University of Virginia Health System

Uterine Fibroid Embolization:
Tiny Beads Can Save a Uterus

About two years ago, 48-year- old Louise Malone of Charlottesville, Virginia, was diagnosed with fibroids, which are benign tumors of the uterus. After consulting with her doctor, Malone opted to do nothing about the condition unless symptoms developed because the fibroids weren't interfering with her life. A few months later the situation worsened. She felt bloated, her skirts were tight around the waist, and Metamucil was part of her daily diet. When the pain increased and she was unable to urinate, Malone knew something had to be done.

Unlike most of the 200,000 young women in the United States who must undergo hysterectomy (surgical removal of the entire uterus) each year because of fibroids, Malone was offered a less invasive alternative: uterine fibroid embolization (UFE), a nonsurgical treatment to shrink fibroids by selectively blocking the arteries that supply blood to the uterine growths. "My doctor explained the options," says Malone, "but he said a hysterectomy for my fibroids was like swatting a fly with a cannon."

"Uterine fibroid embolization is a uterus-sparing alternative to hysterectomy," says UVa radiologist Dr. Alan H. Matsumoto. He meets with women who are candidates for UFE to explain the procedure in detail and take a complete history. Photo by William Faust

Symptoms of uterine fibroids include heavy bleeding, pain, bladder pressure, constipation, low back pain, and feelings of heaviness or bloating in the abdominal area. According to Alan H. Matsumoto, M.D., professor and director of the Division of Angiography, Interventional Radiology and Special Procedures at the UVa Health System, fibroids are very common and about one in four women has them, often without symptoms. For the 10 percent to 20 percent who are symptomatic, there are several treatment options. These include hormone therapy; nonsteroidal anti-inflammatory drugs; surgical removal of fibroids but not the uterus (myomectomy); surgical removal of the uterus (hysterectomy); and more recently, uterine fibroid embolization. "UFE is a uterus-sparing alternative to hysterectomy," says Matsumoto, who performed Malone's procedure.

Although UFE is a new treatment option for uterine fibroids, transcatheter uterine arterial embolization has been used for more than 20 years to control bleeding related to ectopic pregnancies and postpartum or postsurgical hemorrhaging, says Matsumoto. In 1992, a team of French physicians initiated the first clinical trial of UFE after noticing that fibroids were shrinking after they used the procedure in preparation for myomectomies. Interventional radiologists began performing the procedure in the United States in 1995.

Still, not everyone is a candidate. Patients who want to have children; who have chronic infection of the fallopian tubes; or who have a suspected cancerous tumor of the uterus, cervix or ovaries should not have the procedure. "Patients must have an exam with their gynecologist to rule out cancer and infection," Matsumoto says. "And while women have gone on to conceive and deliver a normal baby after UFE, we don't know the long-term effects on fetal growth. I recommend a myomectomy to women who really want a child."

Once it's determined a woman is a candidate for UFE, Matsumoto meets with the patient, explains the procedure in detail and takes a complete history. Patients come to the hospital the day of the procedure and often go home in 24 hours. During the procedure, the patient is conscious but sedated. The groin area is numbed with a local anesthetic. An interventional radiologist makes a small nick in the skin. Then, a catheter is inserted into the femoral artery and is steered into the artery to the uterus with the aid of a contrast dye and flouroscopy. Once the arteries to be blocked are located, the interventional radiologist injects polyvinyl alcohol (PVA) particles, which are much like tiny Styrofoam balls, into the vessels. These balls block the arteries supplying blood to the tumor, which takes away oxygen and nutrients from the fibroids, causing them to shrink. The tube is then removed and a Band-Aid is placed on the puncture site. The procedure usually can be completed in two hours.

Following the procedure, patients may experience severe cramping because of the diminished blood supply to the uterus and fibroids. "This is the body responding to the tissue breaking down," says Matsumoto. "We try to control pain with medication, and it's generally gone in two to four days."

"The procedure itself was kind of neat. Everybody there was so cooperative and helpful," Malone says, "but by the end I was very uncomfortable. It felt like bad cramps. Each day got better, and by the third day all I needed was Advil and I was feeling like a part of humanity again."

Although some patients also experience flu-like symptoms during the first week, Matsumoto says most can resume sedentary work in five to seven days. Complications are rare, and in about 5 percent of patients, the symptoms persist and a hysterectomy is required. Bleeding from the puncture site is rare, and less than 1 percent develop a pelvic infection. Occasionally, patients complain of painful urination, which generally resolves in a few weeks. Less than 5 percent of patients completely lose their menstrual cycles.

The benefits are promising, says Matsumoto. "After six months the fibroids are generally 50 percent smaller. In about 90 percent of the women who have had a UFE, the symptoms are considerably decreased or gone."

"I am so glad I had the procedure done," Malone says. "The symptoms of pressure on the bladder and cramps are gone. And another nice thing, I can now zip my skirts. I have had no instance of feeling that fullness. I was really thrilled to find out that we have somebody as experienced as Dr. Matsumoto right here in Charlottesville."

For more information:
Alan H. Matsumoto, M.D.
Radiology
(434) 924-9279
E-mail: ahm4d@virginia.edu