Uterine Fibroid Embolization

Uterine fibroids are very common and, for many women, cause symptoms that affect the quality of their life. At Florida Hospital, we have a relatively new treatment option called Uterine fibroid embolization that has been shown to provide safe and effective therapy for women with fibroids. To learn more or to schedule a consultation please call Florida Hospital Orlando at, 407-303-5600 extension 6168, or Winter Park Memorial Hospital at, 407-646-7591.

The Female Reproductive System

Ovaries
The ovaries produce the eggs that, once fertilized, become the developing fetus

Fallopian Tubes
The fallopian tubes receive the egg released from the ovary. The egg is fertilized in the fallopian tube as it is transported to the uterus.

Uterus
The uterus, or womb, is a muscular organ that receives the fertilized egg and provides the environment needed for growth of a fetus.

Uterine Fibroids

Definition
Uterine fibroids are benign (non-cancerous) tumors of the uterus and they are a very common problem among women.

Incidence
Uterine fibroids are benign (non-cancerous) tumors of the uterus and they are a very common problem among women.

Effects
Most fibroids do not cause symptoms. Consequently, no treatment is required. However, for many women, fibroids result in severe problems and treatment becomes necessary.

Typical Characteristics

• Typically, women who have uterine fibroids have more than one.
• Fibroids can also range widely in size. In some cases, the fibroid is no bigger than a pea. However, some fibroids can grow to the size of a melon or larger.
• If you are diagnosed with uterine fibroids, your doctor will classify the extent of the fibroids by comparing the size of your uterus to a typical size during pregnancy. For example, if you have a large fibroid or multiple fibroids, the enlargement of your uterus might be classified as equivalent to a six- or seven-month pregnancy.

Types of Uterine Fibroids

Intramural Fibroids

• Intramural fibroids are the most common type of fibroid.
• Because these fibroids grow in the muscular wall of the uterus, they make it feel larger than normal.
• These fibroids can cause an increase in menstrual bleeding, pelvic pain, back pain or pressure.

Subserosal Fibroids

• Subserosal fibroids are the second most common type of uterine fibroid.
• Because these fibroids are located on the outer wall of the uterus, they usually do not affect menstrual flow.
• However, they can cause pelvic pain, back pain or pressure.

Submucosal Fibroids

• Because of their location on the inner surface of the uterus, submucosal fibroids can cause heavy or prolonged periods. This can happen even if the fibroids are very small.

Causes of Uterine Firbroids

• Genetics
  
  • High risk for African-American women. As many as 50% of these women have significant fibroids. This is about twice the rate for other groups of women.
• Estrogen - the female hormone
  
  • Uterine fibroids can dramatically increase in size during pregnancy. It is thought that this effect is due to the increase in the amount of estrogen - the female hormone - that naturally occurs during pregnancy. After delivery, the fibroids usually shrink to the size they were before the pregnancy.
    
    
  • In contrast, during menopause, estrogen levels dramatically decrease. This causes uterine fibroids to shrink, relieving the symptoms of the disease.
    
    
  • However, if a woman takes hormone replacement therapy (HRT) during menopause, estrogen levels do not decrease. For these women, the fibroids may not shrink and the symptoms may remain.

Symptoms of Uterine Fibroids

• Heavy, prolonged menstrual periods
• Unusual monthly bleeding
• Possible anemia
• Increased menstrual cramping
• Pain, pressure or discomfort in the pelvis
• Pain in the back, sides or legs
• Pain during sexual intercourse
• Urinary frequency due to pressure on the bladder
• Blockage of urine flow from the kidney to the bladder
• Constipation and/or bloating due to pressure on the bowel
• Abnormally enlarged abdomen

Diagnosis of Uterine Fibroids

• Usually, uterine fibroids are first diagnosed during a gynecologic internal examination. This pelvic exam allows the physician to check the size of your uterus.
• If your uterus feels enlarged, your physician may send you for an ultrasound examination. This exam can detect if fibroids are present, as well as determine their precise location and size.
• The presence of fibroids can also be diagnosed using magnetic resonance imaging (MRI)
• or computed tomography (CT). In cases of submucosal fibroids, your Gynecologist may use a small scope placed through your vagina to examine the inside wall of your uterus.

Treatment of Uterine Fibroids

The treatment for uterine fibroids depends on the size and location of the fibroids and the severity of your symptoms. If you do not have symptoms, there is no need to treat the fibroids. However, you will need to see your physician yearly to have them checked.

If you develop symptoms, there are a number of treatment options available. These include,

• medical therapy - non-steroidal anti-inflammatory drugs (NSAIDs); birth control pills; and hormone therapy
• surgical therapy - hysterectomy (removal of uterus); myomectomy (removal of fibroids)
• non-surgical therapy (uterine fibroid embolization)

Uterine fibroid embolization is a new, less invasive option that is now available for women with fibroids.

Uterine Fibroid Embolization (UFE)

Uterine fibroid embolization (UFE) is a relatively new approach to the treatment of uterine fibroids. Also known as uterine artery embolization or UAE, this procedure was first performed in the early 1990s. UFE is a less invasive technique that avoids the need for surgery. It also preserves your uterus. It is usually performed by an Interventional Radiologist - a specially-trained physician who is skilled in procedures that use x-ray imaging as a guide.

