Fibroids are growths that develop in the muscular wall of the uterus (womb). They are benign, which means they are not cancerous. Fibroids can vary greatly in size and sometimes become very large. Although they are common, we still do not know what causes them. They do not occur until a woman starts her periods (the menarche) and tend to get better when she reaches the menopause (when her periods stop). They are more common in African-Caribbean women, may be larger and occur earlier in this group.
At least half of all women with fibroids (which have shown on a scan) do not have any symptoms. If women do have symptoms, they are usually related to periods or if the fibroids are large, pressure. They include:
- heavy, prolonged periods (sometimes with clots). This can lead to anaemia (a lack of red blood cells or the chemical haemoglobin, which is found in blood). It can make you feel tired and faint or cause headaches
- painful periods
- pain in the back and legs
- pressure on the bladder, leading to a constant urge to urinate
- pressure on the bowel, leading to constipation and bloating.
In some women, fibroids enlarge the uterus so much that their abdomen appears large and they look as if they are pregnant. This can cause back pain and make them feel bloated and uncomfortable. Fibroids are also associated with infertility and miscarriages Your doctor has recommended treatment because your fibroids are causing problems.
Fibroid embolisation (also known as uterine artery embolisation) is a minimally invasive procedure that blocks the arteries that supply blood to the fibroids.
Fibroids develop from the wall of the uterus and receive blood from the vessels that branch out from the arteries that supply the uterus. Fibroid embolisation blocks off most of these arteries, causing the fibroids to shrink. The uterus has the ability to develop a further blood supply, so is not seriously affected. In this procedure, an interventional radiologist (doctor who is trained to perform this and other minimally invasive procedures) uses an x-ray camera to guide the delivery of small particles to the uterus and fibroids. The small particles and contrast dye are injected through a thin, flexible tube called a catheter.
Embolisation shrinks the fibroids by about half and this usually shows an improvement in symptoms relating to the size of the fibroids or pressure. Symptoms relating to fibroids improve after the procedure in 8 to 9 out of 10 women. Unlike other treatments for fibroids, embolisation treats all the fibroids in a woman’s uterus. It is very rare for fibroids to grow back after the procedure.
Fibroid embolisation is generally very safe. However, as with any procedure there are some risks.
- Any procedure that involves placement of a catheter inside a blood vessel (artery) carries certain risks. These risks include damage to the blood vessel, bruising or bleeding at the puncture site, and infection. When performed by an experienced interventional radiologist, the chance of any of these events occurring is very small.
- There is a small risk of infection, but this can usually be treated with antibiotics. In about 1% of cases, the infection will be serious and you will need a hysterectomy (operation to remove the uterus) or another procedure.
- Very rarely there is a chance that small particles can lodge in the wrong place and deprive normal tissue of its oxygen supply. In an attempt to avoid these complications, the doctors pay close attention to the pattern of the blood vessels in the pelvis, noting that the path of the vessels can be different from woman to woman.
- An occasional patient may have an allergic reaction to the x-ray contrast (dye) used during uterine fibroid embolisation. These episodes range from mild itching to severe reactions that can affect a woman's breathing or blood pressure. Women undergoing uterine embolisation are carefully monitored during the procedure, so that any allergic reaction can be detected immediately and treated by the doctors.
- Very rarely, you may experience menopausal changes after the procedure. This is more likely to happen to women in their mid 40s or older who are already nearing the menopause.
- You may pass out bits of fibroid (expulsion) for several months after the procedure. Very occasionally if a larger fibroid is passed you may need to see your gynaecologist (doctor specialising in disorders and conditions of the female reproduction system) who can help with its removal.
- Failure of the procedure, meaning the fibroids will continue to grow or re-grow within four months of the embolisation.
- Most patients experience vaginal discharge which usually lasts up to two weeks.
Treatment is not always necessary for fibroids. If you do need treatment there are several options. Your gynaecologist will discuss with you any alternatives that they think may be suitable including medicines, which will not cure fibroids but can relieve some of the symptoms.
The fibroids can be removed surgically by:
- myomectomy – surgical removal of the fibroids without the removal of the uterus. This may not be possible in all cases.
- Hysterectomy – surgery that removes your fibroids by removing the entire uterus. This means you cannot have children afterwards. If your fibroids are not treated, it is possible that your symptoms will get worse.
