Uterine Fibroid Symptoms and Treatment Options
Frequently Asked Questions about Uterine Fibroids! Find helpful answers to common questions about uterine fibroids, associated symptoms, and treatment options offe
What Are Fibroids?
Fibroids are benign tumors that arise from smooth muscle cells of the uterus. They are benign meaning they are not cancer. While the precise cause of fibroids is unknown, hormones promote their development. While fibroids may be asymptomatic in some patients, many women suffer from symptoms that cause a significant negative impact on their quality of life. Symptoms caused by uterine fibroids include heavy menstrual bleeding, pelvic pain or pressure, and bulk related symptoms such as urinary frequency.
Uterine fibroids are extremely common. In fact, fibroids are the most common tumor of the pelvis in women. Fibroids are more common in African-American women. By age 35, 40% of caucasian women and 60% of African-American women will have fibroids. By age 50, the incidence of fibroids increases to 70% in caucasian women and over 80% in African-American women. African-American women are also more likely to be symptomatic.
What are the Symptoms of Fibroids?
The symptoms caused by uterine fibroids can be pided into three main groups. These three groups are heavy menstrual bleeding, pelvic pain, and bulk symptoms related to the size or position of the fibroids.
The most common symptom associated with fibroids is heavy menstrual bleeding. This can cause many women to develop anemia and feel severe fatigue. Heavy bleeding causes many patients to miss work or avoid their normal activities. In some patients, bleeding can be so severe that blood transfusions are needed.
Pelvic pain occurs in nearly two thirds of patients with symptomatic fibroids. In over 10% of patients, pelvic pain is the dominant symptom.
Bulk symptoms are caused by the size and location of the fibroids and uterus. Large fibroids can cause bloating, pressure or heaviness as well as painful intercourse. Fibroids can cause pressure on the bladder which may lead to urinary frequency, causing frequent trips to the restroom. Large fibroids can also cause low back pain, constipation, as well as leg pain, swelling, and heaviness.
How Are Fibroids Diagnosed?
Uterine fibroids can be asymptomatic and be discovered incidentally on a routine pelvic exam. In many patients, fibroids can cause symptoms including heavy menstrual bleeding, pelvic pain or pressure, and bulk related symptoms such as urinary frequency.
Symptomatic fibroids are usually diagnosed by clinical history and confirmed with a pelvic ultrasound. In symptomatic patients, if an ultrasound exam reveals the presence of fibroids, then the next step is to discuss the various treatment options. If patients are interested in uterine fibroid embolization, an MRI examination of the pelvis is performed to accurately visualize the fibroids, uterus and all related structures.
Is Hysterectomy Needed to Treat Fibroids?
Approximately 700,000 hysterectomies are performed each year in the United States. The majority of these hysterectomies are due to fibroids. While hysterectomy may be the best treatment for some patients, it is important for women to be informed of all of their treatment options. Hysterectomy is a major surgical procedure that requires a 4-6 week recovery period and will leave a large permanent scar on your abdomen.
Uterine fibroid embolization, abbreviated UFE, is a non-surgical treatment alternative to hysterectomy for patients with symptomatic fibroids who wish to avoid major surgery. UFE is an outpatient procedure with far less downtime than hysterectomy and will leave no significant visible scar.
A practice bulletin from the American College of Obstetrics and Gynecology in 2008 stated uterine fibroid embolization is a safe and effective treatment option for women with fibroids who wish to retain their uterus.
What Are Fibroid Treatment Options?
Uterine fibroid embolization, abbreviated UFE, is a minimally invasive, non-surgical, outpatient treatment option for women suffering from uterine fibroids. UFE is one of many treatment options available to you. If you and your care provider determine that you have uterine fibroids, it is a good idea to discuss the various alternative treatment options for fibroids available to you, including uterine fibroid embolization (UFE).
Non-invasive treatment options include: diagnosis and watchful waiting, hormone treatment, magnetic resonance guided focused ultrasound surgery (MRgFUS).
Less invasive treatment options include: Uterine Fibroid Embolization (UFE), and endometrial ablation
Surgical treatments include myomectomy and hysterectomy. Myomectomy removes inpidual fibroids or portions of fibroids from the uterus. Hysterectomy is the surgical removal of the entire uterus. Various myomectomy approaches include: hysteroscopic, laparoscopic, robotic-assisted, abdominal or "open" myomectomy. Various hysterectomy approaches include: vaginal, laparoscope-assisted vaginal hysterectomy (LAVH), Robotic-assisted laparoscopic hysterectomy, abdominal or "open" hysterectomy.
To learn more about these various treatment options, please click here.
What is UFE?
