The little book of Uterine Fibroid Embolization

The Little Book of Uterine Fibroid Embolisation

Compilation of Frequently

Asked Questions on the minimally !

invasive procedure!

?

A publication of

THE LITTLE BOOK OF UTERINE FIBROID EMBOLIZATION

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Getting rid of these benign tumors?

If you are led to believe by your doctor that hysterectomy is the only

solution, maybe it’s time you changed your doctor. Studies suggest

that 80% of the hysterectomies done are unwarranted. Fibroids and

the hormonal imbalance are as it is causing enough havoc to your

emotions and a doctor who is too quick to suggest a hysterectomy

doesn’t seem to be making things better.

Your treatment option should be zeroed in after carefully evaluating

various factors such as its symptoms and severity, the type, size and

number of fibroids, its location, your age and child bearing potential.

Uterine fibroid embolisation (UFE, also known as uterine artery

embolisation) has been gaining popularity and acceptance as a safe

and effective alternative to hysterectomy surgery for treating fibroids.

Read on to understand more about this much sought after procedure

and when & why you should consider it as an option for treating your

fibroids.

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What is Uterine Fibroid Embolisation?

Uterine fibroid embolisation, also called UFE, is a minimally-invasive,

uterus-sparing procedure that shrinks fibroids by cutting off their

blood supply. A small catheter is inserted through a tiny nick in the

upper thigh into the blood vessels near the fibroids and tiny particles

are injected through the catheter to block blood flow to the fibroids.

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02 How do I know if I am a candidate for uterine fibroid embolisation?

Whether or not a patient is a candidate for UFE depends on the

exact size, number and location of the fibroids as well as the

patient's symptoms. A detailed medical history and pelvic MRI are

necessary prior to making a final determination.

The ideal candidate is a patient who no longer desires fertility, has

multiple small to medium size fibroids and whose primary clinical

symptom is heavy menstrual bleeding (menorrhagia).






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If I would like to maintain fertility, could I still be a candidate for UFE?

The ideal candidate for uterine fibroid embolization has no desire for

future fertility. While there have been multiple anecdotal reports of

normal pregnancies following uterine fibroid embolization in the

medical literature, it is currently unknown whether there is any

increase risk of infertility or pregnancy following this procedure.

Therefore, UFE is generally not recommended in patients who still

desire fertility unless: The patient has failed other treatment options

such as myomectomy and the only other option is hysterectomy; Due

to the size, number, and/or location of the fibroids, there is a relatively

high risk of a myomectomy resulting in a hysterectomy or causing

significant scarring within the uterus, thus eliminating or significantly

decreasing the patient's fertility.

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Is UFE a safe procedure? UFE has been performed safely in thousands of women worldwide. While

no procedure is without risk, fibroid embolization has been shown to have

a lower major complication rate than traditional surgical treatment options

such as myomectomy.

The two most serious potential complications are infection and ovarian

failure leading to premature menopause. Infections are extremely

uncommon and can usually be treated with oral or IV antibiotics. Rarely

(much less than 1 percent), a severe infection can develop and may require

the patient to undergo a hysterectomy.

Ovarian failure leading to premature menopause is also relatively

uncommon occurring in 1 to 2 percent of most patients and 2 to 4 percent

of women nearing menopause.

According to the combined results of major studies of UFE, the

average success rate is approximately 94 percent. A successful

procedure significantly reduces or eliminates uterine fibroid

symptoms and requires no further treatment with surgery or other

options.

What is the success rate of UFE?

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94 %






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What happens to the fibroids after embolisation?

After losing their blood supply, the fibroids shrink

an average of 50 percent in size and also change in

composition. They change from a heavy muscular

tissue to a much lighter spongy, scar-like tissue that

no longer has a blood supply. Small fibroids are

very rarely completely re-absorbed or disappear.

What happens to the normal uterine tissue after uterine fibroid embolisation?

After UFE, the fibroids shrink and die while the normal

uterus and uterine tissue lives. It is thought that the normal

uterine tissue survives due to its ability to recruit new blood

supply from other areas of the pelvis, while the fibroids rely

solely on blood supply from the uterine arteries.

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94% of UFE patients experienced 50-60

percent fibroid shrinkage.






Can UFE be performed regardless of the number and size of the fibroids?

UFE can be performed irrespective of the number and size of

fibroids , there is no set limit involved.

Are there any types of fibroids that cannot be treated with UFE

Most fibroids can be successfully treated using uterine fibroid

embolisation. Moderate-to-large pedunculated fibroids (those that

hang from the uterus by a stalk) are the only types of fibroids that

are generally not treated with UFE.

