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Uterine Fibroid Embolisation (UFE)

What are Fibroids?

Fibroids are benign, non cancerous, growths of the uterus

(womb). They occur very commonly.

How are Fibroids diagnosed?

The diagnosis is best made by a gynaecologist who will perform

an examination in the hospital clinic. Fibroids are then usually

confirmed by an ultrasound scan of the uterus.

At the time of the gynaecologist examination, a sample of cells

may also be taken from the lining of the uterus. This procedure

is mildly uncomfortable; similar to having a cervical smear, but

its result will enable fibroids to be confirmed and other causes

of your symptoms to be excluded. Often, other types of scan are

also performed such as magnetic resonance imaging (MRI).

Why do they need to be treated?

Many fibroids do not cause any symptoms at all, and will not

therefore require treatment. The most common symptom is

menorrhagia – heavy periods, which may be more painful than

usual.

Fibroids may also result in enlargement of the uterus and cause

pressure on the bladder which results in a need to keep passing

urine (a symptom known as frequency). They may also push

on your back pasage or spine. Occasionally, fibroids may be so

large that they are visible as a swelling on the lower part of the

abdomen.

Uterine Fibroid Embolisation (UFE)2

Uterine Fibroid Embolisation (UFE) 3

How will Fibroids be treated?

They may not need to be! Often fibroids are found by chance

as part of an examination for other reasons, e.g. pregnancy

scanning. If the gynaecologist does advise treatment, there are

four options:-

a) Drug treatment:

Current drugs are usually given for a maximum of six

months. They may help symptoms for this time but are

not a cure and have side effects which some women find

unpleasant. Some patients are given a ‘mirena coil’ which is

put in position by the gynaecologist. This may help with the

symptom of heavy bleeding. If this is the case, the coil can be

left in place if you are to procede to UFE.

b) Myomectomy:

In some cases it may be possible to surgically remove fibroids

(myomectomy) without taking the uterus itself.

This means that future pregnancy remains possible. However,

it is important to understand that hysterectomy (removal of

the uterus) may very occasionally be necessary at the time

of myomectomy. Fibroids may regrow after myomectomy,

and in the long term about 1 in 10 women require further

surgery.Myomectomy may be performed as a normal

operation, or by a keyhole technique.

Uterine Fibroid Embolisation (UFE)

c) Hysterectomy:

This is the surgical removal of the uterus, usually including

the cervix. Future pregnancy is impossible.

The operation usually requires about 5 days in hospital and

usual advice is to remain off work for 3 months afterwards.

Separate information is available for this operation.

d) Uterine Fibroid Embolisation (UFE): as discussed below.

How is UFE done?

Fibroids have a rich blood supply – one of the reasons they

cause problems with heavy periods. The aim of UFE is to restrict

this blood supply by injecting tiny plastic type particles into

the arteries supplying the uterus. This process is known as

embolisation. The procedure is performed by a radiologist who is

a specialist doctor trained in scan interpretation and certain types

of key hole type surgery. The procedure is performed under x-ray

guidance. Before the procedure, you will be given antibiotics, a

mild sedative and a local anaesthetic in the groin. The doctor will

then make a tiny nick in the skin just a few millimetres long, and

will introduce a very fine tube through which the particles can be

injected into the right place. It may be necessary to make nicks in

both groins, depending on the situation found at the time.

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Uterine Fibroid Embolisation (UFE)

Is this painful?

The local anaesthetic may sting, and the placement of tubes

(catheters) is only mildly uncomfortable for a short time at

the beginning of the procedure. However, soon after the

embolisation itself, it is usual to experience pelvic pain. This

can be severe but can be controlled with strong painkillers

(analgesics), and is the reason why you stay in hospital for 24hrs

to make sure you are as pain free as possible.

How will pain be controlled?

One hour before the procedure starts, you will be given a

suppository of Diclofenac (Voltarol). This will be placed in the

back passage (rectum) by a nurse. As the suppository is absorbed

into the bloodstream from the rectum it provides very good pain

relief. Further suppositories may be used over the following 24

hours. During the procedure further analgesics, and possibly

further sedation may be given into a vein. One of the advantages

of this procedure is that you will NOT need a general anaesthetic.

Following the procedure, you will be given more strong

painkillers, usually this is only necessary for the first 8-12 hours

after which the Voltarol suppositories and tablets are usually all

that is necessary.

What can I expect after the UFE?

Some mild pain or discomfort is usual for some days after the

procedure. The average time taken to ‘return to normal’ is about

2 weeks. During this time many women experience a thick

yellow/green vaginal discharge which is managed by sanitary

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Uterine Fibroid Embolisation (UFE)

towels. You should not use tampons as there is a risk of infection

with these. You may have a slightly raised temperature for up to a

week afterwards, sometimes with feverish symptoms. If you have

a high temperature (above 37o) more than seven days after the

procedure you should contact the hospital.

When will I notice a difference?

It takes time for fibroids to shrink after embolisation. Gradual

improvement can be expected for up to 6 months afterwards.

How good is it?

n On average, fibroids reduce to less than half of their pre-

operative size by 6 months but this ranges from very little

reduction in some women to complete reduction in others.

n 2 out of 3 of women get satisfactory relief of bleeding

symptoms.

n 2 out of 3 get satisfactory relief of pelvic pain.

n Most women report the procedure as successful.

Will I be able to have a baby afterwards?

