Uterine artery embolisation

About uterine artery embolisation

A uterine artery embolisation is a non-surgical procedure used to treat fibroids. The arteries that supply your fibroids with blood are called uterine arteries. A uterine artery embolisation blocks off the blood supply to your fibroids, causing them to shrink.

The procedure is done by a specially trained radiologist called an interventional radiologist, in the X-ray department of a hospital.

Most women find that their fibroids shrink to at least half their size after having a uterine artery embolisation, and that symptoms such as heavy bleeding and pain are reduced. However, the procedure is not suitable for women who want to get pregnant because it may increase the risk of problems during the pregnancy and birth.

What are the alternatives to uterine artery embolisation?

If you don't have any symptoms, or if your symptoms are mild, you won't need treatment.

If you do have symptoms from your fibroids, the alternatives include the following.

  • Medicines – these can shrink your fibroids by up to half before surgery and reduce symptoms such as heavy periods, but you can only take them for up to six months and they can cause symptoms similar to the menopause. This isn’t a long-term alternative.
  • Image-guided ultrasound treatment – this uses magnetic resonance imaging (MRI) to guide highly-focused ultrasound waves to your fibroids and destroy them. However, this treatment is currently only available at a few centres in the UK.
  • A myomectomy – this operation removes your fibroids without removing your womb. This is usually recommended for women who may want to get pregnant in the future. However, your fibroids may grow back after a myomectomy. In some cases, it might be possible to remove your fibroids using keyhole surgery.
  • A hysterectomy – this operation removes your womb so your fibroids won't return. After a hysterectomy, you will no longer have periods or be able to become pregnant.

Preparing for your uterine artery embolisation

Your radiologist will discuss with you what will happen before, during and after your procedure, and any pain you might have. This is your opportunity to understand what will happen, and you can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the procedure. This will help you to be informed, so you can give your consent for the procedure to go ahead, which you may be asked to do by signing a consent form.

If you have any allergies, you should let your radiologist know. This is especially important if you're allergic to the special dye (contrast medium), which is used during the procedure.

Your radiologist will explain how to prepare for your operation. For example, if you smoke you will be asked to stop, as smoking increases your risk of getting a wound infection and slows your recovery.

The procedure is usually carried out through a big artery in your groin, so you may be asked to shave the skin around this area. You should follow your surgeon’s instructions.

You will be asked to follow fasting instructions. This means not eating or drinking, typically for about four hours beforehand. However, it’s important to follow your radiologist’s advice.

A uterine artery embolisation usually requires an overnight hospital stay. The procedure is commonly done under local anaesthesia which means you will stay awake during the procedure.

What happens during uterine artery embolisation

The procedure can take up to two hours depending on your fibroids.

Your radiologist will insert a thin plastic tube, called a catheter, into your artery. He or she will then use X-ray images to guide the catheter through to your uterine arteries. Contrast medium is injected into your uterine arteries. This allows the radiologist to use X-ray images to find the arteries supplying blood to your fibroids. You may feel some heat in your pelvic area, but this should wear off quickly.

Liquid containing particles of glue is injected through the catheter and into these arteries. The glue particles block the arteries and stop the blood supply to your fibroids.

What to expect afterwards

You may have a small bruise around the area where the needle was inserted, but this is normal.

You will probably have some pain, especially for the first 12 hours after the procedure. When you're in hospital, the nurses will give you some painkillers. You will also be given some tablets to take home to help control the pain. Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist for advice.

You will probably have a slight fever (high temperature) after the procedure. This is nothing to worry about as it means that your fibroids are breaking down. The painkillers will help to reduce your fever.

You will need to arrange for someone to drive you home. You should try to have a friend or relative stay with you for the first 24 hours.

Your nurse will give you some advice about caring for your healing wounds before you go home. You may be given a date for a follow-up appointment.

Recovering from a uterine artery embolisation

At home you will need to rest for one to two weeks, staying in bed for three to four days after your procedure. You will need to take at least two weeks off work.

What are the risks?

