Uterine Fibroid Embolisation (UFE) FAQs

UFE is performed in an angiography suite by an interventional radiologist. The patient is conscious but sedated with IV medications. Local anaesthetic is injected at the groin, where a tiny nick in the skin is made. A catheter (small tube 1 – 2 mm in diameter) is then inserted into the femoral artery at the groin and guided with X-ray to reach the uterine arteries. Tiny plastic particles (0.3 – 0. 5mm in size) are mixed with X-ray dye and injected under X-ray control to block the uterine arteries.

UFE shrinks fibroids by cutting down the blood supply so that the fibroid cells will shrink and die. Normal uterine wall tissue has many dormant blood vessels that can be recruited when needed, such as during pregnancy. During UFE, particles injected will block some of the normal uterine vessels. However, there are numerous dormant vessels the normal uterine wall tissue can recruit. Fibroid tissue does not have dormant vessels to recruit and therefore will not survive UFE.

Many studies have shown UFE is as effective as hysterectomy surgery in alleviating fibroid symptoms and improving quality of life. The procedure is effective for multiple and large fibroids. It is a one-off treatment and there are no fibroid recurrence issues.

Sydney Fibroid Clinic’s own study showed 93% of women treated were happy or very happy with the outcome. The size and number of fibroids does not usually matter to the success of UFE.

UFE is highly effective in treating the symptoms of fibroids without surgical removal of the fibroids or uterus. The procedure is performed under local anaesthetic and is much less invasive than a hysterectomy. When compared to a hysterectomy, UFE requires a shorter hospital stay (1 – 2 days versus 2 – 7 days) and much shorter convalescence (1 week versus 4 – 6 weeks) before returning to work or normal activities. Women can get rid of fibroid symptoms by shrinking their fibroids, instead of having their fibroids or uterus removed by surgery.

No. UFE has been performed since 1995 and has been rebatable by Medicare since 2006. International and local studies have demonstrated UFE is safe and effective in treating fibroid symptoms. It is recognised as a compelling treatment option by colleges of obstetrics and gynaecology in Australia, the UK and USA. In 2014, Cochrane Review – the highest evidence authority in medicine – concluded that UFE is as effective as a hysterectomy in symptom relief and quality of life improvement.

The UFE procedure itself is essentially pain-free. Local anaesthetic at the groin may sting for about ten seconds before taking effect. Soon after embolisation, the fibroids are strangulated (cut off from blood supply) and pain may be experienced – but the degree varies from person to person.

Our robust pain control protocol has worked well for many previous patients for more than 10 years, including patient-controlled analgesia (PCA) administered through an IV drip. Pain is usually worst for the first 12 hours and PCA is not usually required the following day.

Take home medications typically include regular Panadol and nonsteroidal anti-inflammatory drugs (NSAIDs). Additional long and short acting pain medications are also supplied. Pain should subside within 4 – 5 days and patients should anticipate returning to normal activities about 7 days after the procedure.

UFE is a minimally invasive procedure. It is very safe, especially when compared with major surgery.

Procedural-related complications are very rare. Groin haematoma is less than 1%. Other blood vessel injuries are even less common. Non-target injection of particles to other organs should not occur in experienced hands. Bladder infection from catheterisation is around 3%. Ovarian failure or early menopause occurs in 1 – 3% (in women younger than 40).

Delayed complications are usually related to fibroids located near the uterine cavity (submucosal). Small fibroid fragments can slough off – seen as virginal discharge or passage of small tissue fragments. Sloughing of large tissue fragments into the cavity may cause obstruction of the cervix, resulting in pain and infection (smelly discharge, fever and chills) in about 3% of women treated. Some women are able to pass the fibroid fragments themselves; others might require a transcervical removal (like a curette procedure).

The risk of needing a hysterectomy to treat an uncontrollable infection is less than 1%.

Transient loss of periods may occur in 5 – 10% of patients after UFE. Younger patients tend to regain their period within six months.

