Uterine fibroids: Should I have uterine fibroid embolization?
You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.
Uterine fibroid embolization (or uterine artery
embolization) shrinks or destroys a fibroid by cutting off its blood supply.
About 80
out of 100 women who have the procedure get relief from their
symptoms, while 20 out of 100 don't.1
Embolization doesn't always cure
fibroids.
You may want to
have this procedure if your symptoms haven't improved with other
treatments.
You may recover more quickly after embolization than
after
hysterectomy.
This procedure can have
risks and side effects. These include infection, early
menopause, and pain that in rare cases could last for
months.
This procedure may not be a good choice if you want to get
pregnant. It's possible to get pregnant afterward, but it's uncertain how good
the odds are. This procedure does have a risk of damaging an ovary or the
uterus, which would make it much harder to get pregnant. There may be a higher
risk for pregnancy problems.
Fibroids usually get better on their
own after
menopause. If you are near menopause, you could try
hormone therapy for a while.
Over time, the size, shape, location, and
symptoms of fibroids may change.
As women get older, they are more
likely to have uterine fibroids, especially from their 30s and 40s until
menopause.
Most have mild or no symptoms. But fibroids can cause bad
pain, bleeding, bowel blockage, and other problems.
The cause of
fibroids is not known. But the hormones
estrogen and
progesterone can make them grow. A woman's body makes
the highest levels of these hormones during her childbearing years. After
menopause, when hormone levels decrease, fibroids often shrink or
disappear.
Uterine fibroid embolization is a procedure that blocks blood flow to fibroids in the
uterus. It's not surgery.
Fibroids treated with this procedure shrink
by about half.1
The doctor
(a
radiologist) puts a thin, flexible tube called a
catheter into a blood vessel in your upper thigh (femoral artery). Then the
doctor injects a substance called contrast material into the catheter. He or
she uses an X-ray on a video screen to see the arteries and guide the catheter
to the arteries that supply blood to the fibroid. Small particles are injected
into those uterine arteries through the catheter. These particles build up in
the arteries and block blood flow to the fibroid. The rest of the uterus
usually isn't harmed, because it's supplied by other arteries.
You have tried hormones, but they didn't relieve your symptoms.
You don't plan to get pregnant. This treatment is a choice for women who
have no plans to get pregnant.
That's because some women have had damage to an ovary, have
gone into early
menopause, or had trouble getting pregnant after the
procedure.
You don't want to havesurgery (myomectomy or
hysterectomy). You would need only
local anesthesia for this procedure. And the doctor
doesn't have to make any cuts in your skin. For most women, this means no
hospital stay and a quicker return to normal activities, compared to
surgery.2
You have other health problems, such as severe lung or liver disease, that make it
risky for you to have surgery or use hormones.
Embolization
usually works well to treat fibroids. Short-term studies show
that:1
About 80 out of 100 women who had it said
that their symptoms got better, while 20 out of 100 said
their symptoms didn't get better.
It shrinks fibroids on average by
one-half to three-quarters in size.
But the results don't always last: In one study, about 20
out of 100 women who had embolization needed another one or a
hysterectomy within the next 3½ years.3
You could take hormones (GnRH-a) as a
stand-alone treatment or before surgery to shrink fibroids. They're given as a
shot or a nasal spray.
You could have surgery to take out your
fibroids only (myomectomy) or your uterus (hysterectomy).
(If you have a hysterectomy, you won't be able to get pregnant
afterward.)
Hysterectomy would
cure your fibroids.
Myomectomy could control your symptoms and give you the best
chance to get pregnant later.
Hormones could control your symptoms
for a short time if you are near menopause, when fibroid problems usually go
away.
Surgery
has risks, including bleeding and infection.
GnRH-a has side effects, such as:
Symptoms like those of menopause, such as
hot flashes and vaginal dryness.
Possible bone loss if you take it
for more than 6 months.
GnRH-a can be used only for a few months.
Fibroids can grow back after myomectomy or when you stop taking
hormones.
Personal Stories
Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.
Personal stories about uterine fibroid embolization
These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.
