Uterine Fibroid Embolisation (UFE)

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1 Uterine Fibroid Embolisation (UFE) Exceptional healthcare, personally delivered

2 What are Fibroids? Fibroids are benign, non cancerous, growths of the uterus (womb). They occur very commonly. How are Fibroids diagnosed? The diagnosis is best made by a gynaecologist who will perform an examination in the hospital clinic. Fibroids are then usually confirmed by an ultrasound scan of the uterus. At the time of the gynaecologist examination, a sample of cells may also be taken from the lining of the uterus. This procedure is mildly uncomfortable; similar to having a cervical smear, but its result will enable fibroids to be confirmed and other causes of your symptoms to be excluded. Often, other types of scan are also performed such as magnetic resonance imaging (MRI). Why do they need to be treated? Many fibroids do not cause any symptoms at all, and will not therefore require treatment. The most common symptom is menorrhagia heavy periods, which may be more painful than usual. Fibroids may also result in enlargement of the uterus and cause pressure on the bladder which results in a need to keep passing urine (a symptom known as frequency). They may also push on your back pasage or spine. Occasionally, fibroids may be so large that they are visible as a swelling on the lower part of the abdomen. 2

3 How will Fibroids be treated? They may not need to be! Often fibroids are found by chance as part of an examination for other reasons, e.g. pregnancy scanning. If the gynaecologist does advise treatment, there are four options:- a) Drug treatment: Current drugs are usually given for a maximum of six months. They may help symptoms for this time but are not a cure and have side effects which some women find unpleasant. Some patients are given a mirena coil which is put in position by the gynaecologist. This may help with the symptom of heavy bleeding. If this is the case, the coil can be left in place if you are to procede to UFE. b) Myomectomy: In some cases it may be possible to surgically remove fibroids (myomectomy) without taking the uterus itself. This means that future pregnancy remains possible. However, it is important to understand that hysterectomy (removal of the uterus) may very occasionally be necessary at the time of myomectomy. Fibroids may regrow after myomectomy, and in the long term about 1 in 10 women require further surgery.myomectomy may be performed as a normal operation, or by a keyhole technique. 3

4 c) Hysterectomy: This is the surgical removal of the uterus, usually including the cervix. Future pregnancy is impossible. The operation usually requires about 5 days in hospital and usual advice is to remain off work for 3 months afterwards. Separate information is available for this operation. d) : as discussed below. How is UFE done? Fibroids have a rich blood supply one of the reasons they cause problems with heavy periods. The aim of UFE is to restrict this blood supply by injecting tiny plastic type particles into the arteries supplying the uterus. This process is known as embolisation. The procedure is performed by a radiologist who is a specialist doctor trained in scan interpretation and certain types of key hole type surgery. The procedure is performed under x-ray guidance. Before the procedure, you will be given antibiotics, a mild sedative and a local anaesthetic in the groin. The doctor will then make a tiny nick in the skin just a few millimetres long, and will introduce a very fine tube through which the particles can be injected into the right place. It may be necessary to make nicks in both groins, depending on the situation found at the time. 4

5 Is this painful? The local anaesthetic may sting, and the placement of tubes (catheters) is only mildly uncomfortable for a short time at the beginning of the procedure. However, soon after the embolisation itself, it is usual to experience pelvic pain. This can be severe but can be controlled with strong painkillers (analgesics), and is the reason why you stay in hospital for 24hrs to make sure you are as pain free as possible. How will pain be controlled? One hour before the procedure starts, you will be given a suppository of Diclofenac (Voltarol). This will be placed in the back passage (rectum) by a nurse. As the suppository is absorbed into the bloodstream from the rectum it provides very good pain relief. Further suppositories may be used over the following 24 hours. During the procedure further analgesics, and possibly further sedation may be given into a vein. One of the advantages of this procedure is that you will NOT need a general anaesthetic. Following the procedure, you will be given more strong painkillers, usually this is only necessary for the first 8-12 hours after which the Voltarol suppositories and tablets are usually all that is necessary. What can I expect after the UFE? Some mild pain or discomfort is usual for some days after the procedure. The average time taken to return to normal is about 2 weeks. During this time many women experience a thick yellow/green vaginal discharge which is managed by sanitary 5

6 towels. You should not use tampons as there is a risk of infection with these. You may have a slightly raised temperature for up to a week afterwards, sometimes with feverish symptoms. If you have a high temperature (above 37 o ) more than seven days after the procedure you should contact the hospital. When will I notice a difference? It takes time for fibroids to shrink after embolisation. Gradual improvement can be expected for up to 6 months afterwards. How good is it? n On average, fibroids reduce to less than half of their preoperative size by 6 months but this ranges from very little reduction in some women to complete reduction in others. n 2 out of 3 of women get satisfactory relief of bleeding symptoms. n 2 out of 3 get satisfactory relief of pelvic pain. n Most women report the procedure as successful. Will I be able to have a baby afterwards? There have been a number of pregnancies in women after UFE but advice at present is for you to use appropriate contraception for 1 year after the procedure, to avoid early pregnancy. The effects of this procedure on a future pregnancy are not fully known. Occasionally, as mentioned elsewhere in this leaflet, the UFE procedure can result in early menopause. Unless you have an early menopause as a result of UFE you will still be fertile and should continue with contraception. 6

