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About uterine artery embolisation
Uterine artery embolisation is a form of pinhole surgery, which we use to treat fibroids. ‘Pin hole’ means it is minimally invasive. We perform it under X ray guidance via a tiny incision (cut) in your groin.
After we have anaesthetised your skin with local anaesthetic, we pass a fine tube, known as a catheter, into your artery at the groin and manipulate it into your uterine arteries which supply the fibroids with blood.
Once the catheter is in a stable position, we inject small inert particles, about the size of grains of sand, into both sides of your uterus. This blocks off the blood supply to your fibroids and causes them to shrink.
Fibroids are benign (non-cancerous) growths that develop in the muscular wall of the uterus. They do not always cause symptoms, but their size and location can lead to some women having pain and heavy bleeding.
These symptoms typically improve after the menopause when the level of the female hormone oestrogen decreases.
Fibroids range in size from the size of a pea to the size of a small melon.
Depending on their size and position, some symptoms are common. These include:
- heavy and prolonged menstrual periods
- pelvic pain
- pelvic pressure or heaviness
- pain in the back or legs
- pain during sexual intercourse
- bladder pressure leading to a constant need to pass urine
- pressure on the bowel
- bloating
- an enlarged abdomen.
Treatment of fibroids
We usually diagnose fibroids through a physical examination and confirm them by using an ultrasound scan and an MRI scan.
Most fibroids are of a size that does not require treatment.
If you do require treatment, the first step is often hormone manipulation. This can include a prescription for a birth control pill, or non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen.
If these do not control your symptoms, next steps include the following:
- uterine artery embolisation (the procedure that you are considering)
- surgery to remove individual fibroids (myomectomy)
- surgery to remove the whole uterus (hysterectomy).
Who performs uterine artery embolisation and where it takes place
A consultant interventional radiologist will perform your embolisation. This is a doctor who specialises in performing percutaneous (through the skin) procedures under imaging guidance. They have expertise in controlling catheters using X ray and scanning equipment, and in interpreting the images produced. They use the images on screen to guide the procedure and move the catheter into the correct place.
We will perform the procedure in the Interventional Screening Room which is part of the Kingston Hospital Radiology Department.
Why you need uterine artery embolisation
The gynaecologist in charge of your case and your interventional radiologist both feel that this is the best treatment option for you. It is a less invasive way of dealing with fibroids when compared to the surgical intervention of myomectomy or hysterectomy (see above).
They will discuss their recommendation with you and they will take your opinion into account. You will have the chance to ask questions. If, after discussion with your doctors, you do not want us to carry out the procedure, you can decide against it.
We will only go ahead with this procedure after you have given us your written consent.
Most women who have the procedure experience significant or total relief from heavy bleeding, pain and other symptoms.
If your symptoms are not completely controlled by uterine artery embolisation, or if your fibroids grow back, we can offer you further treatment with surgery.
Preparation for your procedure
You will need to be an inpatient for the procedure. We will admit you to Kingston Hospital on the day before the procedure. Most people go home the morning after.
To prepare, do the following.
- You can take sips of water up to 2 hours before the procedure.
- You can take your normal medicines up until the procedure.
- When you receive your appointment letter, tell the Interventional Radiology Unit if you have previously had allergies to foods, medicines or intravenous contrast medium (the dye used for kidney X rays and CT scans).
- When you receive your appointment letter, tell the Interventional Radiology Unit if you have been on blood thinning tablets such as warfarin, aspirin or clopidogrel.
You can expect the following during the procedure.
- A member of the pain control team will meet you on your hospital ward.
- We will place an intravenous cannula (a small flexible tube) in a vein on your arm and connect it to a ‘patient controlled analgesia’ (PCA) pump. This allows you to give yourself pain relieving medicine whenever you need it.
- Once this has been done we will take you to the X ray department and ask you to lie on the X ray table.
- We will wrap a cuff around your arm to monitor your blood pressure, and place a clip on your finger to measure your pulse and breathing.
- We will clean and anaesthetise (numb) the skin of your groin.
- We will then perform the procedure with the catheter and particles as described above (see ‘About uterine artery embolisation’ above).
- When the radiologist is satisfied, we will remove the catheter and the radiologist will press firmly on your skin at the needle entry point for several minutes, to prevent any bleeding.
Pain
As the fibroids are embolised you may experience cramp which feels similar to period pain.
After the procedure
The procedure lasts approximately 1 hour.
When it is over, we will take you back to your ward, where you will rest in bed for the remainder of the day. The nurses will carry out routine observations to make sure you are recovering as expected.
- The following morning most people are able to get out of bed.
- If you feel comfortable, we will disconnect the PCA pump and offer you tablet painkillers if you need them.
- As soon as you are mobile and comfortable, we will discharge you home.
During your first week off work, you are likely to experience a small vaginal discharge, which may be yellow. You may pass part of a fibroid like a clot, but this will be painless.
Risks
Uterine artery embolisation is a safe procedure, but some risks and complications can arise.
They include the following.
- The most significant risk is placing the embolisation particles into the wrong artery. To avoid this, we carry out the procedure under X ray guidance. This allows the radiologist to see exactly where the catheter goes.
- Sometimes it may not be technically possible to move the catheter into a safe position within your uterine arteries. If this happens, we will abandon the procedure. This situation is rare and happens to fewer than 1 in 20 patients.
- Another risk is infection developing within the fibroids as they start to shrivel up. Serious infections are rare as we routinely give patients antibiotics to prevent this happening. Occasionally a patient needs a second course of antibiotics to treat an offensive discharge.
- Adverse and allergic reactions to the X ray dye and other medicines are rare.
We will identify these risk factors during your pre-procedure assessments, and take suitable precautions to avoid risk.
We will closely monitor you during the procedure and the staff looking after you will be equipped to treat reactions if they arise.
If you have concerns or questions about this procedure, you can discuss these with your medical team and your interventional radiologist at any time.
Fertility
A recent study compared the fertility of women who had uterine embolisation with those who had a myomectomy (surgery to remove individual fibroids). This study showed a similar number of successful pregnancies from both groups.
The long-term effects of uterine artery embolisation on the ability of women to have children have not been fully determined. There have been a number of successful local pregnancies after the procedure, so we advise you to continue to use adequate contraception if you do not wish to become pregnant.
Contact information
Interventional Radiology Unit
Interventional Radiology Unit Charge Nurse
Vascular Surgical Unit, Pre-Assessment Nursing Sister
Telephone:
Interventional Radiology Unit: 020 8934 6206
Interventional Radiology Unit Charge Nurse: 020 8934 2758
Vascular Surgical Unit, Pre-Assessment Nursing Sister: 020 8934 3668