Before your appointment, imaging of the uterus is performed to fully check the size, number and location of the fibroids. This is usually with a Magnetic Resonance Imaging (MRI) scan organised by your gynaecologist. A blood test will be also needed before the procedure.
You must let your gynaecologist know if you:
- become pregnant or think you could be pregnant
- have any signs of a vaginal infection (such as itching, smelly discharge)
- have had any recent illnesses or medical conditions
- are taking any medications.
To prepare for the procedure you will need to make sure you do the following:
- Please let us know if you are taking any antiplatelet medicines (for example, aspirin, clopidogrel) or any medicines that thin the blood (for example, warfarin), as these may need to be withheld temporarily before the procedure. Call the X-ray Department for advice assoon as you get your appointment letter.
- If you are taking medicines for diabetes (for example, metformin) or using insulin, then these may need to be altered around the time of the procedure. Call the X-ray Department as soon as you get your appointment letter.
- You must stop eating six hours before your procedure. You may drink clear, non-milky fluids, such as black tea, coffee or water up to two hours before the procedure.
The staff caring for you will ask your permission to perform the procedure. You will be asked to sign a consent form that says you have agreed to the procedure and that you understand the benefits, risks and alternatives. If there is anything you don’t understand or you need more time to think about it, please tell the staff caring for you. Remember, it is your decision. You can change your mind at any time, even if you have signed the consent form. Let staff know immediately if you change your mind. Your wishes will be respected at all times. If you would like to read our consent policy, please tell a member of staff.
You will be given a hospital gown to wear, before you are taken from your ward to the X-ray Department. You do not need to have a general anaesthetic (where you go to sleep) but will be given a spinal anaesthetic and sedation which makes the procedure painless as well as relaxes you and makes you feel sleepy. An anaesthetist will discuss the spinal injection with you beforehand. The spinal anaesthetic is used to numb the abdomen and legs and improve pain relief during and after the procedure. A small, plastic tube (cannula) will be inserted into a vein in your hand or forearm, though which the sedation will be administered.
You will be positioned on the x-ray table. The groin area will then be sterilised and covered with a surgical drape. A fine, flexible, plastic tube about as thick as a spaghetti strand (catheter) is inserted into an artery in your groin. Using x-ray monitoring to check its position, the radiologist guides the catheter into both your uterine arteries (right and left). Only when the catheter is precisely positioned does the radiologist inject fluid, containing tiny particles, through the catheter. This flows into the uterine arteries and blocks them off. They will remain in your body permanently. In over 30 years of use, they have not shown any harmful effects. The procedure itself takes up to one hour and a half. Once the embolisation is completed, the catheter is taken out and the radiologist presses on the puncture site in your groin for about ten minutes to stop bleeding. You do not need any stitches or dressings and there will not be a scar.
No, following the spinal anaesthetic, you should not feel any pain during the procedure
You will stay in the X-ray Department Recovery Room for a short while and will then be taken back to your ward. Your blood pressure and pulse will be checked at regular intervals and a clip on your finger will measure the oxygen level in your blood. The nurse will also check the pedal pulse of your foot. This is found around the base of your ankle – it is not painful.
Everyone gets a bit of bruising where the artery (or vein) was punctured. The bruising will normally be sore and uncomfortable for a few days.
Once the spinal anaesthetic wears off a few hours later, you may have moderate pain and cramping. This is usually well controlled with the oral analgesia prescribed. You will need to stay in hospital overnight so strong pain relief can be given. You can usually go home the next day but will need a responsible adult to travel home with you.
- You may feel tired and we advise you to rest for one to two weeks depending on your recovery. You can then go back to work and resume your usual activities.
- Keep a regular check on the puncture site where you had the procedure. To give the puncture site time to heal, do not drive for 48 hours after the procedure or do any form of strenuous exercise for 48 hours after the procedure.
- You can eat and drink as normal.
- Continue with your normal medication as usual, but if you take any diabetes medicines containing metformin, please do not take them for the next two days after your procedure.
- You may have a cramping feeling in your lower abdomen (similar to period pains) for a few weeks. We will give you painkillers when you leave hospital, which you can take as prescribed to treat this.
- You may expel the fibroids. They vary in size and will look like bits of grey body tissue. This is normal and you do not need to do anything.
- You will have vaginal discharge that can be brown, bloody, yellow or mucus-like. This is the breakdown product of the fibroids. If the discharge becomes excessively smelly and you also have pain or a temperature you should contact the X-ray Department or your gynaecologist as soon as possible.