7 What are the common complications? Fever is usual for about 36 hours and can last up to 7 days. Vaginal discharge is normal for 2 weeks and sometimes longer. Pain, as described above, is usual for up to 5 days. Some women will discharge a fibroid via the vagina 6-12 weeks later. Are there any serious or rare complications? Infection is a risk with any operation. Currently there is a quoted risk of about 5%. Antibiotics are given at the time of the UFE to minimise this risk but late infection some weeks afterwards has been reported. Most can be treated with antibiotics at the time but about 1.5% of women having a UFE will need to have a hysterectomy for infection. It is important that you understand this risk before you agree to have UFE. About 1% of women have an early menopause as a result of UFE. This is more likely if you are approaching the menopause at the time of the procedure, and blood tests are performed before the procedure to assess how likely this is. Most women having UFE are content with the prospect of their periods stopping. What should I do after I leave hospital? You will still have some pelvic pain, similar to period pains, for some days. You may take paracetamol or ibuprofen for this. If you remain feverish or have a high temperature after 7 days you should contact the team at Southmead Hospital in Bristol; further details would be given to you before you are discharged home, after the embolisation has been performed. 7

8 You may return to normal activity as soon as you feel ready; this is usually after about 2 weeks. You may resume sexual activity when you feel ready, and once the discharge has settled. You will be seen in the Outpatients Clinic, 4-6 weeks after the procedure. If you have any further questions, please ask the Doctors in the clinic. Information for patients after uterine fibroid embolisation (UFE) You may find the following information useful after going home from Hospital after a UFE. Eating and drinking: You were given some light sedation to make you feel mildly sleepy during the procedure. You should not eat or drink until this has entirely worn off but it is likely you will feel fine by the next day. One of the antibiotics may make your feel mildly nauseated should you drink alcohol and it is best to avoid this for 24 hours. Driving: You should not drive or operate machinery for at least 2 days after procedure this means you should ask for a relative or friend to drive you home from hospital. It is important you ensure you can operate the pedals in the car prior to any driving. 8

9 Your groin: A very small nick was made in the artery and usually, this is in the right groin. It is possible you will get a little bruising or swelling in the first few days after the procedure but if you are worried about this it is best you call the ward. Vaginal discharge: It is common for women to experience a moderate vaginal discharge after this procedure. It can occasional contain small parts of the fibroid which is breaking down and can also be blood stained. It is important you manage this with a sanitary towel rather than tampons to avoid risk of infection. It is common for the discharge to last for 2 weeks and occasionally can last for 3 or 4 weeks. Occasionally a fibroid can be passed through the vagina. If the discharge you experience changes in its nature or becomes more offensive and smelly it is important that you contact the ward as this may indicate you are developing an infection. Pain: The purpose of you staying overnight in hospital after the procedure is to ensure you are pain free. The ward should give you further pain killers to take home with you. Should the pain continue again you can call the ward for further advice. 9

10 Fever: It is common to experience a low grade temperature for up to 1 week after this procedure. You can occasionally feel generally slightly unwell with this like mild flu. If the fever and these flu like symptoms resolve and then return (particularly if you experience more of a temperature and change in the nature of vaginal discharge) this may indicate you are developing an infection and again a telephone call to the ward is suggested. Your periods and sexual intercourse: It is common for the 1st period after an embolisation to be slightly different from usual. It may take 1, 2 or even 3 months for a reduction in the blood loss you have been experiencing but it is common for this to have occurred by 6 months after the procedure. You may resume normal sexual activity when you feel able to do so. It is important however that you use appropriate contraception for 1 year after fibroid embolisation as there is some suggestion that miscarriage and problems with pregnancy are increased after this procedure. Follow up: The team looking after you will either give you an appointment for gynaecology follow up or will be in touch post procedure. It is common for this to occur around 6 weeks after the procedure. 10

11 If you have any doubts or are concerned about any aspects of the above it is best for you to call the ward and they will put you in touch with the gynaecology team or the Interventional Radiologist who performed the procedure. NHS Constitution. Information on your rights and responsibilities. Available at 11

12 How to contact us: Gynaecology Co-ordinator, Cotswold Ward, Southmead Hospital, Westbury-on-Trym, Bristol BS10 5NB Cotswold ward 24 hours If you or the individual you are caring for need support reading this leaflet please ask a member of staff for advice. North Bristol NHS Trust. This edition published February Review due February NBT002898