al. (2003). Highly cumulative incidence of uterine leiomyoma in black and white women: Ultrasound evidence. American Journal of Obstetrics and Gynecology, 188(1): 100–107.
Smith SJ (2000). Uterine fibroid embolization. American Family Physician, 61(12): 3601–3607.
American College of Obstetricians and Gynecologists (2004, reaffirmed 2006). Uterine artery embolization. ACOG Committee Opinion No. 293. Obstetrics and Gynecology, 103(2): 403–404.
Walker WJ, Pelage JP (2002). Uterine artery embolisation for symptomatic fibroids: Clinical results in 400 women with imaging follow-up. British Journal of Obstetrics and Gynaecoloogy, 109(11): 1262–1272.

Credits

Author	Kathe Gallagher, MSW
Editor	Kathleen M. Ariss, MS
Associate Editor	Pat Truman, MATC
Primary Medical Reviewer	Kathleen Romito, MD - Family Medicine
Specialist Medical Reviewer	Kirtly Jones, MD - Obstetrics and Gynecology
Last Updated	August 16, 2007

Author:	Kathe Gallagher, MSW	Last Updated: August 16, 2007
Medical Review:	Kathleen Romito, MD - Family Medicine Kirtly Jones, MD - Obstetrics and Gynecology
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