There have been a number of pregnancies in women after UFE

but advice at present is for you to use appropriate contraception

for 1 year after the procedure, to avoid early pregnancy. The

effects of this procedure on a future pregnancy are not fully

known. Occasionally, as mentioned elsewhere in this leaflet, the

UFE procedure can result in early menopause. Unless you have

an early menopause as a result of UFE you will still be fertile and

should continue with contraception.

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Uterine Fibroid Embolisation (UFE)

What are the common complications?

Fever is usual for about 36 hours and can last up to 7 days.

Vaginal discharge is normal for 2 weeks and sometimes longer.

Pain, as described above, is usual for up to 5 days.

Some women will discharge a fibroid via the vagina 6-12 weeks

later.

Are there any serious or rare complications?

Infection is a risk with any operation. Currently there is a quoted

risk of about 5%. Antibiotics are given at the time of the UFE to

minimise this risk but late infection some weeks afterwards has

been reported. Most can be treated with antibiotics at the time

but about 1.5% of women having a UFE will need to have a

hysterectomy for infection. It is important that you understand

this risk before you agree to have UFE.

About 1% of women have an early menopause as a result of UFE.

This is more likely if you are approaching the menopause at the

time of the procedure, and blood tests are performed before the

procedure to assess how likely this is. Most women having UFE

are content with the prospect of their periods stopping.

What should I do after I leave hospital?

You will still have some pelvic pain, similar to period pains, for

some days. You may take paracetamol or ibuprofen for this. If

you remain feverish or have a high temperature after 7 days you

should contact the team at Southmead Hospital in Bristol; further

details would be given to you before you are discharged home,

after the embolisation has been performed.

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Uterine Fibroid Embolisation (UFE)

You may return to normal activity as soon as you feel ready; this is

usually after about 2 weeks. You may resume sexual activity when

you feel ready, and once the discharge has settled.

You will be seen in the Outpatients Clinic, 4-6 weeks after the

procedure. If you have any further questions, please ask the

Doctors in the clinic.

Information for patients after uterine fibroid embolisation (UFE)You may find the following information useful after going home

from Hospital after a UFE.

Eating and drinking:

You were given some light sedation to make you feel mildly

sleepy during the procedure. You should not eat or drink until this

has entirely worn off but it is likely you will feel fine by the next

day. One of the antibiotics may make your feel mildly nauseated

should you drink alcohol and it is best to avoid this for 24 hours.

Driving:

You should not drive or operate machinery for at least 2 days

after procedure – this means you should ask for a relative or

friend to drive you home from hospital. It is important you ensure

you can operate the pedals in the car prior to any driving.

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Uterine Fibroid Embolisation (UFE)

Your groin:

A very small nick was made in the artery and usually, this is in the

right groin. It is possible you will get a little bruising or swelling

in the first few days after the procedure but if you are worried

about this it is best you call the ward.

Vaginal discharge:

It is common for women to experience a moderate vaginal

discharge after this procedure. It can occasional contain small

parts of the fibroid which is breaking down and can also be blood

stained. It is important you manage this with a sanitary towel

rather than tampons to avoid risk of infection. It is common for

the discharge to last for 2 weeks and occasionally can last for 3 or

4 weeks. Occasionally a fibroid can be passed through the vagina.

If the discharge you experience changes in its nature or becomes

more offensive and smelly it is important that you contact the

ward as this may indicate you are developing an infection.

Pain:

The purpose of you staying overnight in hospital after the

procedure is to ensure you are pain free. The ward should give

you further pain killers to take home with you. Should the pain

continue again you can call the ward for further advice.

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Uterine Fibroid Embolisation (UFE)

Fever:

It is common to experience a low grade temperature for up to

1 week after this procedure. You can occasionally feel generally

slightly unwell with this like mild flu. If the fever and these flu like

symptoms resolve and then return (particularly if you experience

more of a temperature and change in the nature of vaginal

discharge) this may indicate you are developing an infection and

again a telephone call to the ward is suggested.

Your periods and sexual intercourse:

It is common for the 1st period after an embolisation to be

slightly different from usual. It may take 1, 2 or even 3 months

for a reduction in the blood loss you have been experiencing

but it is common for this to have occurred by 6 months after the

procedure. You may resume normal sexual activity when you feel

able to do so. It is important however that you use appropriate

contraception for 1 year after fibroid embolisation as there is

some suggestion that miscarriage and problems with pregnancy

are increased after this procedure.

Follow up:

The team looking after you will either give you an appointment

for gynaecology follow up or will be in touch post procedure. It is

common for this to occur around 6 weeks after the procedure.

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Uterine Fibroid Embolisation (UFE)

If you have any doubts or are concerned about any aspects

of the above it is best for you to call the ward and they

will put you in touch with the gynaecology team or the

Interventional Radiologist who performed the procedure.

NHS Constitution. Information on your rights and responsibilities.

Available at www.nhs.uk/aboutnhs/constitution

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If you or the individual you are caring for need support reading this leaflet please ask a member of staff for advice.

How to contact us:

Gynaecology Co-ordinator, Cotswold Ward, Southmead Hospital, Westbury-on-Trym, Bristol BS10 5NB

Cotswold ward 24 hours 0117 414 6785

www.nbt.nhs.uk

© North Bristol NHS Trust. This edition published February 2015. Review due May 2017. NBT002898