Uterine Artery Embolization (UAE)is one of the newer procedures that is being used to treat fibroid tumors. Also known as Uterine Fibroid Embolization or UFE it takes the approach of starving these non-cancerous tumors of their blood supply, which helps them to grow.

UAE was developed in the late 1960's, typically used by interventional radiologists, to treat women with emergency uterine bleeding. The procedure has been refined over the last 30 years to treat fibroid tumors in non-emergency situations. In 1995 a Parisian gynecologist published a paper on using UAE as a primary treatment for uterine fibroids. Approximately 25,000 Uterine Artery Embolizations have been performed worldwide. Before choosing UAE as a treatment option it is important to asses your doctors experience with UAE. In the event they do not perform this procedure you may be able to get a referral to another physician who has the necessary experience needed for UAE.

The Surgery The procedure is done in a hospital with the patient under mild sedative and local anesthesia. Before the UAE is started a dye is inserted to map the blood flow. X-rays are then taken to have images to use as a guideline for the procedure. Then s small incision is made in the groin and then another small incision is made in the femoral artery. These incisions allow an angiographic catheter to be guided into the uterine artery. These arteries are what feed blood to the fibroid tumors allowing them to grow. After the catheter is in place 300 to 700 tiny particles are permanently lodged in the artery. The same incisions are them made on the opposite side and more particles are inserted in that uterine artery. After the UAE is complete another dye series is performed to confirm the blood flow has been sufficiently blocked. The entire surgery takes from 1 to 1 1/2 hours. The hospital stay is usually 24 to 48 hours barring any complications. To help fight any infection the surgery may cause antibiotics are administered prior to surgery. Most women experience mild to moderate menstrual cramping that can last up to a week after the UAE. In some cases sever cramping has been reported. Most women resume normal activities between 4 to 10 days. Over the next few months fibroid tissue can be passed during menstruation. This needs to be closely monitored by your doctor so that excessive bleeding does not occur. In a small number of women a D&C may need to be performed to remove dead fibroid tissue from the uterine wall.

The Results With more and more women opting for treatments for fibroid tumors, that does not result in the removal of the uterus, UAE is being refined. The risks for this procedure vary from women to women. The size, location and number of fibroids is a factor that needs to be discussed with your doctor to review your individual options. The success of UAE also varies from women to women. The average results* show a shrinkage rate of 48 to 78%. At six-month follow-up, the size of the uterus has decreased by 50 percent. From 81 to 92 percent of patients with fibroid-related menstrual bleeding who are treated with UFE report a significant improvement or resolution of abnormal uterine bleeding, while 79 to 92 percent of patients with bulk symptoms report significant improvement.

UAE and pregnancy The ability to become pregnant after UAE is unknown. Long term studies have not shown conclusive information. According to Georgetown University Hospital's study "There are a number of ways that pregnancies may be affected by UAE. During the procedure, some of the flow in the uterine arteries is decreased at least temporarily. It is uncertain what effect this will have on the ability to become pregnant or to carry a pregnancy to term. It appears that in most patients, the arteries reopen to the normal parts of the uterus and it is rare for there to be a permanent injury to the uterus. As the fibroids die and begin to shrink, in some cases this may weaken the wall of the uterus. This would appear to be most likely with large fibroids that span the entire wall of the uterus. However, fibroids compress the normal uterine tissue adjacent to them and as they shrink, we have seen the normal tissue restored to a more normal configuration. For any individual, it is difficult to predict whether the uterus will be weakened to the point where there might be a problem during delivery of a baby. For our patients that have become pregnant, we recommend that a sonogram be performed to assess the site of implantation and the overall integrity of the uterine wall.

Another potential effect of this procedure is the loss of menstrual cycles, with the onset of menopause. The overwhelming majority of women who have had embolization of fibroids have had decreased bleeding with normal menstrual cycles. There have been a few women (most of whom are near the age when menopause would be expected) who have lost their menstrual periods after uterine embolization. The cause is most likely decrease in blood supply to the ovaries as a result of the embolization. Most researchers have noted a 2 to 6% chance of losing menstrual periods and the onset of menopause as a result of UAE. There has been one study that noted a higher rate of menopause after the procedure (15% of patients treated) but the reason for this higher rate is not clear. It is very rare for a woman under the age of 45 to lose menstrual periods.

To further evaluate ovarian function after UAE, at Georgetown, we have completed a study on ovarian function after uterine embolization. Among the 35 women in the study under the age of 45, there was no permanent change in FSH, a hormone often used to estimate the likelihood of pregnancy. None of the women in that study had cessation of menstrual periods."
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* Source American Family Physicians Steven Janney Smith, M.D LaGrange Memorial Hospital, LaGrange, Illinois