If you decide to proceed, we ask that you have your physician send us a copy of your medical records. This is often the slowest step and we encourage you to be proactive in requesting these from your physician. You must have been evaluated by a gynecologist within 6 months of your visit. If you do not have a gynecologist, a referral can be provided.

Once we receive your medical records, an MRI (Magnetic Resonance Imaging) exam of your pelvis will be scheduled. This is a non-invasive test that does not use radiation like other types of X-rays. An intravenous line will be started to give dye for the test as this helps us evaluate your fibroids better. The i.v. is removed as soon as the exam is completed. Even if you have already had an ultrasound to diagnose fibroids, we ask that you get an MRI as we have found that this is the most reliable way to diagnose and evaluate fibroids. We will follow the decrease in fibroid size after the procedure with MRI imaging.

You will then be scheduled for a consult visit with an Interventional Radiologist. (Directions to UAB) At this visit he or she will sit down with you, review your history and MRI, and do a brief physical exam. She will discuss the procedure with you, including the benefits and risks to you of fibroid embolization. Some patients are not candidates for fibroid embolization and if not, other medical and surgical options will be discussed and referrals provided if necessary. If you wish to proceed, you can schedule your procedure. Insurance coverage will be confirmed at this time and you will be notified if there are any problems.

Once you are ready, you will be taken to the Interventional Radiology pre-procedure area. Your procedure will take approximately 1-2 hours once we begin. You will be given conscious sedation and will be sleepy, but not under general anesthesia. Most patients sleep comfortably throughout the exam. After the procedure, you will be given pain medicine through your i.v. and sent to a room. You will be on strict bed rest for 6 hours after the procedure. You will stay in the hospital overnight. The morning after the procedure, your Foley catheter will be removed and you will be started on oral pain medication as needed. Most patients go home the next day around lunch time. You will receive a sheet of written discharge instructions and an appointment for a follow-up visit and MRI in 6 months. The Interventional Radiology staff will follow-up with you by phone in your first days and weeks home, and we encourage you to call us with any questions or concerns. See pictures below of a typical fibroid embolization.

Many patients will experience moderate to severe crampy abdominal pain and nausea the first day. This usually substantially improves after the first 12-24 hours. Most patients will have some continued crampy abdominal pain and discharge for the first 1-2 weeks after the procedure. By two weeks post procedure the majority of patients are able to go back to work and resume normal activities.

Today there are more than 5,000 interventional radiologists in the United States. The Society of Interventional Radiology (SIR), the professional association of interventional radiologists based in Fairfax, VA, has seen its membership steadily increase to more than 4,000 worldwide in 2004.

– Most procedures can be performed on an outpatient basis or require only a short hospital stay.
– General anesthesia usually is not required.
– Risk, pain and recovery time are often significantly reduced.
– The procedures are sometimes less expensive than surgery or other alternatives.

Fibroid tumors may start in women when they are in their 20s, however, most women do not begin to have symptoms until they are in their late 30s or 40s. Physicians are not able to predict if a fibroid will grow or cause symptoms.

The exact causes for fibroid development are unclear, but researchers have linked them to both a genetic predisposition and a subsequent development of susceptibility to hormone stimulation. Women may have a genetic predisposition to fibroid development and then subsequently develop factors that allow fibroids to grow under the influence of a number of hormones. This would explain why certain ethnic groups or racial groups are more likely to develop fibroids and also why there tends to be genetic predisposition in some families.

Fibroids range greatly in size from very tiny to the size of a cantaloupe or larger. In some cases, they can cause the uterus to grow in the size of a five-month pregnancy or more. Fibroids may be located in various parts of the uterus. In most cases, there is more than one fibroid in the uterus. There are three primary types of uterine fibroids.

The presence of fibroids is most often confirmed by an abdominal ultrasound. This is a painless procedure in which a radiologist or technician moves an instrument (transducer/receiver) about the size and shape of a computer mouse across the outside surface of the abdomen. Sound waves are transmitted through the skin and allow the technician to "see" the size, shape and texture of the uterus. A picture is displayed on a computer screen as the radiologist or technician takes the ultrasound.

Fibroids also can be confirmed using magnetic resonance (MR) imaging or computed tomography (CT). MR and CT also are painless diagnostic tests that can give accurate and clear information on the presence of fibroids.