Ovarian failure resulting in menopause occurs in 1 – 3% of women younger than 40, but more frequently (7 –  14%) in women aged 45+. This may reflect the fact that women in their mid-40s and up are already nearing menopause.

Many prior studies have shown pregnancy is possible after UFE. Overall, meta-analysis suggests that the pregnancy rate post-UFE is in the range of 30-48%. There is a small risk of ovarian failure of 1-3% following UFE in women younger than 40 years of age. In other words, 97-99% of the time her ovaries are not injured with UFE.

Though a successful pregnancy outcome is possible after UFE, this is a complex issue. The presence of fibroids may make it difficult to get pregnant, cause potential miscarriage and present difficulties with normal vaginal delivery.

Traditionally, a myomectomy is recommended if fibroids are thought to be interfering with fertility and pregnancy. A myomectomy is still a major surgery however and is generally more technically challenging than a hysterectomy. Risk of blood transfusion is higher than with a hysterectomy and the risk of hysterectomy remains if the surgeon is unable to preserve the uterus.

For those fibroids unsuitable for a myomectomy or hysteroscopic resection, UFE should be considered as an option for treatment.

Following UFE, there is more than a 90% chance that the uterus can be conserved. However, women younger than 40 needs to be warned about the 1 – 3% risk of ovarian failure. Egg harvesting should be considered as an option.

It should be emphasised that the aim of UFE is to provide fibroids treatment with a minimally invasive technique, in order to avoid hysterectomy. Although pregnancy is still possible after UFE, successful pregnancy depends on many other factors and therefore cannot be guaranteed.

The blocking agent we inject into the uterine arteries are PVAs. It is a pure form of plastic without harmful additives. PVA as embolic material in medicine has been around for more than 30 years .

Clearly there has been plenty of research on PVA.

We’ve seen PVA used in numerous medical settings such as soft contact lens material, artificial heart linings, artificial cartilages, catheters, skin, and pancreas membranes(1). PVA is commonly used as capsules for medicine, vitamins and dietary supplements.

Pharmacologists have explored using PVA as drug delivery systems to distribute medications through various routes effectively. They’ve also harnessed the film-forming and adhesion properties in body washes, multipurpose creams, and sunscreens (1,2).

Researchers and manufacturers continue to explore the potential uses of PVA to keep foods safe. We see PVA in food packaging and commonly used as capsules for dietary supplements. It’s safe to consume in normal quantities, and the FDA recognizes it as a GRAS ingredient(1).

Check out this link for the  reference .

https://www.canr.msu.edu/news/trending-polyvinyl-alcohol

Yes. International studies and Sydney Fibroid Clinic’s own studies have demonstrated UFE (also known as UAE) is highly effective for adenomyosis as well.

More information on Sydney Fibroid Clinic’s adenomyosis treatments can be found here.

UAE For Adenomyosis

If you’re troubled by the symptoms of fibroids and simple measures have not been effective, UFE could be an ideal fibroids treatment – especially if you wish to preserve your uterus, avoid major surgery and recover quickly.

For more information on whether you’re a suitable candidate for UFE, chat with us online, come to our information nights or book a consultation with Dr Eisen Liang.

All patients are required to have a pre-procedure consultation with our interventional radiologist. This allows us to obtain a gynaecologic and general medical history, review imaging findings, go through all treatment options and answer any questions regarding UFE.

A MRI of the uterus is also required. The MRI maps out fibroid locations, demonstrates richness of cells and blood supply. It helps to rule out fibroids unsuitable for embolisation. The MRI is also used as a baseline for follow-up evaluation at six months. This should be done by our preferred MRI service provider, who is familiar with our protocols and has an online viewing arrangement with us.

Patients must not be pregnant. A pregnancy test is required if there is possibility of pregnancy and the procedure is done more than 10 days since the beginning of your last menstrual cycle.

