This treatment is a safe and effective alternative to surgery for some women who suffer from symptoms related to uterine fibroids. This method of treatment that does not require an operation was first reported in 1996.

80% of women find relief of their symptoms, and the fibroids shrink by about 40% in volume.

It is less invasive than myomectomy or hysterectomy for the treatment of symptoms of fibroids, and in the short term it is associated with a shorter hospital stay and return to normal activities

Is it suitable for all fibroids?

It is best suited for fibroids that are located in the muscle of the womb. It is less suitable for fibroids that have developed stalks and are attached by these stalks to the uterus (pedunculated fibroids), as sometimes when this type of fibroid is deprived of blood supply by the embolization process, they may drop off onto bowel and become necrotic and cause complications.

Who performs the procedure?

Interventional radiologists perform the procedure.

How is the procedure performed?

A general anaesthetic is not required for this procedure. A catheter is inserted into the femoral artery (a major vessel in the groin area) after local has been used to numb the crease of the groin. X-ray guidance (fluoroscopy) is used to manipulate the catheter until it gets to the uterine artery (the major vessel that supplies the womb and the fibroids). The aim is to block off the blood supply to the fibroid. Once the blood supply of the fibroid has been identified special particles are used to effect blockage. The procedure usually takes the best part of 45 minutes.

After effects of the procedure

The procedure can be painful thus all women are usually given painkillers for the procedure.

After the procedure for a week or two women may have flu like symptoms (post-embolization syndrome) but these usually pass with the use of painkillers and anti-inflammatory agents. For this reason though the symptoms may regress in the first few days it is best to plan a week or maybe 2 off work

There may be a vaginal discharge, for the first few weeks, which also gets better over time but may persist in about 16% of women for up to a year.

Some women may notice that they pass one or more of their fibroids vaginally (fibroid expulsion). This is usually of little consequence, but if it still attached to the womb by a stalk and cannot detach itself, an additional procedure may be required to remove the fibroid this happens in about 6-10% of women and is  usually within 6 months of the procedure.

Embolisation can result in infection in about 0.5% of cases most of which settle with a course of antibiotics. In the extremis it can result in septicemia necessitating emergency hysterectomy as a life-saving procedure.

Embolization is contraindicated in women who have active pelvic infection

Pregnancy and embolization

As a general rule embolization is not recommended for women who want to get pregnant.

It is best for women who have completed their families and are looking for a non-surgical alternative to treat their fibroids.

Women who want to be pregnant after fibroid treatment should probably opt for a surgical procedure rather than embolization, as though it can be used in

women who are looking to get pregnant, the main drawback is the possibility of going into premature menopause which can happen in about 1-2% of women aged 40 years and under, and as many as 5% in women over the age of 45 years, reaching up to 15% by the age of 50years

Pregnancy after embolization can also be associated with:

Increased risk of miscarriage

Increased risk of bleeding after delivery

Increased risk of caesarean section

Increased risk of baby being in the wrong position

For these reason myomectomy remains a sensible option for women who want to get pregnant and if possible laparoscopic myomectomy is the best option.

Is the procedure effective?

Yes in a recent report by NICE (National Institute of Clinical Excellence) in 2010, they reported on a registry of 1387 women and found that symptoms related to fibroids were improved by 84% at 6 months and 83% at 24 months, with significant improvement in quality of life.

It can be expected that the fibroids will decrease in size by 40%

Is it as effective as myomectomy?

In relation to pregnancy it is not. A recent medical study that looked into this thought it was not superior to myomectomy they looked at 121 women treated with embolization they had a pregnancy rate of 50% compared to 78% in the myomectomy group.

Miscarriage rate was also more in the embolization group 64% compared to 23%

Looking at resolution of symptoms surgery is also superior to embolization at 1month and 12 months follow up

What are the down sides of having an embolization?

In one study up to 23% of women needed another intervention to control their symptoms either hysterectomy or repeat embolization another reported the rate to be 28% at 5 year follow up.

The chance of re-intervention increases the younger you are when you have the procedure.

Is it suitable for women who have had a failed surgical procedure for fibroids?

Yes it may be suitable but again for women who have completed their family.

Unfortunately there have been recent reports that it is more likely to fail in women who have had a previous myomectomy. However for this group of women it is a matter of weighing up risks and benefits. Usually if women have had a previous myomectomy particularly an “open” procedure, there is a 90% chance that there will be adhesions (scar tissue) in the abdomen. Of these adhesions 30% may be significant and increase the risk of complications for a repeat operation. Therefore for some women embolization may be a safer option.

Again this should be weighed up against the benefits of a repeat procedure for fibroids. In women who have had a previous open operation for fibroids the results for control of symptoms are not as good neither are fertility rates.

The likelihood of fibroid regrowth is 20-25% over 5 years.