This is because there is a small chance of the stalk breaking after

the fibroid loses its blood supply after which the fibroid may fall

into the pelvis and cause additional problems.

Patients with these types of fibroids can be considered as

candidates for joint procedures using a combination of uterine

fibroid embolisation and laparoscopic myomectomy.

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Can fibroids be completely removed after the procedure?

Fibroids begin to shrink post procedure and die over time.

They shrink primarily in the first six months, but they may

continue to shrink for up to a year. Although fibroids never

completely go away, they usually become small enough to

relieve most symptoms including heavy bleeding, pressure,

frequent urination and pain.

Do fibroids grow back after UFE?

A successful UFE procedure treats all fibroids that are present on the day of the

procedure, regardless of size, number, or location. Once fibroids infarct they are

dead and do not regrow. If, however, a fibroid's blood supply is not completely

eliminated, it could continue to grow and cause symptoms.

For women who have initially responded to UFE there are few reported

recurrences of fibroids. Once menopause is reached there is usually no further

growth of fibroids.

By comparison, approximately 30 percent of patients have a recurrence of

fibroids after myomectomy.

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Can Fibroids b

e

completely

Removed after

UFE?? �

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12 How long does the UFE procedure take?

The fibroid embolisation procedure usually takes

approximately one hour to perform. During the

procedure, you will be awake but given IV medication

to make you sleepy.

Is UFE Painful? 13

The uterine fibroid embolization procedure itself is painless.

The only pain encountered by the patient is the local

anesthetic shot at the puncture site near the right hip (like a

shot at the dentist's office). The procedure does not require

general anesthesia (or for the patient to be put completely to

sleep).

Immediately following the procedure, however, a majority of

patients develop pain as part of the post-embolization

syndrome. This pain begins immediately after the procedure,

increases for 8 to 12 hours, and usually improves significantly

by the following morning.






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Other symptoms which may be encountered as part of the post

embolisation syndrome include nausea or vomiting, low-grade fevers, a lack

of energy, and vaginal discharge. The morning after the procedure, the

symptoms usually improve to a point were they can be easily controlled

with oral medications provided for the patient at the time of discharge to

take home.

What other symptoms I might experience post procedure? 14

How long do I stay at the hospital after the procedure?

After the procedure , patient is

maintained at the healthcare unit for 2-3

days to rule out complications. Some

providers observe only overnight stays

before discharging the patient.

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What type of follow-up is required after the UFE procedure

After the procedure, patients are asked for routine

follow-up in seven to 10 days. One must continue

routine gynecologic exam once in 2-3 months.

MRI is recommended in six to nine months to

assess the results of embolization and to insure

that the blood supply to the fibroids is eliminated.

How long will it take for my symptoms to resolve following UFE?

Most patients notice a difference in heavy menstrual bleeding

(menorrhagia) by their next cycle. Bulk related symptoms including

pelvic pain, pressure, frequent urination and constipation may

take up to 3-5 months to notice a significant difference.

How quickly your symptoms resolve depends largely upon the

exact size number and location and your fibroids.

A patient's symptoms may continue to improve for up to 18 to 24

months after the procedure although most patients experience

maximum benefit within one year.

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17

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•  Doctor Follow up �•  MRI appointment ��








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Most women notice a lighter flow right away.

Some women, however, may not notice a

significant decrease in menstrual bleeding until

after their first few periods following UFE

Will my heavy periods go away after the procedure?

How successful is UFE in controlling symptoms caused by fibroids?

Heavy menstrual bleeding (menorrhagia) is controlled in 85 to

95 percent of patients after their procedure. Bulk related

symptoms such as pelvic pain, pelvic pressure, frequent

urination, constipation, back pain and painful intercourse are

controlled in 80 to 95 percent of patients undergoing UFE.

Careful pre-procedure planning and evaluation are vital to

increasing the chance of a successful outcome.

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99% of patients Post UFE experienced immediate

relief from heavy bleeding






Will UFE affect my Sexual Response?

Most patients report either no change or improvement in their sexual

desire and response after UFE. Those women with dyspareunia (pain

during intercourse) caused by fibroids usually improve.

Concerns about effects of UFE on sexuality should be discussed with

your Interventional Radiologist during the initial consultation.

How soon can I have sex post procedure?

Patients may generally resume sex and other

normal activities in about a week.

Because UFE usually does not affect the ovaries, most women

will not experience the hormonal changes or depressions that

are common with hysterectomy/removal of the ovaries. Women

near the age of menopause, however, may be more likely to

start menopause after UFE.

Will I experience any hormonal changes after the procedure?

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How quickly can I go back to work?

