Uterine Fibroids Facts

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1 Uterine Fibroids Facts Heavy/Painful Periods and Pelvic Pain It is normal for women to experience heavy menstrual periods or cramps from time to time. What is not normal is a heavy period that impacts how you live your daily life or pelvic pain that is constant or unbearable. If you have these symptoms, you should be checked by a doctor. Women who experience pelvic pain or heavy menstrual bleeding may have a common, non-cancerous growth(s) in the uterine wall called a uterine fibroid. Uterine fibroids are very common non-cancerous (benign) growths that develop in the uterus. They can range in size from very tiny (a quarter of an inch) to larger than a cantaloupe. Sometimes fibroids can cause the uterus to grow, similar to when the uterus increases in size during pregnancy. In many cases, there is more than one fibroid found in the uterus. Uterine Fibroid Symptoms Heavy, prolonged menstrual periods, and/or bleeding between cycles. Passage of numerous clots during the menstrual cycle Pelvic pain and pressure Pain in the back and legs Bladder pressure leading to a frequent urge to urinate. Urinating more than eight times per day or 1-2 times per night Pressure on the bowel, leading to bloating and/or constipation Enlarged or distended abdomen For most women with symptomatic uterine fibroids, the standard treatment has been hysterectomy, (surgical removal of the uterus) or myomectomy, (surgical removal of the fibroids). Fortunately, for the past 20 years, there has been another option uterine fibroid Embolization (UFE). Uterine fibroid Embolization is a nonsurgical, minimally invasive treatment that shrinks the fibroids in order to provide symptom relief. UFE is performed by an Interventional Radiologist.

2 Uterine Fibroid Embolization: Non-surgical Treatment of Symptomatic Uterine Fibroids Uterine fibroid embolization (UFE) has been performed in the United States for almost 20 years. It is 85 90% effective in reducing the symptoms caused by fibroids. The overwhelming majority of patients have significant or complete resolution of symptoms. This procedure is performed at Community Health Network (Community Hospitals North and East) by the Interventional Radiologists of Irvington Interventional Consultants. All patients participate in a detailed pre-procedure consultation with our physicians and nurse practitioner. Following the consultation, an MRI (magnetic resonance imaging) is performed to most accurately determine the location and size of the fibroids. The MRI will also look at how much blood flow is getting to the fibroids and check the surrounding structures of the pelvis. Once the pre-procedure consultation and MRI results are known, the UFE procedure can be scheduled if the patient is an appropriate candidate for UFE. Uterine fibroid embolization involves blocking off the blood supply to the fibroid(s) through a minimally invasive, non-surgical procedure. UFE treats ALL of the fibroids in the uterus. Uterine Fibroid Embolization Procedure After numbing a small area in the groin, the interventional radiologist makes a small puncture into the femoral artery (blood vessel in the groin) and places a small catheter, about the size of a piece of spaghetti, into the femoral artery. The interventional radiologist guides the catheter through the arteries (blood vessels). Once the tip of the catheter is in the uterine artery, tiny particles are injected into the uterine artery, blocking off the abnormal blood vessels that supply blood flow to the fibroid(s). The fibroid(s) then shrink and die due to lack of sufficient blood flow. The UFE procedure usually takes around 1 hour. When the procedure is over, the catheter is removed and pressure is applied to the femoral artery puncture site for approximately 20 minutes to stop any bleeding. A bandage is then applied. There are no stitches. Patients are observed overnight in the hospital. Patients are discharged the next morning with specific, pre-printed instructions for recovery at home. Time is spent with each patient before discharge, reviewing the instructions and answering questions.