I have had
pain before and during my period for years. In the past year or so I started
having really heavy bleeding, and my periods were lasting longer than usual. I
tried nonprescription and prescription medicines to control the bleeding.
Nothing was working. My doctor suggested a procedure called uterine fibroid
embolization. I had the procedure, and my doctor was able to treat the
fibroids. It didn't hurt too much, and I was surprised at how quickly I
recovered. It has been 6 months now, and I no longer have those days of heavy
bleeding. I am glad I had uterine fibroid embolization.
Marlena, age 43
Over the past 3 or 4 years, my periods have
been getting heavier and heavier. My doctor did a bunch of tests and thought
that uterine fibroids may be causing my symptoms. He suggested that I have a
procedure called uterine fibroid embolization to control my bleeding. The
procedure sounded scary, so I asked if waiting a few months would be dangerous.
He said waiting would be fine. After a few months, my periods eased up. I am
glad I decided to wait and see if my bleeding decreased before having the
procedure.
Angie, age
44
About 3 years ago, my menstrual periods
really changed for the worse. I began having cramps, and my periods were heavy
with clotting and lasted for 2 weeks. I thought, "No way was that a totally
normal period," and I made an appointment with my doctor. I tried a bunch of
different medicines and nothing seemed to make much difference. After lots of
further testing and discussion I had uterine fibroid embolization. I figure
that since I don't want any more kids, any risk of losing my fertility is okay.
The procedure was quick, and I was completely recovered in about 3 days. I had
some pretty severe cramping afterwards, but it only lasted for about 12 hours
and got better with ibuprofen. The embolization worked but I still have some
odd cycles in that I bleed too many days per month, I get clotting some cycles,
and some of my periods are heavier. My doctor says I may have to have another
embolization, but I think it will be worth it.
Raquel, age 32
A couple of
years ago I started having heavy, painful periods. My doctor said she thought I
might have something I had never even heard of called uterine fibroids.
Apparently they are pretty common as you get older. My doctor outlined all the
different treatments I could try, including something called uterine fibroid
embolization, if it ever got really bad. She said I might consider starting
with birth control pills, as well as ibuprofen for a few days right before my
period starts and then for several days during my period, to help control the
bleeding. The embolization sounded pretty risky—I don't know if I could ever do
that. Lucky for me, the birth control pills and ibuprofen have helped a lot. In
fact, my doctor says that means the bleeding was more of a menstrual problem
than a fibroid problem!
Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.
Reasons to have uterine fibroid embolization
Reasons to choose another treatment
I don't want to have surgery or take hormones.
I would rather have surgery or take hormones.
More important
Equally important
More important
I don't plan to get pregnant.
I would like to be able to get pregnant after treatment.
More important
Equally important
More important
I want a shorter recovery.
I don't mind taking time to recover after surgery.
More important
Equally important
More important
I'm not close to menopause.
I'm close to menopause.
More important
Equally important
More important
I'm not worried about possible risks such as infection or pain.
I'm concerned about possible side effects from the procedure.
More important
Equally important
More important
My other important reasons:
My other important reasons:
More important
Equally important
More important
Where are you leaning now?
Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.
Having embolization
NOT having embolization
Leaning toward
Undecided
Leaning toward
What else do you need to make your decision?
Check the facts
1.
Uterine fibroid embolization could be a good choice for me, because I don't plan to have more children.
TrueYou're right. Embolization may be a good choice for women who don't want to get pregnant. There may be a higher-than-normal risk of pregnancy problems with this procedure.
FalseSorry, that's not right. Embolization may be a good choice for women who don't want to get pregnant. There may be a higher-than-normal risk of pregnancy problems with this procedure.
I'm not sureIt may help to go back and read "Key points to remember." Embolization may be a good choice for women who don't want to get pregnant. There may be a higher-than-normal risk of pregnancy problems with this procedure.
2.
I can recover more quickly after embolization than after surgery.
TrueYou're right. You can recover more quickly after embolization.
FalseThat's not correct. You can recover more quickly after embolization.
