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 Fibroids: Should I Have Uterine Fibroid Embolization?
Get the facts
- Have uterine fibroid embolization to treat your symptoms.
- Choose another treatment, such as over-the-counter pain medicine, hormones, or surgery.
This decision aid is for women who have decided to treat their uterine fibroids. Many fibroids don't need treatment.
Key points to remember
- 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.
Uterine fibroids are growths in the uterus. They are not cancer. Fibroids can grow on the inside of the uterus, within the muscle wall of the uterus, or on the outer surface of the uterus. They can change the shape of the uterus as they grow. This can make it hard for you to get pregnant, or it can cause problems during a pregnancy.
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 fibroids usually need treatment when they cause:
- Anemia from heavy fibroid bleeding.
- Ongoing low back pain or a feeling of pressure in the lower belly.
- Trouble getting pregnant because a fibroid changes the shape of the uterus or the location of the fallopian tubes.
- Problems during a past pregnancy, such as miscarriage or premature labor.
- Pressure on the bladder or blockage of the urinary tract or bowels.
- Infection, if the tissue of a large fibroid dies.
Depending on the reasons you need treatment, one type of treatment may work better for you than another.
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.2
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.
Uterine fibroid embolization can be used to control heavy, long-lasting menstrual bleeding when:
- 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 have surgery (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.3
- 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 an average of about 50%.1
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 couple of years.4
The chance of a problem after embolization is low. But the risks include:
- Infection. This is the most serious possible problem. In rare cases, an emergency hysterectomy is needed to treat an infected uterus.
- Early menopause.
- Scar tissue (adhesions).
- Pain that in rare cases could last for months.
Although some women can get pregnant after this procedure, experts don't yet fully know the risks to pregnancy.
If you're thinking of having this procedure, look for a radiologist who has done it many times with few problems.
Your doctor might recommend this procedure if:
- You've tried hormones, and they didn't work for you.
- You have another health problem that makes surgery or hormones too risky.
- You don't plan to get pregnant.
Compare your options
What is usually involved?
What are the benefits?
What are the risks and side effects?
- You have local anesthesia so that you won't feel pain, and you get medicine to make you sleepy.
- You will probably go home the same day, or you might spend the night in the hospital.
- You probably can return to your usual activities in 7 to 10 days.
- It may relieve your symptoms.
- You probably would have a shorter recovery than you would with a hysterectomy.
- Possible but
rare problems include:
- Early menopause.
- Damage to the uterus or an ovary. This could make it harder to get pregnant.
- Fibroids can grow back.
- If your fibroids are large, embolization may not shrink the fibroid enough to make your symptoms go away.
- Pain that could last for months. This is rare.
- You could take over-the-counter pain medicine.
- 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 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 that I might consider starting with birth control pills and that I could try 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
What matters most to you?
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.
I don't plan to get pregnant.
I would like to be able to get pregnant after treatment.
I want a shorter recovery.
I don't mind taking time to recover after surgery.
I'm not close to menopause.
I'm close to menopause.
I'm not worried about possible risks such as infection or pain.
I'm concerned about possible side effects from the procedure.
My other important reasons:
My other important reasons:
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.
NOT having embolization
What else do you need to make your decision?
Check the facts
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 "Get the Facts." 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 can recover more quickly after embolization than after surgery.
Embolization will fix my fibroids for good.
Decide what's next
Do you understand the options available to you?
Are you clear about which benefits and side effects matter most to you?
Do you have enough support and advice from others to make a choice?
How sure do you feel right now about your decision?
Use the following space to list questions, concerns, and next steps.
Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
|Primary Medical Reviewer||Sarah Marshall, MD - Family Medicine|
|Specialist Medical Reviewer||Divya Gupta, MD - Obstetrics and Gynecology, Gynecologic Oncology|
- 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.
- American College of Obstetricians and Gynecologists (2008, reaffirmed 2012). Alternatives to hysterectomy in the management of leiomyomas. ACOG Practice Bulletin No. 96. Obstetrics and Gynecology, 112(2, Part 1): 387–399.
- Gupta JK, et al. (2012). Uterine artery embolization for symptomatic uterine fibroids. Cochrane Database of Systematic Reviews (5).
- Lethaby A, Vollenhoven B (2011). Fibroids (uterine myomatosis, leiomyomas), search date June 2009. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.
Last Updated:April 19, 2013