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11 Questions Women Want to Ask When Considering UFE as Their Non-Surgical Fibroid Treatment Option

Dr Eisen Liang - Saturday, February 04, 2017

11 Questions Women Want to Ask When Considering UFE as Their Non-Surgical Fibroid Treatment Option


Did you know that one in four women will develop uterine fibroids during their reproductive age? It is the most common tumour in women and while it is not malignant, it can still cause some symptoms that 10-40% of women need medical treatment or even surgery for. Sometimes, they will even get a hysterectomy which, most of the time, is too invasive just for removing uterine fibroids and relieving its associated symptoms.

Uterine fibroid embolization (UFE) is the non-surgical alternative to a hysterectomy for treating uterine fibroids. It's been proven to be highly effective in shrinking fibroids and relieving symptoms such as heavy bleeding, bladder symptoms and period pain, while being less invasive with a shorter hospital stay, faster recovery, and fewer adverse events compared to hysterectomies.

Compared to hysterectomy, uterine fibroid embolization is minimally invasive. Only a tiny nick in the skin is required to insert  a small catheter into the uterine arteries, blood flow is cut off from the fibroids, ‘starving’ them and causes fibroids to shrink. All of this is done under local anesthetic with x-ray guidance by a skilled interventional radiologist.

Uterine fibroid embolization (UFE) has been around much longer than most people realize. UFE is no longer an experimental procedure and has been around for 20 years. In fact, then Secretary of State of the US Condoleeza Rice had Uterine Fibroid embolization (UFE) back in 2004.

For women who have been diagnosed with uterine fibroids and are thinking of getting treatment for fibroids, here are some questions to ask about UFE, or find answers to, in order to make an informed decision.

                                                  

What is uterine fibroid embolization (UFE)?

Uterine fibroid embolization (UFE) is an interventional radiology procedure done under local anaesthetic and performed in an angiographic suite. Embolization means the blocking of blood vessels, in this case the left and right uterine arteries. They are catheterised and injected with embolic particles so blood flow to the fibroids is stopped, resulting in fibroid shrinkage. This alleviates the symptoms of heavy bleeding, period paid, and bladder problems. UFE is also known as uterine artery embolization (UAE).

Is UFE still experimental?

Uterine fibroid embolization (UFE) has been around for around 20 years. It was first described in 1995. Since then, more than 200,000 UFEs have been performed worldwide. It got approved for medicare funding in 2006 and it's been endorsed as a fibroid treatment option by the American College of Obstetricians and Gynecologists and the Royal Australian and New Zealand College of Obstetricians and Gynecologists in 2008. There are currently six randomized control trials comparing uterine fibroid embolization (UFE) with surgical alternatives like hysterectomy and myomectomy.

How does UFE compare with hysterectomy or myomectomy?

With UFE, there is no surgical cuts, no blood loss, no risk of blood transfusion or wound complications, and no risk of bladder, bowel or ureteric injuries. Hospital stays and time to resume routine activities are also shorter.

UFE and hysterectomy are essentially the same in terms of patient outcomes. A Cochrane review concluded that there is no difference in quality of life improvement at 1 year or patient satisfaction rate at 2 and 5 years.

Not all fibroids can be removed by myomectomy and the remaining fibroids can continue to grow. UFE simultaneously treats all fibroids present in the uterus and was shown to have higher success rate in controlling heavy periods compared to myomectomy.

 

Can fibroids be malignant?

Malignant fibroids are called leiomyosarcoma and their occurrence is very rare. Malignant fibroids are found in merely 2-5 per thousand hysterectomy specimens. Fibroids vary in size and growth rate but these do no indicate malignancy. Fear of one's uterine fibroids turning malignant should not be used to justify getting a hysterectomy when the surgery itself has a mortality rate of 1-6 per thousand.

How safe is UFE?

The rate of complications from UFE is very low and most complications are temporary. One potential  complication from UFE is passage of fibroid debris that occurs in approximately 2.5% of patients. This is likely to occur if the fibroid is protruding into the uterine cavity.

The most serious UFE complication is endometritis, with a reported incidence of 2%. This can be managed with prompt administration of antibiotics and removal of the sloughed fibroid if it is present.

The rate of hysterectomy subsequent to UFE ranges between 0.25% and 1.6% and is generally due to infection, pain, and bleeding.

Is UFE painful?

The procedure itself is not painful. Pain can be at its worst in the first few hours after the procedure. This is managed with paracetamol, NSAID and patient controlled narcotic analgesia. Common symptoms after UFE include low-grade fever, nausea and vomiting, lethargy, and minor vaginal discharge. Patients should expect to return to normal activities in one week.

Is there local Australian data?

Yes, in 2012 we published in ANZJOG the first Australian series of 75 UFEs, achieving a 96% success rate for alleviating heavy periods, 93% overall patient satisfaction, and reported improvement in painful period in 89% of patients.

Can a woman lose her period after UFE?

Yes, but this is more likely to be due to natural menopause. If the patient is a younger woman, UFE does not appear to affect their ovarian function whereas permanent loss of period tends to occur in older women who are about to enter into their menopausal stage.

Is pregnancy possible after UFE?

Yes, pregnancy is possible after UFE. The birth weight were shown to be not affected by previous UFE. However, because women who require UFE already have an abnormal uteruses to start with, they generally have a higher rate of miscarriage, caesarean section, and postpartum haemorrhage compared to the normal obstetric population. Currently a randomised control trial is being conducted in UK to compare fertility outcomes between UFE and myomectomy. In the meantime we recommend MRI to study fibroid anatomy. We would consider UFE if myomectomy is technically challenging and its outcome is likely to be unfavourable for pregnancy, or if the woman prefers a non-surgical approach. 

Can adenomyosis and adenomyoma be treated by UFE?

Yes, we have 90% clinical success in alleviating symptoms of heavy bleeding and period pain. These conditions are usually missed or misdiagnosed on ultrasound. MRI is the most reliable imaging test. Smaller embolic particles are used to treat adenomyosis and adenomyoma.

Who are the ideal candidates for UFE?

Women who are significantly troubled by fibroid or adenomyosis related symptoms such as heavy periods, severe period pain, and bulk symptoms, but want to avoid major surgery and have faster recovery time.



Dr Eisen Liang is an interventional radiologist with special interest in gynaecological intervention such as Uterine Fibroid Embolisation (UFE), adenomyosis embolisation and ovarian vein embolisation for pelvic congestion syndrome. He performed his first UFE in 1998 and has been performing UFE at Sydney Adventist Hospital since 2007.
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