3 Expected Outcomes Following UFE Following the embolization, you should be able to return to your usual activities in approximately 7 to 10 days. The treated fibroids shrink approximately 50-60% in size over the course of a year. Patients who mainly present with symptoms of abnormal uterine bleeding notice improvement within a couple of days. Patients who present mainly with bulk-related symptoms (pelvic pain, pressure, etc.), notice improvement within a few weeks. Uterine Fibroid Embolization Facts provided by: The Society of Interventional Radiology About 20 to 40 percent of women age 35 and older have uterine fibroids of significant size. About 15,000-20,000 UFE procedures have been performed worldwide, at least half of them in the United States. Using embolization to treat uterine fibroids has been performed since Interventional radiologists also perform uterine artery embolizations to treat heavy bleeding after childbirth or injury to the pelvis / uterus. o o Most women with symptomatic fibroids are candidates for UFE and should obtain a consult with an Interventional Radiologist to determine whether UFE is a treatment possibility for them. It is reassuring to know that the particles used for UFE have been available with FDA approval for over 20 years. During that time, they have been used in thousands of patients without any long-term complications. Recently, the FDA approved Embospheres for use in the treatment of uterine fibroids. Embospheres are tiny particles injected into the uterine arteries during uterine fibroid embolization to block the blood flow to the fibroids. Uterine fibroid embolization may be a good treatment option for women who choose not to receive blood transfusions or who have other serious health conditions which increase the risk of surgical procedures (hysterectomies and myomectomies). Benefits of UFE: >90% of patients are satisfied with the outcomes of the UFE procedure. Growth of new fibroids or re-growth of embolized fibroids is rare. There is minimal blood loss and therefore no need for blood transfusions. All the fibroids may be treated during a single embolization procedure. All major insurance companies cover this procedure as a provided benefit. We encourage you to contact your insurance company about: Coverage for the UFE consultation with an Interventional Radiologist. Specifically, is a referral required for consultation and is the Interventional Radiologist of choice in your network?

4 Is pre-certification required for the pre-procedure pelvic MRI? Is pre-certification required for the UFE procedure? Typically, our patients have an overnight stay in the hospital, but are released the next morning. UFE is considered a 23-hour overnight outpatient procedure. FREQUENTLY ASKED QUESTIONS What are the particles used to block the blood supply to the uterine fibroid made of? The particles are made of polyvinyl alcohol (PVA) or Tris Acrylgel (Embospheres). Both particle substances are medical grade material and FDA approved for embolization of vascular tumors. There is no silicone in PVA or Embospheres. Recently, the FDA approved Embospheres specifically for use in the treatment of uterine fibroids. Could the particles travel to another part of my body? During the procedure, the particles are precisely injected into the vessel(s) (uterine arteries and/or ovarian arteries) that provide blood flow to the fibroids. The particles become lodged within the tiny blood vessels that supply blood to the fibroids. This process is called embolization and stops the blood flow to the fibroids. Once the particles are in place, they stay put because the blood immediately clots in these tiny vessels, trapping the particles. The particles remain in place as the fibroids shrink and do not break free. Does the procedure ever have to be done more than one time? The UFE procedure provides treatment of all the fibroids present in the uterus at one time. The uterine arteries supply 99 % of all blood flow to the fibroids. By embolizing the uterine arteries, all of the fibroids are treated during a single procedure. In a very small number of women, the procedure may be performed more than one time due to continued blood flow to the fibroids after the initial UFE procedure. Typically, if there is another source of blood flow supplying the fibroids, it can be identified and treated during the initial UFE procedure. Will the procedure work if I have one fibroid or multiple fibroids? Yes, UFE is successful with treating one or multiple fibroids. ALL fibroids are treated during the UFE procedure.. Once the blood supply to the fibroids is blocked, the fibroids can shrink up to 50-60%. If each fibroid shrinks approximately 50-60%, regardless of the number, the vast majority of treated patients experience a significant reduction of symptoms. Will I feel the catheter or particles inside my body? Patients cannot feel the catheter moving inside the body or particles being injected into the uterine arteries. A local anesthetic is provided before the procedure to numb the area where the catheter is inserted. The procedures are all performed using IV conscious sedation (twilight anesthesia); general anesthesia is not necessary.

