This page contains answers to questions asked by visitors to this site.

What happens to the spheres you inject? Can they get to any other place in my body?

The spheres are made of an inert acrylic, the same material that a soft contact lens is made from. They stay in you, permanently. You could have a hysterectomy 20 years later and they would find them.

The spheres are 500-900 microns in diameter. A capillary, the tube through which a sphere would have to travel in order to get to the venous system (and then to your lungs) is only about 50 microns. so the spheres cannot escape the uterine artery. Once we put them there, they are permanent.

Will my insurance pay for UFE?

The vast majority of insurers recognize UFE as an established and necessary therapy and are willing to cover the procedure. But it is always best to ask them first rather than find out there is a problem afterwards. We will help you find out, first review the list of insurance companies for whom we are providers. But if you do not see your company we may still have an arrangements with them; call us at the IRC (my clinic) (210) 616-7780 to find out.

How can I find an Interventional Radiologist who performs UFE in my area?

The Society of Interventional Radiology (SIR) is our professional society. Go to our www site www.sirweb.org and you will see a link on the home page called Doctor Finder. This link takes you to a physician database that allows you to locate the Interventional Radiologists in your state. You can specify that you only want to see the list of doctors who perform UFE. The list will include addresses, e-mail addresses, and telephone numbers.

How do you embolize just the fibroids and not the whole uterus?

We do embolize the whole uterus. It is just that the arteries to the fibroids steal the majority of the incoming blood, so they get stopped-up with most of the particles we inject into the bloodstream. Also, the uterus has the ability to recruit blood from adjacent tissues, whereas the fibroids usually cannot. The first branch of the uterus usually supplies the cervix and vagina, as opposed to the uterus and fibroids. It is safe to embolize this branch, but it is also possible that blocking off this artery could result in decreased sensation and therefore less pleasurable sex. This subject is under investigation. If it is technically feasible to spare this branch we do so. None of our patients has reported sexual dysfunction after UFE.

What side effects will I experience?

The typical course is a day or two of requiring strong pain medicine to stay comfortable followed by a few days of intermittent crampy pain and /or nausea. We will make sure that you have the appropriate medications to keep these symptoms tolerable. You will not feel 100% normal, but you should not be miserable.

Some of our patients have noted that the procedure caused no more discomfort than their usual period.

Most women feel run down, tired, for a couple of days to two weeks following UFE, and rarely my patients have reported this sensation to last for a month or longer. You can have nausea, and you might run a low grade fever during this time. These are post-embolization syndrome (PES) symptoms. This as analogous to having the flu. When you have the flu, a virus is in your body killing lots of cells so it can reproduce. that cell death makes you nauseated, causes pains and fever and a feeling of malaise. The same thing is happening after UFE. The fibroid cells have died, and the reaction to that death, mediated by your inflammatory cells, causes PES. Taking the Motrin for a week after UFE really helps minimize those symptoms.

Many women have a brown, tacky, odorless discharge for a period of time following UFE. Some women experience hot flashes and/or night sweats for a short time after UFE. Sexual function is usually unaffected by UFE, unless that fibroids have been causing painful intercourse in which case sexual satisfaction can be improved! None of my patients have reported a loss of sexual function but there are internet discussion groups that contain discussions by women reporting decreased sensation in the uterus or vaginal dryness. There is a case report of loss of uterine orgasms following UFE. If uterine orgasm is key to your sexual fulfillment, you may want to consider another alternative. We spare the first branch of the uterine artery if possible, as it mostly supplies the cervix and upper vagina. Some researchers believe that this may leave the ability to achieve uterine orgasm intact. That said, none of my patients have reported loss of uterine orgasm.

What if I am allergic to Iodine?

The X-ray dye (also known as X-ray contrast) injected during the procedure contains iodine. Being allergic to iodine is a hurdle that can be overcome many ways. The approach depends on the kind of reaction(s) you had previously. It might be as simple as giving you a medicine (steroid) to take by mouth the night before the procedure. On the other end of the spectrum, if you previously had a severe reaction to modern contrast, the procedure could be done under general anesthesia to ensure the highest level of control. And there are many in-between levels of management.

Regardless, we are all fully prepared to recognize and treat any reaction you might have.

Are the chances of a successful procedure minimized by approaching menopause (because the arteries narrow)?

The existence of severe narrowing of the arteries could theoretically be a problem but in practical terms does not occur. if your arteries were that small the fibroids would likely have already died from the lack of blood. UFE can induce menopause. While not yet proven, it is likely that the closer you are to entering menopause, the higher the chance that UFE will initiate menopause. In fact, one study found that 15% of women between the ages 45-50 enter menopause following UFE.

Does UFE work for women after menopause?

