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Frequently Asked Questions
- Is UFE an experimental procedure?
UFE is not an experimental procedure. Many thousands of patients have been treated with UFE worldwide with excellent results. Recently published studies have shown that up to 93% of patients with abnormal menstrual bleeding or bulk symptoms related to fibroids report their symptoms completely relieved or significantly improved. UFE is an effective treatment alternative for symptomatic uterine fibroids. The safety and efficacy of UFE is well established in the medical literature.
- What symptoms do fibroids cause?
Symptoms include abnormally heavy menstrual bleeding, painful menstrual cycles, pelvic cramping, pain during sexual intercourse, abdominal or pelvic pressure or fullness, frequent urination, consitpation, and swelling in the legs.
- How do I know if I have fibroids?
Fibroids can be diagnosed during pelvic examination if your physician feels an enlarged lobulated uterus. Fibroids are also diagnosed with ultrasound or MRI. If you were to have only one imaging study, MRI should be performed. MRI is much better than ultrasound in determining the exact number and location of fibroids. MRI can also determine if pedunculated fibroids are present. Pedunculated fibroids protrude from the surface of the uterus on a thin stalk. Pedunculated fibroids can become detached from the uterus following UFE and remain in the body as a source of infection. Because of this, UFE is not recommended for pedunclated fibroids. MRI is excellent at detecting this type of fibroid as well as identifying other fibroids which may not be seen on ultrasound.
- Am I a candidate for UFE?
UFE is indicated in the treatment of symptomatic uterine fibroids. The ideal UFE candidate has symptoms caused by moderately sized fibroids and has no plans for future children.
- Does it matter how many fibroids I have?
UFE is an excellent treatment alternative for multiple symptomatics fibroids. All fibroids are treated simultaneously during embolization. In contrast, myomectomy only removes fibroids visible on the surface of the uterus. Fibroids not visible on the surface or fibroids located on the posterior surface of the uterus may be difficult to remove during laparoscopy. Patients with multiple fibroids may not be candidates for myomectomy.
- Will UFE work for me?
The answer to this depends on your particular situation. If you have significant bleeding or bulk-related symptoms caused by uterine fibroids which are moderately sized (3-8 cm), UFE is an excellent treatment alternative. If you have minimal symptoms which are easily contolled with medication, UFE is unlikely to provide any benefit. UFE is indicatied only for treatment of uterine fibroids. Patients with abnormal bleeding and pain symptoms caused by other problems like endometriosis or adenomyosis should seek other forms of therapy.
- Is it better than the other options?
The answer to this question depends entirely on your situation. We feel that the most appropriate patient for UFE is a woman who has completed her family, who does not want or cannot tolerate surgery, and has symptoms that are clearly caused by fibroids of moderate size and are not responsive to medications.
Patients who desire future pregnancy who are good candidates for myomectomy or hormonal therapy should still consider these to be their main treatment options. We simply do not yet know whether UFE is as safe as myomectomy or medical therapy for patients who still plan to have children in the future.
Patients who are near menopause with symptoms controlled by medication should consider waiting for menopause. Most fibroids shrink and symptoms resolve following menopause.
- Can fibroids grow back after UFE?
The first published reports of UFE were in 1994. During the years since then, there have been no reported recurrences of fibroids in patients who have had UFE. By comparison, in patients undergoing myomectomy, up to 35% will experience a recurrence of fibroids.
- Is it dangerous? What are the potential complications?
When performed by an experienced Interventional Radiologist, embolization is a very safe procedure. Although there can be complications, they are uncommon. The most serious potential complication is infection. If an infection developed after UFE quir my. Of course, infections can also develop after myomectomy, hyster ster nts should be treated with antibiotics during UFE or surgery, and pre-existing pelvic infections need to be resolved prior to the procedure.
Although unlikely, it is possible for blood flow to other organs to be blocked during UFE. This complication can result in injuries to the urinary bladder, the intestine, the ovary, or other adjacent structures. Fortunately, this complication can be avoided with careful technique and x-ray guidance during embolization. As with infections, injury to adjacent organs is a risk of both UFE and the common surgical alternatives. The use of x-ray guidance is mandatory for UFE. The specific amount of radiation received by the uterus and ovaries in any given UFE procedure is directly related to the time required and the techniques used by the IR. While no particular dose of radiation can be shown to cause a specific risk of injury, less is better than more. Surgical and medical treatment alternatives do not use x-rays.
- Is UFE harmful to the uterus?