I'm not sureIt may help to go back and read "When is embolization an option to treat uterine fibroids?" You can recover more quickly after embolization.
3.
Embolization will fix my fibroids for good.
TrueThat's not right. The procedure often gets rid of fibroids. But they may come back afterward.
FalseThat's right. The procedure often gets rid of fibroids. But they may come back afterward.
I'm not sureIt may help to go back and read "How well does this procedure work to treat uterine fibroids?" Fibroids can come back after the procedure.
Decide what's next
1.
Do you understand the options available to you?
2.
Are you clear about which benefits and side effects matter most to you?
3.
Do you have enough support and advice from others to make a choice?
Certainty
1.
How sure do you feel right now about your decision?
Not sure at all
Somewhat sure
Very sure
2.
Check what you need to do before you make this decision.
Practice Committee of the American Society
for Reproductive Medicine, Society of Reproductive Surgeons (2008). Myomas and
reproductive function. Fertility and Sterility, 90(3):
S125–S130.
Gupta JK, et al. (2006) Uterine artery embolization
for symptomatic uterine fibroids. Cochrane Database of Systematic Reviews (1). Oxford: Update Software.
Edwards RD, et al. (2007). Uterine-artery
embolization versus surgery for symptomatic uterine fibroids. New England Journal of Medicine, 356(4): 360–370.
Walker WJ, Pelage JP (2002). Uterine artery
embolisation for symptomatic fibroids: Clinical results in 400 women with
imaging follow-up. British Journal of Obstetrics and Gynaecology, 109(11): 1262–1272.
Uterine fibroids: Should I have uterine fibroid embolization?
You can use this information to talk with your
doctor or loved ones about your decision.
Get the facts
Compare your options
What matters most to you?
Where are you leaning now?
What else do you need to make your decision?
1. Get the Facts
Your options
Have uterine fibroid embolization to treat your
symptoms.
Choose another treatment, such as
over-the-counter pain medicine, hormones, or surgery.
This Decision Point is for women who have decided to
treat their uterine fibroids.
Uterine fibroid embolization (or uterine artery
embolization) shrinks or destroys a fibroid by cutting off its blood supply.
About 80
out of 100 women who have the procedure get relief from their
symptoms, while 20 out of 100 don't.1
Embolization doesn't always cure
fibroids.
You may want to
have this procedure if your symptoms haven't improved with other
treatments.
You may recover more quickly after embolization than
after
hysterectomy.
This procedure can have
risks and side effects. These include infection, early
menopause, and pain that in rare cases could last for
months.
This procedure may not be a good choice if you want to get
pregnant. It's possible to get pregnant afterward, but it's uncertain how good
the odds are. This procedure does have a risk of damaging an ovary or the
uterus, which would make it much harder to get pregnant. There may be a higher
risk for pregnancy problems.
Fibroids usually get better on their
own after
menopause. If you are near menopause, you could try
hormone therapy for a while.
Over time, the size, shape, location, and
symptoms of fibroids may change.
As women get older, they are more
likely to have uterine fibroids, especially from their 30s and 40s until
menopause.
Most have mild or no symptoms. But fibroids can cause bad
pain, bleeding, bowel blockage, and other problems.
The cause of
fibroids is not known. But the hormones
estrogen and
progesterone can make them grow. A woman's body makes
the highest levels of these hormones during her childbearing years. After
menopause, when hormone levels decrease, fibroids often shrink or
disappear.
Uterine fibroid embolization is a procedure that blocks blood flow to fibroids in the
uterus. It's not surgery.
Fibroids treated with this procedure shrink
by about half.1
The doctor
(a
radiologist) puts a thin, flexible tube called a
catheter into a blood vessel in your upper thigh (femoral artery). Then the
doctor injects a substance called contrast material into the catheter. He or
she uses an X-ray on a video screen to see the arteries and guide the catheter
to the arteries that supply blood to the fibroid. Small particles are injected
into those uterine arteries through the catheter. These particles build up in
the arteries and block blood flow to the fibroid. The rest of the uterus
usually isn't harmed, because it's supplied by other arteries.
