Uterine Fibroid Embolisation (UFE or Non- Surgical Treatment for Fibroid Disease) Patient information leaflet

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1 Uterine Fibroid Embolisation (UFE or Non- Surgical Treatment for Fibroid Disease) Patient information leaflet What are fibroids? Uterine fibroids are non-cancerous growths that develop in the muscular wall of the uterus. They can be very tiny or larger than a melon. Usually there are several of them which vary in size and in the part of the uterus which they occupy. The location of the fibroid within the uterus may determine how it presents. Many are asymptomatic and found by accident during other kinds of examinations. Some develop on the surface of the womb giving it a knobbly appearance. They can be associated with local pain and pressure. Fibroids that are concealed within the wall of the uterus enlarge the uterus and may cause local pressure and pain. Occasionally they increase menstrual flow. A third group grow just under the lining of the womb and these are the most troublesome. They can be associated with heavy bleeding, often gushing and prolonged periods. The Treatment of Fibroids Not all fibroids need treatment. Many do not cause symptoms. Even if they are bulky, their natural history is to shrink around the time of menopause and they will continue to reduce as one becomes older. There are a number of ways of treating them if they are creating problems. Page 1 of 5

2 Traditionally hysterectomy has been the standard approach; however there are other techniques which deal with specific problems caused by fibroids. Heavy bleeding for example may be corrected by using an IUS, which is a small plastic device or coil which contains the hormone progesterone often called the Mirena coil (see separate information leaflet). Fibroids lying close to the lining of the womb can be resected using a telescope or hysteroscope. Myomectomy is a surgical procedure where fibroids are surgically removed from the womb but the womb is retained. This may be considered for women whose families are incomplete. Magnetic Resonance Guided Focused Ultrasound uses high intensity focused ultrasound waves to destroy fibroids. This is completely non invasive but not yet widely available. What is uterine fibroid embolisation? This is a procedure performed by an interventional radiologist who is trained to perform minimally invasive procedures. It is performed during a wakeful sedation; in other words a patient is sedated and given pain killers but remains rousable. The aim of the procedure is to reduce or cut off the blood supply to the fibroids. In order to reach the blood supply the interventional radiologist makes a tiny nick in the skin in the groin and inserts a catheter or very fine tube into the underlying artery. Using x-ray facilities the radiologist guides the catheter into the artery supplying the fibroids and releases tiny particles like grains of sand into the vessel supplying blood. Ultimately this blocks the blood flow and the fibroid shrinks and may infarct or die-off. Am I suitable for this procedure? The most suitable candidates for this are women who have completed their childbearing/family. This is because there is a 1 to 2% risk of embolising the arteries supplying the ovaries and this may lead to infertility or indeed, early menopause. There is also a risk of rupture of the uterus [during labour] or intra-uterine growth restriction [inadequate growth of babies in the womb] in patients who do go on to become pregnant. However, successful pregnancies have also occurred following fibroid embolisation. Therefore, on the whole, UFE is best preserved for women who have completed their families and who still have troublesome fibroids. Page 2 of 5

3 Who has made the decision that I am suitable for this procedure? The gynaecologist who has taken charge of your case will have considered the matter following appropriate investigations [including ultrasound scan and MRI scan] and asked for the opinion of the interventional radiologist also. If you choose to consider this option the consultant radiologist will arrange to see you prior to the procedure to explain in greater detail what it involves and how it will feel. How will I prepare for this procedure? You will have most of the pre-procedure investigations completed at a consent clinic. On the day of the procedure you will be admitted to hospital and normally would require staying in hospital overnight. Typically you will receive pain killing drugs and this will be before during and after the procedure. The amount of discomfort experienced varies quite a bit but at worst the patient may experience abdominal pain and cramping for several days following the procedure. However, subsequent recovery time is short and most people should expect to go back to normal within seven to ten days. What exactly is involved in this procedure? Following admission to the ward you will be sent to the radiology department and subsequently to a modified theatre area where there is a bed and a large camera. Most people will have the opportunity to see this prior to admission at the consent clinic. Subsequently you will be asked to lie on the table. The groin selected for access to your blood vessels will be painted with iodine to sterilise the area. You will then be covered in surgical drapes. Local anaesthetic will be administered to the puncture site and afterwards you will not feel pain from that procedure. A fine tube or catheter will then be fed into the artery through the skin and will be negotiated into position into the artery that supplies the area of treatment. In some cases it is necessary to make punctures in both groins but every effort will be made to confine the procedure to one groin only. Once the catheter is in place the small particles or PVA micro spheres can be injected into the artery until blood flow ceases. This is the point at which you may experience pain but provision will be made for that moment and delivered by self medicating on the spot. At the end of the procedure the catheter will be withdrawn and we will either press on the groin to prevent any bleeding or use a small closure device which will enable you to mobilise more quickly subsequently. Page 3 of 5

4 How long will this procedure take? From beginning to end the procedure would be expected to take one to one and a half hours. Very occasionally it may be more complicated but it is normally sufficient to allow this amount of time. What are the risks? The uterine fibroid embolisation is considered a very safe procedure. However it is important that you understand the risks. A small number of patients have experienced infection usually controlled by antibiotics. There is also a small risk of damage to the uterus which can create the need for an urgent hysterectomy. There is a 1 to 2% risk of ovarian failure which would result in an instant menopause and would render the patient infertile. There are small risks from the puncture site such as bleeding again after the procedure but this is an uncommon occurrence. Are there after effects? There can be after effects although many women have virtually no symptoms. The most common reported symptom is pain and it varies from mild to moderately severe requiring regular analgesia. You may also experience a discharge for anything up to two months following the procedure and in fact patients have presented with late discharge from fibroids that have slowly shrivelled following such treatment. Less frequently the fibroid itself passes when it shrivels and this would present as solid material in the vagina. Rarely a procedure such as dilatation and curettage ( scrape ) is required for toileting. What are the alternative procedures? The main procedure for troublesome fibroids is hysterectomy. A small number of fibroids are suitable for resection either by a standard surgical procedure or by approaching the fibroid from inside the womb (hysteroscopy). What happens after the procedure? After the procedure you will return to the ward and it will probably be necessary for you stay in bed for a couple of hours. Page 4 of 5

5 The puncture sites will need to be checked regularly during that time. The radiologist will return to see that you are progressing well before you are discharged. Ordinarily you will be discharged the following morning provided any discomforts or pain that you are experiencing are controlled. You will subsequently return to your gynaecologist outpatient clinic for follow up (usually three months after the procedure). Contact Numbers for advice: X-Ray Pre assessment nurse Diagnostic Imaging X-ray Department Telephone: Monday Friday (09:00am 5:00pm) Radiology sister Diagnostic Imaging X-ray Department Telephone (0191) Monday to Friday (09:00am 5:00pm) Website: Data Protection Any personal information is kept confidential. There may be occasions where your information needs to be shared with other care professionals to ensure you receive the best care possible. In order to assist us improve the services available your information may be used for clinical audit, research, teaching and anonymised for National NHS Reviews. Further information is available in the leaflet Disclosure of Confidential Information IL137, via Gateshead Health NHS Foundation Trust website or the PALS Service. Information Leaflet: NoIL148 Version: 3 Title: Uterine Embolisation First Published: June 2008 Last Reviewed: January 2012 Review Date: January 2014 Author: Dr Timmons - Radiology This leaflet can be made available in other languages and formats upon request Page 5 of 5