The first published reports of UFE were made in 1994 by a french gynecologist. He had his Iterventional Radiologist embolize the uterine arteries in a series of patients prior to planned hysterectomy or myomectomy. Many of these patients cancelled their surgeries after finding that their symptoms due to uterine fibroids were relieved after embolization alone. Some patients in this group did have hysterectomy as originally planned. In these patients, examination of the uterus showed that the fibroids had died and shrunk but the uterine muscle tissue remained alive without damage following embolization. This finding has been confirmed in follow-up reports of patients undergoing hysterectomy following UFE. Infection is a rare complication of UFE occuring in less than one per cent of patients treated. Rarely, an infection con occur that is so severe that hysterectomy must be performed.
It is not known with certainty why the fibroids die but the uterus survives following UFE. This may be due to the fact that the vessels that supply the fibroids are larger than the ones that supply the uterine tissue. The particles used are sized to preferentially fill the vessels supplying the fibroids. Additionally, the fibroids are extremely hypervascular, monopolizing the blood supply. Since they receive most of the blood flow, they also receive most of the blood borne embolization particles. Another reason why the uterine muscle tissue is unharmed is that it receives collateral blood supply from other sources not available to the fibroids.
- What happens to the fibroids after UFE?
After embolization, the fibroids lose their blood supply and source of oxygen and nutrients. The fibroids die, shrink, and are gradually replaced by scar tissue. Because the fibroids no longer respond to hormonal stimulation, they no longer grow or cause symptoms during menstrual cycles. Although fibroids can shrink to one half to one third of their original volume following UFE, they do not go away completely.
- What happens to the embolization particles after UFE?
We use Embospheres exclusively for UFE. These are the only embolization particles specifically approved by the FDA for Uterine Fibroid Embolization. Embospheres are inert and cause virtually no reaction in the body. Embospheres have an excellent safety profile. They do not get absorbed, do not dissolve, and do not migrate to other parts of the body after the procedure.
- What do I do if UFE does not relieve my symptoms?
Over 90% of patients treated with UFE report their symptoms completely relieved or significantly improved following UFE. If you are in the small minority of patients who need further treatment following UFE, all other treatment options remain available to you. You may respond better to medical therapy such as birth control pills or anti-inflammatory agents. You may elect to undergo a myomectomy or a hysterectomy if your symptoms remain severe. All of these treatment options remain open to you.
- Do I have to see an OB/GYN physician before considering Uterine Fibroid Embolization?
There are many causes of excessive menstrual bleeding, cramping, urinary frequency, and bloating other than fibroids. It is very important that you be thoroughly evaluated by your doctor to exclude these other causes before we evaluate you for uterine fibroid embolization. Before being considered for UFE your doctor should confirm that you have fibroids with ultrasound or MRI and determine that your symptoms are caused by fibroids. We require all women to see a doctor experienced in women's health care. This may be your OB/GYN or your primary care doctor. If your doctor is not trained and experienced in womens health care or if you would like to speak with an OB/GYN doctor about other treatment options, you are encouraged to contact your OB/GYN or find one using our OB/GYN finder.
- I don't have an OB/GYN. How can I find one?
There are many OB/GYN physicians in this area who are familiar with UFE. For a list click on our OB/GYN Finder.
- What if my physician is not familiar with UFE or is uncomfortable referring me for UFE?
Many physicians are familiar with UFE as an effective treatment for symptomatic uterine fibroids. If your physician has any questions regarding your case or UFE in general, we will be happy to speak with them. If your physician is not familiar with UFE or is uncomfortable referring you for the procedure, you may either contact us directly at (281) 880-6947 or seek a second opinion via our OB/GYN Finder.
- Which studies or tests do I need to undergo before being considered for UFE?
You should have either an ultrasound or MRI examination of the pelvis to confirm that you have fibroids. You will need a recent pelvic exam and pap smear within 3 months of the procedure. In some situations, you also need an endometrial biopsy. Before undergoing UFE, routine blood tests will be obtained.
- I have heavy menstrual bleeding and pelvic cramping but I don't have fibroids. Can I still be considered for UFE?
Uterine Fibroid Embolization is only used to treat symptoms caused by uterine fibroids. If you do not have fibroids, you should consider other treatment options.
- Will I be able to become pregnant after a UFE?
There are no long-term studies specifically addressing the question of fertility following UFE. We know that fertility is preserved in patients who have had emergency uterine artery embolization for life-threatening bleeding following child birth. There have also been multiple anecdotal reports of successful pregnancies in women who have undergone UFE. Currently, the best answer we can give is that fertility will probably be preserved following UFE but should not be considered guaranteed. If you definitely desire to become pregnant in the future and you have a fibroid that can be removed surgically, you should consider myomectomy. If you want children in the future but your OB/GYN feels you are not a candidate for myomectomy, UFE may be an option for you.