Generally women return to most of their normal activities in about 7 to 10

days. The interventional radiologist will provide you with written post-

procedure instructions to ensure that you are comfortable in your recovery.

Some women recover more quickly than others, and your personal results

may vary.

Recovery time for UFE patients is much shorter

than hysterectomy or myomectomy , which can

lead up to 6 weeks or more.

You may resume your usual diet and

medications immediately. You are however,

recommended to take fluids. Drinking plenty of

liquids may be helpful as well to prevent any

constipation that may occur due to intake of

painkillers.

Will I have to take special diet after UFE procedure?

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99% of patients returned to work in less than a week







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Who is an Interventional Radiologist?

Interventional Radiologists are specially trained doctors who use their

expertise in reading x rays, ultrasound, and other medical images to

guide small instruments through blood vessels and other pathways to

treat disease without an open surgical incision.

Most procedures performed by Interventional Radiologists are

minimally invasive (that is they do not require an open surgical incision)

and are performed using imaging guidance (x-ray fluoroscopy, CAT

scan, ultrasound, and/or MRI).

The procedures performed by an Interventional Radiologist are

typically less invasive and much less costly than traditional surgery.

Interventional Radiologists are specially trained in performing these

procedures and this training is certified by the American Board of

Medical Specialties.

While gynecologists are specially trained to performed

hysterectomies, myomectomies and other less invasive laparoscopic

and hysteroscopic surgical procedures, most of them have not been

formally trained and therefore do not possess the skills necessary to

perform uterine fibroid embolization.

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The scan confirmed it. I was suffering from uterine fibroids. Internet assured me that I was not the only one

suffering (wonder whether I can draw solace from that!). Fibroids are pretty common. These benign tumors

occur in more than 70% of women. “

I had heavy irregular bleeding, which was very unpleasant and inconvenient. Being a Business Director required me to travel frequently and planning my trips around my dates was getting bothersome. That was when I decided a trip to my gynaec was needed. She examined me, did a couple of tests and informed that I was suffering from uterine fibroids which required treatment and put me on medication for temporary relief to reduce the heavy bleeding.

Omolora Sule was treated of uterine fibroids in April 2013 at a well known Hospital in

India

Hysterectomy versus Myomectomy versus Embolisation. Which is best?

READ FULL STORY OF OMOLORA SULE

My gynaec explained that not all fibroids require treatment and do not result in health problems. But given my history of hypertension and obesity, she recommended very strongly that I should have a hysterectomy to remove the fibroids. I am not sure what I expected to hear but just the thought of hysterectomy had me nearly fainting. The mere mention of surgery brought on a panic attack in me. Friends suggested I take a second opinion and that was when we contacted Makewell. That I believe was the turning point of my quest for a fibroid free life.


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WANT TO TRAVEL ABROAD FOR UTERINE FIBROID EMBOLISATION? Rely on our expertise for a Hassle Free Medical Travel

Designing your personal treatment strategy to treat Fibroids requires a lot of careful thought. We urge you to speak about your case and get your personalized Treatment Plan.

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End Notes

Northwest Radiology Associates. (2013). Uterine Fibroid Embolization .Available: http://www.fibroiddoc.com/contact-us/. Last accessed 23th October 2013. Duke Health. (2011). FAQ - Uterine Fibroids Embolization . Available: http://www.dukehealth.org/services/radiology/care-guides/uterine-fibroid-embolization-ufe/faq-uterine-fibroid-embolization. Last accessed 22nd October 2013. Hampton Road centre. (2012). Fibroids Embolization . Available: http://www.ufecenter.com/faqs.html. Last accessed 21st October 2013. Steve Eisinger, M.D., F.A.C.O.G.. (2008). Uterine Fibroids Facsheet.Available: http://womenshealth.gov/publications/our-publications/fact-sheet/uterine-fibroids.cfm#j. Last accessed 21st October 2013. UAB Medicine. (2012). Uterine Fibroid Embolization . Available: http://www.uabmedicine.org/conditions-and-services/fibroid-embolization#benefits. Last accessed 22nd October 2013. RIA Endovascular. (2011). Uterine Fibroid Embolization . Available: http://www.riaendovascular.com/services-procedures/womens-interventional-procedures/uterine-fibroid-embolization/#Benefits of the uterine fibroid embolization procedure. Last accessed 23th October 2013. CIRSE. (2010). Increased patient demand for Uterine Fibroids Embolization . Available: http://www.cirse.org/files/files/CIRSE%202010/8-UFE_PR.pdf. Last accessed 23th October 2013. WWW.MAKEWELLGLOBAL.COM




The little book of Uterine Fibroid Embolization

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