Who are good candidates for Uterine Fibroid Embolization? [Dr. Shams]

 

Most patients with symptomatic fibroids, at least 90% of patients that we see with symptomatic fibroids, are good candidates for the Uterine Fibroid Embolization (UFE) procedure. If a patient is pregnant, then they’re not a candidate for the procedure. If the patient wants to become pregnant and is already over 40, then we may not want to do this procedure because it may decrease the fertility in this patient. In a patient over 40, where the fertility is already significantly lower, we may not want to jeopardize fertility further by doing this procedure. In general, it’s not only for the UFE procedure; surgical procedures will also affect fertility. For patients wishing to avoid surgery or a long recovery, Uterine Fibroid Embolization is an excellent option. Those who undergo the UFE procedure have it done in an outpatient setting, they do not stay in the hospital, and they are most often home recovering for about a week or two after the procedure. With surgical procedures, depending on the type of hysterectomy or myomectomy, a patient may require a stay in the hospital for up to a week, and the recovery is usually about two months following the surgery.

Patients desiring uterine preservation are also good candidates for UFE. If they want to keep their uterus, UFE would be a good choice for that patient, because it could save the uterus while treating their symptoms. Perimenopausal patients, patients who are close to menopause, are ideal for the Uterine Fibroid Embolization procedure because they will probably be going to menopause anyway. In general, after menopause, fibroids tend to shrink on their own because the blood supply decreases, the hormones change. Perimenopausal patients are excellent candidates for Uterine Fibroid Embolization.

Patients who are poor surgical candidates may find the fibroid embolization procedure a desirable option. If there is a problem with these patients undergoing surgery, if they have anemia, if they are anti-coagulated, and so on, then the fibroid embolization procedure is a great procedure. Patients with hysterectomy Hormone Replacement Therapy (HRT) concerns may also prefer UFE. In general, with the fibroid embolization procedure, there should be no hospital stay. For hysterectomy, the average is 2.3 days, myomectomy, 2.5 days. Return to work timeframes are also hugely affected, with the UFE average just 10.7 days, while hysterectomy is 32.5 days and myomectomy 37 days. Complications are higher with surgery, and major complications are significantly higher with surgery.

Does UFE only work for fibroids that are in the uterus, or does it work for submucosal fibroids?

No, Uterine Fibroid Embolization works for all fibroids in the uterus. The only question is, if there is a submucosal fibroid that’s too large, in general, the fibroids do not come out. Once this procedure is done, they stay in the uterus, and they shrink internally. The body eats them up basically and scars them down.

Will the Uterine Fibroid Embolization (UFE) procedure work for all types of fibroids, submucosal, subserosal, and intramural?

The issue is, if there are very large submucosal fibroids or very large subserosal fibroids, they may be better treated surgically. They can be treated with UFE, but you may not get a good result as with surgery.

What happens after the procedure?

Patients can have some pelvic cramping after the procedure that’s well treated with medication, some loss of appetite for a couple of days. It’s likely they are not going to feel great for a couple of days after this procedure but, compared to surgery, it’s a different ball game.

What can I do after the procedure?

Patients can resume normal activities within two weeks after the procedure; go back to the gym, resume a regular diet, resume sexual activity, about two weeks after the procedure. Menstrual periods usually won’t normalize for up to three months after the procedure. Meaning that, in general, if you have heavy bleeding, the heavy bleeding will stop. There will be spotting for several weeks after the procedure, but regular cycles may not resume until about three months after the procedure, regular periods should resume.

Summary –

The Uterine Fibroid Embolization procedure is a proven effective method to treat symptomatic uterine fibroids. About 30,000 of these procedures are performed annually in the United States, with between 80% to 95% clinical success, a little bit better for bleeding symptoms and a little bit less for bulk-related symptoms. Clinical studies show equivalent symptom relief compared to surgery, with less recovery time and complications. It is minimally invasive, meaning there’s no incision here, just a tiny puncture hole, and you’re out of the procedure in an hour and usually out of the facility within a couple of hours after the procedure. We are an outpatient service now. When I first started doing this procedure, I would only do it in the hospital, but we’ve done so well with it, and patients tolerate it very well in an outpatient setting.

Patients stay in the office in the surgery center for about two hours after the procedure and then can go home. They can return to regular activity in about one to two weeks and have very low complication rates.

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