Most fibroids don’t cause symptoms. Only 10 to 20 percent of women with fibroids have symptoms that require treatment. Symptoms may include:
- Heavy menstrual bleeding that tends to be prolonged
- Intermittent, unusual monthly bleeding
- Pelvic pain and pressure
- Painful menstrual cramping
- Frequency in urination secondary to bladder pressure
- Pain during sexual intercourse
- Increase in waist size
Uterine fibroids are categorized by their location within the muscular wall of the uterus.
Subserosal fibroids develop under the outside lining of the uterus. They typically don’t cause changes of menstrual flow, however they may cause pelvic or back pain, pressure, and/or bloating. Subserosal fibroids can have stalk or stem. These are called pedunculated subserosal fibroids.
Intramural fibroids are the most common type of uterine fibroid. These develop within the muscular wall of the uterus and tend to grow inward. They cause enlargement of the uterus and can cause heavy menstrual bleeding, generalized pelvic pressure, increased waist size, frequency in urination, and/or constipation.
Submucosal fibroids develop under the uterine cavity lining. Although they are the least common type, they cause the greatest symptoms. Even small subserosal fibroids can cause heavy menstrual bleeding with clots and gushing as well as prolonged cycles.
Typically an ultrasound can determine the presence of uterine fibroids. However, MRI (magnetic resonance imaging) is far superior in determining the presence, location, and type of fibroids. It is also a better test to diagnose other uterine and pelvic pathology that may be the cause of the symptoms. It is necessary prior to UFE.
UFE, also known as uterine artery embolization, is performed by an interventional radiologist, a physician who is trained to perform this and other types of minimally invasive procedures, including embolization. UFE doe snot require general anesthesia and is performed while the patient is conscious, but sedated and feeling no pain. The physician makes a tiny nick in the skin in the groin and inserts a catheter into the femoral artery. Using real-time imaging, the physician guides the catheter through the artery and then releases tiny embolic particles, the size of grains of sand, into the uterine arteries that supply blood to the fibroid tumor. This blocks the blood flow to the fibroid tumor and causes it to shrink and die.
UFE can be performed safely in an outpatient setting. Non-steroidal medication (e.g., Motrin) and pain killers are prescribed for several days following the procedure to help control pain and cramping. In addition, medication for nausea may be prescribed as needed. Most women resume light activities in a few days and are able to return to normal activities within ten days. In comparison, recovery time after a hysterectomy is approximately six weeks.
- 85-90 percent of women experience significant relief from symptoms
- UFE is effective on most sizes and types of fibroids
- Recurrance of treated fibroids is rare
- Approximately 14,000 UFE procedures are performed annually in the US
- Embolization of the uterine arteries has been performed by interventional radiologists for more than 20 years; it was and still is used to treat life-threatening bleeding after childbirth
- The embolic particles are FDA approved and have been in use in people for more than 20 years
- UFE is covered by most major insurance companies
- It is an organ sparing procedure
- UFE preserves fertility with numerous reports of successful pregnancies after UFE
UFE is a very safe method and, like other minimally invasive procedures, has significant advantages over conventional open surgery. However, as with any medical procedure, there are some associated risks. A small number of patients have experienced infection, which usually can be controlled by antibiotics. There also is a less than one percent chance of injury to the uterus, potentially leading to a hysterectomy. These complication rates are lower than those for hysterectomy and myomectomy.