5 How long does the procedure take and how long will I be in the hospital? UFE typically takes about an hour. All patients stay overnight in the hospital (23 hr outpatient stay). How long will it take to see an improvement in my symptoms? Patients who mainly present with symptoms of abnormal uterine bleeding notice improvement within a couple of days. Patients who present mainly with bulk-related symptoms (pelvic pain, pressure, etc.), notice improvement within a few weeks. Fibroids may continue to shrink up to one year following the procedure, so continued improvement in symptoms may be expected. How will I feel after the procedure and when can I return to work and daily activities? You may experience a mild to moderate amount of pelvic cramping for approximately 4-6 hours after the procedure. Each patient experiences varying amounts of pain/cramping. However, our goal is to keep the cramping pain at a tolerable level with pain medication and nursing comfort measures. You are able to control the amount of pain medication you receive by using a patient controlled analgesia pump (PCA pump). This pump delivers narcotic pain medication intravenously (through your IV) only when you push the control button allowing you to adjust the amount of pain medication based on your own, personal comfort level. The PCA pump is specially programmed so that you do not receive too much pain medication. You may also experience nausea, which is controlled with medication. Typically, mild to moderate pelvic cramping continues intermittently for approximately one week to fourteen days following the procedure. To help keep pain at a tolerable level while recovering at home, you will be instructed on the use of ibuprofen, oral narcotic medications, and nursing comfort measures before leaving the hospital. After embolization, some patients may experience post embolization syndrome. This is a combination of symptoms that occur approximately 3-5 days after embolization. The symptoms occur in response to cutting off the blood supply to the fibroids. This is a normal body reaction to the fibroid tissue dying which may cause inflammation. Symptoms include fatigue, achiness, low-grade fever, and nausea. Many patients describe it as feeling like you have the flu. These symptoms usually go away in about 3-5 days. Patients may return to work one week after the procedure. This is an average recovery time; some women require more or less time depending on how they are feeling. Heavy lifting and strenuous exercise restrictions are suggested for 1-2 weeks after the procedure. Will the fibroids grow back? Embolizing the uterine arteries stops the blood supply to all of the fibroids present in the uterus. Once this blood supply is blocked, new fibroids typically do not grow. All of the fibroids may shrink about 50-60% after the procedure. Although the fibroids will always be present, they become small enough to relieve symptoms. Typically after the fibroids shrink, they do not grow larger at a later date.

6 What is the chance of entering menopause after UFE? For women over 45 years of age, the incidence of entering menopause increases to about 2-10% after UFE. In addition, if the fibroids are receiving blood flow from the ovarian arteries and these blood vessels are embolized, the chance of entering menopause after the procedure is slightly increased. Will my insurance cover the procedure? UFE is covered by all major insurance companies for the treatment of symptomatic fibroids. It is not an experimental procedure and the particles used for embolization are FDA approved for the treatment of vascular tumors. Recently, the FDA approved Embospheres specifically for use in the treatment of uterine fibroids. It is always helpful to contact your insurance company for particular details about coverage/eligibility and to determine if pre-certification/ preauthorization is necessary. You should ask your insurance company the following questions: Is a referral required for consultation and is the Interventional radiologist in your network? Is pre-certification required for the pre-procedure pelvic MRI and the fibroid embolization procedure? Who does pre-certification? Typically, the referring physician will fill out a referral/request for consultation form and precertify (if required by the patient s insurance carrier) the patient for an initial consult (with an Interventional Radiologist) and treatment. During the consultation, the Interventional Radiologist will determine if the patient is a candidate for UFE based on clinical symptoms and medical history. Then, a pelvic MRI will be performed to determine if you are a good candidate, based on the size, location, and vascularity (blood flow) to the fibroids. Once the results of the MRI are known, the UFE procedure will be scheduled (if indicated). If the patient is determined to be a good candidate for UFE, our interventional office will contact the insurance company for pre-certification.

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