Diagnostic hysteroscopy also is an option, particularly to evaluate the presence of submucosal fibroids. A long, thin probe-like instrument is passed through the vagina and cervix into the uterus, where the physician can check for growths and take samples of tissue. The lighted hysteroscope illuminates the uterus. This procedure, which can cause some discomfort, is generally performed by a gynecologist, and can be done without anesthesia or with a local anesthetic in an office.

If symptoms develop, there are a number of treatment options:

Drug therapy, including non-steroidal anti-inflammatory drugs (NSAIDs), birth-control pills and hormone therapy;

Uterine fibroid embolization, a non-surgical treatment that causes the fibroid to shrink.

Surgical treatments, including myomectomy (surgical removal of the fibroids) and hysterectomy (surgical removal of the uterus).

In some patients, symptoms are controlled with these treatments and no other therapy is required. However, some hormone therapies can have risks and side effects (menopausal symptoms, erratic or no menstruation, bloating, moodiness) when used long-term, and generally are used temporarily.

A newer group of drugs being used for fibroids are hormones known as GnRH analogues, which are administered by injection by the gynecologist. These synthetic (man-made) hormones act like the hormones that are naturally produced by the body and reduce the level of estrogen. The result is reduced blood flow to the uterus and, therefore, to the fibroids, decreasing the size of both. Some physicians recommend these hormones prior to surgery to reduce the size of the fibroids and make them easier to remove. The effectiveness of the hormones is considered temporary as studies show that when the therapy is stopped, fibroids regrow to their original size in four to six months. The GnRH hormones also may cause side effects that mimic menopause, including hot flashes, vaginal dryness, mood swings and a decrease in bone density (osteoporosis).

Fibroid embolization is performed by an interventional radiologist, a physician who is specially trained to perform this and other minimally-invasive procedures.

Fibroid embolization usually requires a hospital stay of one night. Pain-killing medications and drugs that control swelling typically are prescribed following the procedure to treat cramping and pain. Fever sometimes occurs after embolization and is usually treated with acetaminophen. Many women resume light activities in a few days and the majority of women are able to return to normal activities within one to two weeks.

While embolization to treat uterine fibroids has been performed since 1995, embolization of arteries in the uterus is not new. It has been used successfully by interventional radiologists for more than 20 years to treat heavy bleeding after childbirth.

– On average, 90 percent of women who had the procedure experience significant or total relief of heavy bleeding. The procedure is about 85 percent effective for pain.
– The procedure is effective for multiple fibroids and large fibroids.
– Recurrence of treated fibroids is very rare. Short and mid-term data show UFE to be very effective with a very low rate of recurrence. Long-term (10 year) data is ongoing and not yet available, but in one study in which patients were followed for six years, no fibroid that had been embolized regrew.

For additional research information, review our UFE bibliography.

Many women wonder about the safety of leaving plastic particles in the body. It is reassuring to know that the particles most commonly used in UFE have been available with FDA approval for over 20 years. During that time, they have been used in thousands of patients without long-term complications.

Less than 2 percent of patients have entered menopause as a result of UFE. This is more likely to occur if the woman is in her mid-forties or older and is already nearing menopause

A small number of patients have entered into menopuase after embolization. This is more likely to occur if the woman is in her mid-forties or older, and is already nearing menopause.

Myomectomy and hysterectomy also carry risks, including infection and bleeding leading to transfusion. Patients who undergo myomectomy may develop adhesions causing tissue and organs in the abdomen to fuse together, which can lead to infertility. In addition, the recovery time is much longer for abdominal myomectomy, generally one to two months.

You should talk to your doctor about possible risks of any procedure you may choose.

While myomectomy is successful in controlling symptoms about 80 percent of the time, the more fibroids there are in a patient's uterus, the less successful the surgery generally is. In addition, fibroids grow back several years after myomectomy in 10 percent to 30 percent of cases.

In a hysterectomy, the uterus is removed in an open surgical procedure. This operation is considered major surgery and is performed while the patient is under general anesthesia. It requires 3 to 4 days of hospitalization and the average recovery period is about six weeks. Some women are candidates for a newer, laparoscopic procedure. The recovery time for this procedure is considerably shorter.

Hysterectomy is the most common current therapy for women who have fibroids. It is typically performed in women who have completed their childbearing years or who understand that after the procedure, they cannot become pregnant.