A woman who begins bleeding after menopause needs to be carefully evaluated. Of particular concern is the possibility that the lining of the inside of the uterus (the endometrium) is abnormal. The possibility of endometrial hyperplasia or cancer can be excluded by endometrial biopsy.

Fibroids typically die on their own after a woman enters menopause. Women who take hormone replacement therapy after menopause may continue to suffer from fibroids because the hormones can stimulate the fibroids. If this happens, sometimes a different type or dose of hormone is all that is needed to allow the fibroids to degenerate.  If changing the hormones does not work and the endometrial biopsy shows no abnormality, UFE might be appropriate.

They do not always die immediately, and can linger for an annoyingly long time after menopause begins. Data became available in 2007 that shows UFE can be helpful to women in menopause who suffer from fibroid bulk symptoms.

What happens if there is a problem with the procedure and it is unsuccessful?

For all of our procedures, failures are categorized as either technical failures or clinical failures

A technical failure means something happened during the procedure that prevented success. Say you have anatomy that prevents my being able to embolize the arteries that feed the fibroids. Perhaps it would be too dangerous , or just "technically" impossible (meaning I can not safely get the catheter into the uterine arteries). Technical failures for UFE are very unusual; on the order of 1 to 2 in 1,000 patients.

A clinical failure means we had a technical success (the arteries feeding the fibroids were successfully blocked) but you get little or no relief from your symptoms. A clinical failure could happen if the fibroids do not shrink very much and the main symptom is pelvic fullness. Or they continue to cause heavy periods when that was the problem. We know from about 10,000 procedures in the US that around 90% of women will get significant improvement or complete resolution of their symptoms after UFE. That means 10% will say that the UFE did not help very much. We are working to decrease that number. 

If the UFE does not resolve your symptoms and you elect to have a hysterectomy, the hysterectomy will be safer than it would have been before UFE. This is because there will not be as much blood loss, so the likelihood of your needing a transfusion is much less. In fact, that is how UFE got started in the first place. A French Gynecologist was trying to reduce the risk of hysterectomy by having a radiologist embolize the uterus before surgery. But none of his patients wanted the hysterectomy after the embolization!

We could also consider performing UFE a second time to see if that takes care of the problem. 

I was wondering if a fibroid only grows on or in the uterus? Is it possible to have a fibroid somewhere else? All I find is information about the uterus? 

The term “fibroid” is actually a lay term for the benign leiomyoma of the uterus. A leiomyoma is a tumor of a type of muscle known as “smooth muscle”. Any tissue with smooth muscle can form a leiomyoma. Since smooth muscle occurs in the gut as well as in the wall of every artery in your body, leiomyomata can form just about anywhere. 

But it is unusual to hear of any outside the uterus and GI tract. And the uterus is by far the most common location. In fact, uterine fibroids are the most common tumor of any type found in women.

What are the contraindications to UFE?

Fortunately there are not many conditions or situations that are contraindications to UFE.

1. A woman with chronic endometritis or salpingitis (longstanding infection of the uterus or fallopian tubes) should not have UFE as her chances of developing a runaway infection is too great.

2. If a highly pedunculated fibroid is present (this is a fibroid attached to the uterus by a thin stalk; like a tether ball) that fibroid should be removed laparoscopically prior to UFE.

3. A woman with a condition that makes arteriography unsafe, such as renal insufficiency or uncorrectable coagulopathy.

4. If the MRI demonstrates a disease that is best treated by surgery, such as an abnormal ovary, the options of having both the surgery and the UFE versus having the surgery including hysterectomy will need to be discussed.

5. A woman whose main goal is to prepare her uterus for pregnancy should have a myomectomy rather than UFE. This relative contraindication will be reassessed when better data on the effects of UFE on childbearing is available. Of patients who come to us for UFE, this is our number 1 reason for recommending against UFE.

Is it possible that one might not be able to have this procedure because her uterus is too large? 

There is no true limit, but the larger your uterus is when it is embolized the larger it will be when it stops shrinking after UFE. Some radiologists use a rule that if your uterus extends above your naval it is too large. I do not follow that rule, letting each woman make up her mind. And I would say that about half of the women I have seen with a uterus that large decided not to do it, the other half went through with UFE. And those who have been treated still have a large, though smaller, uterus. But not one of them has told me they did not feel better.

 Women decide to seek treatment for their symptoms once those symptoms become annoying enough to endure the treatment. Bulk symptoms are related to the volume of the uterus. A normal uterus is 150 cc. The bulk symptoms of a large uterus can go away without the uterus being anywhere near close to normal in size. Most of my patients have a uterus in the 450 to 750 cc range. But I have treated several women with uterine volumes greater than 1,000 cc.

For more information, please contact me by e-mail or by phone 210.616.7780.  Or visit the Society of Interventional Radiology's www site and follow the links about UFE.

 

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This page was last updated onSunday, June 10, 2007

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