Side-effects

Side-effects are the unwanted but mostly temporary effects you may get after having the procedure. These can include extreme tiredness, especially in the first few days, and pain similar to period pains or cramps.

You may also notice that you have vaginal discharge which may have some blood in it. This usually stops around two weeks after the procedure, but can sometimes go on for a few months. You may need to wear sanitary towels. If the discharge has an unpleasant smell, contact your GP as soon as possible because this may indicate that you have an infection.

After your procedure you may pass a fibroid, or part of one, through your vagina. If this happens, it will be between six weeks and three months after your procedure and can be accompanied by period pains and bleeding. If this happens, you will need to wear a sanitary towel.

Your periods may stop but this is rare.

Complications

This is when problems occur during or after the procedure. Most women aren’t affected.
There is a risk that you may develop an infection after the procedure has been carried out.

Signs of an infection are:

  • feeling unwell
  • developing a high fever
  • feeling a lot of pain
  • having a sore and tender lower abdomen (tummy)
  • having a vaginal discharge with an unpleasant smell

If you have any of these symptoms, contact your GP as soon as possible.

Infections can usually be treated with antibiotics. However, there is a small chance that if you develop a serious infection, you may need to have a hysterectomy. This would mean that you would no longer be able to become pregnant.

Is having a uterine artery embolisation painful?

Answer

You will be given a local anaesthetic before the procedure is carried out. This will block all feeling from the area, so you shouldn't feel any pain.

Explanation

Uterine artery embolisation is commonly done under local anaesthesia. This completely blocks feeling from around the area and you will stay awake during the operation.

As well as the radiologist, there will also be a nurse or another member of hospital staff with you throughout the procedure. If the procedure does become painful, let him or her know. He or she will be able to give you some painkillers through a needle in your arm, which will be inserted at the beginning of the procedure.

After uterine artery embolisation, you may have pain similar to period pains or cramp.

Will having a uterine artery embolisation make me infertile?

Answer

At the moment there isn't much information about how it may affect your fertility and your chances of getting pregnant. Your doctor should inform you that the effects of the procedure on fertility and on pregnancy are uncertain. Therefore, he or she will be very cautious about offering you this treatment if you wish to have a child in the future.

Explanation

Information is currently being collected from women who have had a uterine artery embolisation to see how it has affected them afterwards. This is so that doctors can record the effect that the procedure has on fertility over time.

There is evidence to suggest that the procedure may cause increased pregnancy complications. However it’s important to remember that having fibroids may also increase your risk of having problems during pregnancy, and for most women, the benefits usually outweigh the risks.

Another important reason that your doctor will be cautious about offering this procedure if you want to have children is there's a risk that you may develop an infection after the procedure. Infections can usually be treated with antibiotics, but there is a small chance that if you develop a serious infection you may need to have a hysterectomy. If you have a hysterectomy, you will no longer be able to become pregnant.

If you have any concerns about having a uterine artery embolisation, talk to your doctor.

How does uterine artery embolisation compare to other procedures for fibroids?

Answer

Uterine artery embolisation is a less intrusive type of procedure than surgery, such as hysterectomy or myomectomy. However, you may be more likely to need further treatment if you have had a uterine artery embolisation.

Explanation

There are certain benefits of uterine artery embolisation over more intrusive surgical procedures, such as hysterectomy and myomectomy. Women who have a uterine artery embolisation generally spend less time in hospital and recover from the procedure more quickly than women who have a hysterectomy or myomectomy. They also tend to have less pain following the procedure than women who have surgical procedures. Uterine artery embolisation can be a good option if major surgery could be risky for you, for instance, if you have diabetes, heart problems or are obese.

However, women who have uterine artery embolisation seem to be more likely to need further treatment for fibroids after the procedure, compared to women who have their fibroids removed by hysterectomy or myomectomy. Around one in 10 women who have uterine artery embolisation may need further treatment with another embolisation or surgery within a year. This may be as many as one in three women within five years of treatment.

It's important to remember that every woman's situation will be very different, and one type of treatment may be more appropriate for you. Talk to your surgeon, who can explain in more detail what the best treatment option is for you.