You have tried hormones, but they didn't relieve your symptoms.
You don't plan to get pregnant. This treatment is a choice for women who
have no plans to get pregnant.
That's because some women have had damage to an ovary, have
gone into early
menopause, or had trouble getting pregnant after the
procedure.
You don't want to havesurgery (myomectomy or
hysterectomy). You would need only
local anesthesia for this procedure. And the doctor
doesn't have to make any cuts in your skin. For most women, this means no
hospital stay and a quicker return to normal activities, compared to
surgery.2
You have other health problems, such as severe lung or liver disease, that make it
risky for you to have surgery or use hormones.
Embolization
usually works well to treat fibroids. Short-term studies show
that:1
About 80 out of 100 women who had it said
that their symptoms got better, while 20 out of 100 said
their symptoms didn't get better.
It shrinks fibroids on average by
one-half to three-quarters in size.
But the results don't always last: In one study, about 20
out of 100 women who had embolization needed another one or a
hysterectomy within the next 3½ years.3
You could take hormones (GnRH-a) as a
stand-alone treatment or before surgery to shrink fibroids. They're given as a
shot or a nasal spray.
You could have surgery to take out your
fibroids only (myomectomy) or your uterus (hysterectomy).
(If you have a hysterectomy, you won't be able to get pregnant
afterward.)
What are the benefits?
It may relieve your
symptoms.
You probably would have a shorter recovery than you would
with a
hysterectomy.
Hysterectomy would
cure your fibroids.
Myomectomy could control your symptoms and give you the best
chance to get pregnant later.
Hormones could control your symptoms
for a short time if you are near menopause, when fibroid problems usually go
away.
Personal stories about uterine fibroid embolization
These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.
"I have had
pain before and during my period for years. In the past year or so I started
having really heavy bleeding, and my periods were lasting longer than usual. I
tried nonprescription and prescription medicines to control the bleeding.
Nothing was working. My doctor suggested a procedure called uterine fibroid
embolization. I had the procedure, and my doctor was able to treat the
fibroids. It didn't hurt too much, and I was surprised at how quickly I
recovered. It has been 6 months now, and I no longer have those days of heavy
bleeding. I am glad I had uterine fibroid embolization. "
— Marlena, age 43
"Over the past 3 or 4 years, my periods have
been getting heavier and heavier. My doctor did a bunch of tests and thought
that uterine fibroids may be causing my symptoms. He suggested that I have a
procedure called uterine fibroid embolization to control my bleeding. The
procedure sounded scary, so I asked if waiting a few months would be dangerous.
He said waiting would be fine. After a few months, my periods eased up. I am
glad I decided to wait and see if my bleeding decreased before having the
procedure. "
— Angie, age
44
"About 3 years ago, my menstrual periods
really changed for the worse. I began having cramps, and my periods were heavy
with clotting and lasted for 2 weeks. I thought, "No way was that a totally
normal period," and I made an appointment with my doctor. I tried a bunch of
different medicines and nothing seemed to make much difference. After lots of
further testing and discussion I had uterine fibroid embolization. I figure
that since I don't want any more kids, any risk of losing my fertility is okay.
The procedure was quick, and I was completely recovered in about 3 days. I had
some pretty severe cramping afterwards, but it only lasted for about 12 hours
and got better with ibuprofen. The embolization worked but I still have some
odd cycles in that I bleed too many days per month, I get clotting some cycles,
and some of my periods are heavier. My doctor says I may have to have another
embolization, but I think it will be worth it. "
— Raquel, age 32
"A couple of
years ago I started having heavy, painful periods. My doctor said she thought I
might have something I had never even heard of called uterine fibroids.
Apparently they are pretty common as you get older. My doctor outlined all the
different treatments I could try, including something called uterine fibroid
embolization, if it ever got really bad. She said I might consider starting
with birth control pills, as well as ibuprofen for a few days right before my
period starts and then for several days during my period, to help control the
bleeding. The embolization sounded pretty risky—I don't know if I could ever do
that. Lucky for me, the birth control pills and ibuprofen have helped a lot. In
fact, my doctor says that means the bleeding was more of a menstrual problem
than a fibroid problem! "
— June, age 38
3. Your Feelings
Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.
