Uterine artery embolisation

Uterine artery embolisation was first performed approximately 20 years ago to stop uncontrollable bleeding from the womb due to cancer or complications of child birth or surgery. More than 10 years ago, uterine embolisation started to be used in France prior to myomectomy to reduce bleeding during surgery. Somewhat unexpectedly, it was found that some women no longer required surgery as their symptoms had subsided and their fibroids begun to shrink. The procedure began to be used as the primary treatment for fibroids. 

Fibroid embolisation is performed by an interventional radiologist (cf. gynaecologist) under local anaesthesia and, if necessary, light sedation. The procedure involves occluding blood vessels supplying the fibroids. This is done by injecting small plastic particles through a narrow catheter which is inserted into an artery in the groin, and guided to the uterus. The plastic particles block the blood supply feeding the fibroids and this results in embolisation. Without a blood supply the fibroids degenerate (waste away) and become smaller in size, thus reducing the uncomfortable symptoms associated with them.

World experience indicates a success rate for fibroid embolisation of over 85%, with an average decrease in fibroid volume of between 40 - 60%. Up to 90% of women presenting with abnormal uterine bleeding and size related symptoms (eg. pressure) have demonstrated significant improvement. You can expect improvement almost immediately with respect to heavy bleeding and pelvic pain; shrinkage of the fibroids usually starts within a few weeks.

The main complication of the procedure is infection, leading to hysterectomy. The incidence of this complication is approximately 1-2%. In addition, patients can become menopausal following the procedure, the incidence rising with the patient's age. Other serious complications are rare. Lesser complications include pain, which can sometimes be severe, and nausea in the first few hours following the procedure. Symptoms can be controlled with appropriate medication, and most symptoms are substantially improved within days although there may be pain and cramping for several days. A "Post-Embolisation Syndrome", consisting of pain, nausea, vomiting and fever affects some women in the week following the procedure. Others experience a watery, non-offensive vaginal discharge in the weeks following the embolisation. Approximately 7% of patients may pass a degenerating fibroid in the weeks or months following the procedure. Many women report returning to work within a week or two of having the procedure.

	Suitable for large fibroids Avoids general anaesthesia, surgery and abdominal incisions Short hospital stay (1-2 days usually) Quick return to normal activities and work Good symptom relief (e.g. pressure symptoms, heavy periods)
	Considerable post-procedure pain Small risk of hysterectomy (because of infection) Chance of early menopause not inconsiderable in women over the age of 40 years No specimen to check fibroids are benign Fibroids shrink but do not disappear Currently not recommended in the UK for women who wish to conceive

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