- I have had a myomectomy but my symptoms have returned. Can I still be considered for UFE?
Uterine Fibroid Embolization is an excellent option for patients who have failed previous medical therapy or myomectomy. As many as 35% of patients will have recurrent symptoms following myomectomy. Many of these patients do not wish to undergo further surgery and elect to have UFE to treat their recurrent symptoms.
- If my physician and/or I feel I may be a candidate for UFE, what do I do next?
You or your doctor can schedule an appointment with us by calling 281-880-6947. For directions and scheduling information, click here.
- Does insurance cover UFE?
Most insurance carriers now provide coverage for UFE. We will work closely with your insurance carrier to obtain all the necessary approvals before scheduling you for a UFE procedure. Vascular & Interventional Associates is a division of Houston Northwest Radiology. Click on our list of insurance carriers that are accepted.
- How long does it take to perform UFE? Will I be put to sleep for the procedure?
The procedure usually takes one to two hours to perform. During UFE, you will be awake but sedated with intravenous pain medication. The procedure is very well tolerated under local anesthesia and IV sedation. Being put to sleep with general anesthesia for UFE would add unnecessary risk and expense to the procedure.
- How much pain do patients have following UFE?
All patients experience pelvic cramping following UFE. The degree of pain is extremely variable from patient to patient. While most patients describe the pain as moderate, it is very difficult to predict what degree of pain each individual patient will experience. Pain usually peaks 6-8 hours after the procedure and gradually decreases over the next 48 hours. After the procedure, all patients receive intravenous pain medication via a patient controlled analgesia (PCA) pump. Pain medication is delivered on demand with a trigger controlled by the patient. You will be transitioned from IV to oral pain medications during the evening. Upon discharge, you will receive several prescriptions for oral pain medications along with detailed instructions. Our patients have reported this medication regimen to be very effective in controlling their pain after the procedure. Our office will be in contact with you frequently to monitor your progress.
- Why do I have to stay overnight in the hospital?
Some centers send patients home the same day after performing UFE. Studies have shown that as many as 30% of patients sent home the same day will return that evening to the ER and need to be admitted to the hospital due to inadequate pain control. The degree of pain experienced by patients is extremely variable and difficult to predict. With these issues in mind, we have all of patients admitted to the hospital for an overnight stay for observation and pain control. All patients go home the next morning with prescriptions for oral pain medications.
- What symptoms other than pelvic cramping will I encounter following the UFE procedure?
Many patients experience cramping in each leg which may last 2-3 days. Some report nausea and loss of appetite. Many patients also experience "post-embolization syndrome" which presents as a flu-like illness a few days after UFE. With this syndrome, patients may experience fever, chills, muscle aches, and diminished appetite. This post-embolization syndrome can be seen after emboliztion of any tumor or organ. Most patients report a vaginal discharge that may last up to 2 weeks. Occasionally patients report burning with urination after the procedure. This is usually attributed to irritation from the foley catheter placed in the bladder for the procedure and will resolve spontaneously. Sometimes the burning with urination will be due to a bladder infection which may require antibiotics. You will go home with detailed instructions which will include what to expect, what medications to take, what activities to avoid, and contact information to get in touch with our office for any questions or concerns.
- When can I return to work after UFE?
The majority of our patients are back to work in 3-5 days. We usually peform UFE on Tuesday, Wednesday, or Thursday. After an overnight stay and brief recovery period, the majority of patients are able to return to work the following Monday.
- How long will it take for my symptoms to resolve after UFE?
In patients primarily suffering from abnormally heavy menstrual bleeding and cramping, the majority of patients report significant improvement with the first or second menstrual cycle after UFE. In patients with large fibroids and bulk-related symptoms from compression on adjacent structures like the bladder and rectum, symptoms will resolve more slowly and make take as long as 6 months to reach maximum benefit.
- Will I still be able to have children?
A small number of women enter menopause after UFE. Virtually all women who entered menopause following UFE were 45 years or older at the time of UFE. The overwhelming majority of patients maintain their baseline fertility. We know this because several women have had successful pregnancies after UFE. We also know from years of experience that, when the uterine artery is embolized or surgically tied off for pelvic trauma, fertility remains normal. What we do not know is whether UFE will shrink fibroids enough to improve fertility in women who have had problems with miscarriage.
- If I want to become pregnant after UFE, how long should I wait?
There is no long term data regarding fertility following UFE. Therefore, as a precaution, we recommend that all women refrain from becoming pregnant for at least 12 months following UFE in order to facilitate complete healing of the uterus.
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