Reasons to have uterine fibroid embolization
Reasons to choose another treatment
I don't want to have surgery or take hormones.
I would rather have surgery or take hormones.
More important
Equally important
More important
I don't plan to get pregnant.
I would like to be able to get pregnant after treatment.
More important
Equally important
More important
I want a shorter recovery.
I don't mind taking time to recover after surgery.
More important
Equally important
More important
I'm not close to menopause.
I'm close to menopause.
More important
Equally important
More important
I'm not worried about possible risks such as infection or pain.
I'm concerned about possible side effects from the procedure.
More important
Equally important
More important
My other important reasons:
My other important reasons:
More important
Equally important
More important
4. Your Decision
Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.
Having embolization
NOT having embolization
Leaning toward
Undecided
Leaning toward
5. Quiz Yourself
Check the facts
1.
Uterine fibroid embolization could be a good choice for me, because I don't plan to have more children.
True
False
I'm not sure
You're right. Embolization may be a good choice for women who don't want to get pregnant. There may be a higher-than-normal risk of pregnancy problems with this procedure.
2.
I can recover more quickly after embolization than after surgery.
True
False
I'm not sure
You're right. You can recover more quickly after embolization.
3.
Embolization will fix my fibroids for good.
True
False
I'm not sure
That's right. The procedure often gets rid of fibroids. But they may come back afterward.
Decide what's next
1.
Do you understand the options available to you?
2.
Are you clear about which benefits and side effects matter most to you?
3.
Do you have enough support and advice from others to make a choice?
Certainty
1.
How sure do you feel right now about your decision?
Not sure at all
Somewhat sure
Very sure
2.
Check what you need to do before you make this decision.
I'm ready to take action.
I want to discuss the options with others.
I want to learn more about my options.
3.
Use the following space to list questions, concerns, and next steps.
Credits and references
Credits
Author
Sandy Jocoy, RN
Editor
Kathleen M. Ariss, MS
Associate Editor
Michele Cronen
Primary Medical Reviewer
Sarah Marshall, MD - Family Medicine
Specialist Medical Reviewer
Kirtly Jones, MD - Obstetrics and Gynecology
References
Citations
Practice Committee of the American Society
for Reproductive Medicine, Society of Reproductive Surgeons (2008). Myomas and
reproductive function. Fertility and Sterility, 90(3):
S125–S130.
Gupta JK, et al. (2006) Uterine artery embolization
for symptomatic uterine fibroids. Cochrane Database of Systematic Reviews (1). Oxford: Update Software.
Edwards RD, et al. (2007). Uterine-artery
embolization versus surgery for symptomatic uterine fibroids. New England Journal of Medicine, 356(4): 360–370.
Walker WJ, Pelage JP (2002). Uterine artery
embolisation for symptomatic fibroids: Clinical results in 400 women with
imaging follow-up. British Journal of Obstetrics and Gynaecology, 109(11): 1262–1272.
Note: The "printer friendly" document will not contain all the information available in the online document some Information (e.g. cross-references to other topics, definitions or medical illustrations) is only available in the online version.
Practice Committee of the American Society
for Reproductive Medicine, Society of Reproductive Surgeons (2008). Myomas and
reproductive function. Fertility and Sterility, 90(3):
S125–S130.
Gupta JK, et al. (2006) Uterine artery embolization
for symptomatic uterine fibroids. Cochrane Database of Systematic Reviews (1). Oxford: Update Software.
Edwards RD, et al. (2007). Uterine-artery
embolization versus surgery for symptomatic uterine fibroids. New England Journal of Medicine, 356(4): 360–370.
Walker WJ, Pelage JP (2002). Uterine artery
embolisation for symptomatic fibroids: Clinical results in 400 women with
imaging follow-up. British Journal of Obstetrics and Gynaecology, 109(11): 1262–1272.
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