Uterine Fibroid Embolization

Discharge Instructions

Puncture Site

The arterial puncture site at the top of your right leg has a Band-Aid covering it. You may shower but replace the wet Band-Aid with a clean dry one today and following two days. This action will promote healing at the site. You may remove the Band-Aid on the fourth day. If you notice any swelling or active bleeding from the puncture site, you should use direct pressure by placing your fingers and a clean cloth or paper towel over the site. Immediately call for assistance and report to the nearest emergency room for evaluation. This problem at the puncture site is very rare; occurring in less than 1 in 500 patients. Normally, some bruising at the puncture site is observed. The bruise tends to spread out and change colors from red-purple to yellow-blue-green over several days. This process is the normal way that a small amount of blood under the skin is reabsorbed and should not alarm you.

Diet, Medications, Activity

Resume your normal diet and medications. You should slowly increase your activity over the next three to four days. Do not drive if you are taking the prescription pain medicines (Lortab or Demerol). These medications make you sleepy and slow your response time, do not operate any machinery or kitchen appliances while you are taking them. You may have unrestricted activity, including sexual activity and exercise, 7 days after the procedure.

        You should expect to have pelvic pain and cramping over the next several days to two weeks. Usually this lasts for 3 to 4 days. It is most intense the night following the procedure and decreases each day thereafter. You have been given a prescription for ibuprofen; the same drug that is in Motrin and Advil. While this drug does provide pain relief, the dose of 800 mg every 6 hours for 7 days is to keep the inflammation caused by the embolization under control. It is important that you take the ibuprofen for the full week. After a week, you can use the left over ibuprofen for pain control.

In addition, you have been given two narcotic-containing drugs to assist with pain control. Lortab is a narcotic pain reliever that also contains Tylenol. It is very effective for pain relief. You may take one or two tablets of Lortab every 4 to 6 hours, but do not take more than 8 tablets in any 24-hour period. The other drug, Demerol, is an even more powerful painkiller: You may take 1 to 3 Demerol tablets every 3-4 hours during intense pain.

Nausea, Heartburn, Constipation, Gas

It is not unusual to experience nausea after UFE. You have been given a prescription for Phenergan (promethazine). You may take Phenergan every 4 to 6 hours as needed for nausea. It may make you sleepy.

While taking ibuprofen it is important to protect your stomach from irritation. Try to eat some food with each dose.

A common side effect of the prescription pain medicine is constipation and excess gas. Feel free to use Milk of Magnesia or a glass of prune juice prior to drinking your morning coffee. Or you can take Colace; a gentle laxative that you can purchase over the counter at your pharmacy. Phazyme is another over the counter medicine that can help relieve gas pain. Also, remember to drink at least 8 glasses of water a day.

Fever

        A mildly elevated temperature is a common side effect of UFE, occurring in about one-third of patients. Fever should be treated with Tylenol. You may take 2 extra strength Tylenol tablets every 6 hours while the fever is present. Do not take more than 8 Tylenol in any 24-hour period.  Each Lortab tablet contains the equivalent of one extra strength Tylenol. So the number of Tylenol + Lortab you take should not exceed 8 per day.

        High temperatures, greater than 102°, are of some concern. Call the Radiology department as described at the end of this instruction set if your fever reaches 102° or greater. Fever is a side effect of the dying fibroids and does not necessarily indicate an infection. Infection is unlikely to occur, but if it happens it is more likely to develop in a week to several weeks after the procedure than in the first few days following UFE.

Summary of your medicines

Anti-inflammatory                  Motrin                                     Ibuprofen

Pain relief, moderate            Lortab                                     Hydrocodone

Pain relief, severe                 Demerol                                 Meperidine

Anti-nausea                           Phenergan                             Promethazine

Laxative                                  Colace                                    Docusate

Anti-fever                                Extra Strength Tylenol           Acetaminophen

Anti-gas                                  Phazyme                                Simethicone

Discharge or Spotting

        A brown or reddish brown vaginal discharge or spotting after UFE is considered normal. You may use either a tampon or sanitary napkin; whichever you prefer. Your menstrual cycle may begin just after the procedure; also considered normal. A foul smelling discharge is abnormal. Please call us if this occurs.

Menstrual Periods

        Your first menstrual period may be heavier, lighter, or the same. It may also come sooner than usual. If abnormal menstrual bleeding is one of the primary reasons you had the UFE, do not be discouraged. It is quite common that it may take 2 or even 3 periods before improvement in the bleeding is noted. Almost every patient will have improvement by the third month after the procedure.

        The first and possibly second menstrual periods may be more uncomfortable than typical. Some patients have increased cramps during these periods. These symptoms resolve as the fibroids shrink. The fibroids take six weeks to three months to significantly shrink, so rapid results should not be expected.

Hormonal Changes.

        Some patients may experience symptoms as a result of changes in their hormonal balance after the procedure. Fibroids are driven by estrogen. As the fibroids die, there may be a sudden change in hormones. Some women experience mild depression, which subsides in s few days. Others experience “hot flashes” and/or night sweats. In our experience we have found these symptoms resolve without treatment for most patients.

Signs of Potential Problems

        Symptoms that might indicate problems include pain that occurs several days or weeks after the initial pain resolved; a temperature several days to weeks after the procedure; an irregular vaginal discharge (particularly if foul smelling or profuse). These symptoms may indicate either an infection or partial passage of a fibroid and may require gynecological evaluation. If any of these symptoms occur, please contact the Radiology Department so that we can assess the symptoms and make further treatment recommendations.

Gynecologic Care

        You should continue your normal gynecologic care. This includes monthly self-breast exams and yearly pelvic exams with Pap smear as suggested by your gynecologist.

Follow-up Care with Interventional Radiology

        We will see you in two weeks for a post procedure visit. If your symptoms do not resolve in the expected time frame, or if your symptoms worsen or other questions develop, we might schedule another MRI or ultrasound of your pelvis. Please tell us if you are developing symptoms, otherwise we have no way of knowing! We may contact you on occasion to check on your well being but there is no longer any scheduled follow-up beyond the two week visit.

If you have a question or problem…

        If at any time you have any questions regarding the procedure or any symptoms you might have, please feel free to call us. Call the IRC at (210) 616-7780. At night or during weekends, the answering service will contact the on-call IRC radiologist who will call you back.