On the day of your procedure, you’ll need to avoid solid food for 6 hours. Clear fluid and medications are allowed up until the time of procedure.

Nursing staff will start an intravenous line to give you fluid, sedatives and pain relief medications. We’ll also need to place a catheter in your bladder, to ensure your bladder remains empty during the procedure. As your bladder is in front of your uterus, X-ray dye collected in the bladder will obscure our view.

After your procedure, you’ll need to lie still for 2 hours to prevent bleeding in the groin.

You may experience pain and nausea. Medications are prescribed to control these symptoms and you may ask the nurses if you require them. The pain is worse in the first 12 hours. You’ll be given a patient-controlled analgesia (PCA) pump that allows you to administer the dose you need. You are allowed to eat and drink, but you might be nauseous and you might not have any appetite.

Typically, you will no longer require the PCA the next morning and the bladder catheter can be removed to allow you to move around and to shower. The majority of our patients are able go home, though some might need to stay another night until the pain is under control and oral fluid intake is adequate.

Take home medications typically include regular Panadol and nonsteroidal anti-inflammatory drugs (NSAIDs). Additional long and short acting pain medications are also supplied. Coloxyl with Senna is also provided to prevent constipation.

In the next few days, you may experience residual pain, lethargy and low-grade fever. You should be well enough to go to the local shops on days 4 – 5. You should anticipate returning to work and normal activities about 1 week after your procedure.

Some vaginal discharge and minor bleeding is normal after UFE.

You’ll need to see Dr Liang at 3 months post UFE to check your clinical progress. You’ll also need a progress MRI at 6-month review with Dr Liang.

Sydney Fibroid Clinic believes in a multidisciplinary approach to deliver the best care for fibroid-related symptoms. Therefore, we share the care with your GP and gynaecologist.

You might have seen your own gynaecologist, who may or may not be familiar with UFE. Dr Liang is happy to discuss your case with your gynaecologist if he or she wishes to do so. Otherwise, we are happy to see you to provide you with a second opinion.

If you have not seen your own gynaecologist, Dr Liang is willing to see you and discuss all your treatment options. If necessary, Dr Liang will invite his gynaecologist associate to conduct a joint consultation to discuss your case.

During the first week, you might experience residual pain, lethargy and low-grade fever. Minor vaginal discharge or bleeding and passage of small tissue fragments are also expected. These are normal

If the vaginal discharge is smelly, there could be bacterial colonisation and antibiotics may be required. You should see your GP or contact us for antibiotic treatment. Passage of larger fibroid fragments may be associated with pelvic cramps. Panadol and Nurofen can be used for pain control.

Resurgence of severe pelvic pain, fever, chills, and smelly vaginal discharge may indicate cervical blockage and infection. You may require urgent medical assessment. If any of these symptoms occur, please contact us immediately, or see your GP or gynaecologist. If symptoms are serious and urgent (e.g. after clinic hours), you should visit the emergency department for assessment and ask emergency doctors to contact Dr Liang via the hospital switch (the hospital where you had UFE).

Some women are able to pass fibroid fragments themselves; others might require a transcervical removal (like a curette procedure).

The risk of needing a hysterectomy to treat an uncontrollable infection is less than 1%.

 

	Hysterectomy	UFE
	Major surgery	Minimally invasive
Where	Operating theatre	Angiogram suite
Performed by	Gynaecologist	Interventional radiologist
Anaesthetic	General	Local
Size of cut	15cm	0.3 cm
Hospital stay	4 – 6 nights	1 – 2 nights
Recovery	4 – 6 weeks	1 week
Risk of blood transfusion	2 – 3%	Nil
Acute complication	5 – 10%	< 1%
Delayed complication	Nil	1 – 5%
Effectiveness for fibroid symptoms	Same	Same
Quality of life improvement	Same	Same
Imaging follow-up	No	Yes
Future fertility	No	Possible
Cost	Higher	Lower