Overview

UFE is a technique that involves injection of small particles through a catheter to block the flow of blood to fibroids. This deprives the fibroids of the oxygen and nutrients they require to grow. As a result, over time, the fibroids shrink.

Procedure

At the beginning of the procedure you will be given medication to relax you. You will be awake but will be drowsy and will feel little or no pain. The skin in your groin area is cleaned and a local anesthetic is injected to numb the area.

A tiny incision is made in your skin above where a blood vessel - the femoral artery - is found. The small, flexible catheter is then inserted through that incision and into the femoral artery.

Your fibroids receive blood from your uterine arteries - blood vessels that branch from your femoral arteries on both sides of your uterus. The physician will first steer the catheter up to the uterine artery on the far side of your uterus. X-rays will be taken as the catheter is advanced to make sure that it is placed correctly. Once the catheter is in place, the physician injects a special dye to examine the fibroids. Then, small PVA particles or microspheres are injected through the catheter. These particles or microspheres flow into the branches of your uterine artery, blocking the vessel and preventing blood from reaching the fibroids.

Deprived of oxygen and nutrients, your fibroids will shrink, relieving your symptoms. The catheter is then positioned in the uterine artery on the near side of the uterus and the procedure is repeated, ensuring that there is complete blockage of the blood flow. After the procedure is complete, a small dressing is placed over the skin incision in your groin.

After the Procedure

After UFE, most women need to stay in the hospital overnight. However, some do go home on the day of the procedure. Medications will be prescribed for you to control any discomfort, swelling and cramping that you may experience after the procedure. Before you leave the hospital, you should ask your doctor about your medications and the care of your dressings.

Recovery

Before you go home, you should also ask your physician if there are any activities you should avoid. In most cases, women who have had this procedure are able to return to light activity within a few days. They are usually back to work and normal activity within 7 to 10 days.

After you are discharged from the hospital, it will be important to contact your doctor if you develop a fever or if you experience pelvic pain that increases over time and lasts more than 24 hours. You should also immediately call if you notice a foul-smelling discharge.

Success Rates

• Women who have had UFE generally experience significant or total relief from heavy bleeding, pain and other symptoms of their fibroids.
• The procedure is also available for treatment of multiple fibroids.
• Long-term results not available.

Advantages

• Avoids use of hormone therapy or surgery
• Generally decreases menstrual bleeding, urinary frequency, pelvic pain and pressure
• Virtually no blood loss
• Faster recovery than after surgery
• Generally significant improvement in quality of life

Risks and Complications

• Discomfort and cramping in the first several hours following the procedure.
• In some cases, nausea and fever can occur. You will be given medications to control these symptoms and most are substantially improved by the next morning.
• However, there may be some discomfort and cramping for several days after the procedure.
• Low incidence
  
  • Infection
    
  • Allergic reactions to the dye, particles or medications
    
  • Delayed pain or rash
    
  • Injury in the groin area
• Low incidence of serious complications which may include injury to the uterus that may require hysterectomy, injury to pelvic organs due to migration
  of PVA embolization particles, pulmonary embolism
  due to migration of a blood clot to the lungs, bleeding
  or radiation burns

Pregnancy and Fertility

It is important to realize that you should not have UFE if you are pregnant. Further, UFE is also not intended for women who desire future pregnancy. This is because the effects of UFE on the ability to become pregnant and carry a baby to term - as well as on the development of the baby - have not been determined. However, research in this area is continuing.

There have been a few women whose menstrual periods have stopped after UFE. Most of these women were near the age of menopause at the time of their UFE and it is not known if this premature menopause was a result of the procedure. However, if this should happen, it does result in infertility.

If you should become pregnant following UFE, you may be at increased risk for complications. These include,

• premature delivery
• incorrect positioning of the baby
• post-delivery bleeding
• tearing of the uterus

You may require a cesarean section for delivery of the baby.

Locations and Scheduling

Florida Hospital Orlando
601 East Rollins Street
Orlando, FL 32803
Questions and Scheduling: 407 303-5600 extension 6168

Winter Park Memorial Hospital
200 North Lakemont Avenue
Winter Park, FL 32792
Questions and Scheduling: 407646-7591 (Monday - Friday 8:30 a.m. to 5:00 p.m.)
After hours call 407-646-7025.

Meet Our Interventional Radiologists that Perform UFE

Winter Park Memorial Hospital

Alberto Mansilla, M.D. Medical Director

Thomas Green M.D.

Michael Addonizio M.D.

Meenor Sagar M.D.

Bradford Uricchio M.D.

Florida Hospital Orlando

Alberto Mansilla, M.D. Medical Director

Thomas Green M.D.

Francis Fernández, Jr. M.D.

The goal of our Interventional Radiologists and at Florida Hospital is to provide you the highest quality of care. To schedule a procedure, please call 407-303-5600 extension 6168 for Florida Hospital Orlando or 407-646-7591 for Winter Park Memorial Hospital.