Uterine fibroid embolization, abbreviated UFE, is a minimally invasive, non-surgical, outpatient treatment option for women suffering from uterine fibroids. During a UFE procedure, a small catheter is inserted into an artery in the wrist or groin. This catheter is a long flexible tube less than 2 mm in diameter. The catheter is guided through the body with x-ray equipment into the arteries of the pelvis. Angiograms are performed to map out the blood vessels supplying the uterus and pelvis. The catheter is then positioned in the uterine arteries and tiny particles are injected which float downstream and shut off the blood supply to the fibroids. Once they lose their blood supply, the fibroids shrivel up and the symptoms go away.
UFE is an outpatient procedure and does not require a hospital stay. After the procedure, ladies are able to leave in a few hours and recover in the comfort of their own home. Unlike hysterectomy, UFE will leave no significant visible scar and will not require a long recovery period. After treatment, most ladies can return to work and resume normal activities after 1 week. UFE is very successful at eliminating fibroid symptoms without surgery and results in extremely high patient satisfaction.
UFE vs Hysterectomy?
Hysterectomy and uterine fibroid embolization are both treatment options for patients suffering from uterine fibroids. Hysterectomy can work well for many patients but it is a major surgery. Hysterectomy usually requires a long recovery period of up to 4-6 weeks which will cause you to take significant time off from work. Hysterectomy will also leave a large surgical scar on your abdomen. If your uterus is small enough, you may have a horizontal scar that can be hidden by a bathing suit. If your uterus is moderately sized or larger, you may end up with a more noticeable, vertical scar in the midline of your abdomen. African-American women who form keloids may have even larger, more visible scars which can be painful.
Uterine fibroid embolization, abbreviated UFE, is an outpatient, non-surgical treatment option for ladies suffering from fibroids. The UFE procedure requires minimal downtime. Most ladies resume normal activity and are back to work after only 1 week. We perform uterine fibroid embolization using an artery in the wrist which allows a faster recovery and will not leave a noticeable scar. A practice bulletin from the American College of Obstetrics and Gynecology in 2008 stated uterine fibroid embolization is a safe and effective treatment option for women with fibroids who wish to retain their uterus. For patients looking to avoid the long recovery time and surgical scars of a hysterectomy, uterine fibroid embolization is an excellent option.
What are the Advantages of UFE Compared to Hysterectomy?
Uterine fibroid embolization, also called UFE, is a minimally invasive, non-surgical, outpatient treatment option for symptomatic uterine fibroids. UFE is an outpatient procedure and does not require a hospital stay. After UFE, ladies are able to leave in a few hours and recover in the comfort of their own home.
Hysterectomy is a major surgical procedure and usually requires a hospital stay of at least 1 to 2 days. The recovery period after UFE is much shorter compared to hysterectomy. After UFE, patients can resume light activity the next day and most ladies can return to work and normal activities after only 1 week. In comparison, hysterectomy usually requires a 4 to 6 week recovery period requiring women to refrain from their normal activities and take significant time off from work.
Hysterectomy is usually performed through an abdominal incision. If your uterus is small enough, a horizontal incision over the lower abdomen can be used which can be hidden with a bathing suit. If your uterus is moderately sized or larger, a midline vertical incision may be required. Unlike hysterectomy, UFE will leave no significant visible scar.
We perform uterine fibroid embolization using access through a small artery in the wrist which will require no incision or a tiny nick in the skin of the upper thigh. After UFE at our practice, there will either be a small dot over your left wrist or tiny nick in the skin of the upper thigh which will be almost invisible. In African-American women who form keloids, avoiding the surgical scar of a hysterectomy is a great advantage of UFE compared to hysterectomy.
With a hysterectomy the uterus is completely removed from the body, possibly along with the ovaries and fallopian tubes. Many patients with fibroids do not want to lose their uterus or have their body parts removed.
A practice bulletin from the American College of Obstetrics and Gynecology in 2008 stated uterine fibroid embolization is a safe and effective treatment option for women with fibroids who wish to retain their uterus. UFE is very successful at eliminating fibroid symptoms without surgery and results in extremely high patient satisfaction.
What is Adenomyosis?
Adenomyosis is a condition where the inner lining of the uterus, known as the endometrium grows implants in the muscle of the uterine wall. These abnormal endometrial implants can cause painful menstrual cramps, heavy bleeding, bloating, along with pelvic pain and pressure. Adenomyosis is difficult to detect with ultrasound but it can be diagnosed with MRI. This is one of the reasons we recommend pelvic MRI prior to treatment with uterine artery embolization. Placement of an intrauterine device can be an effective treatment option in many patients with adenomyosis. Patients with adenomyosis who fail medical management have traditionally been treated with hysterectomy.
In patients who wish to avoid major surgery, adenomyosis can be treated with uterine artery embolization with excellent results. Recent studies show short term symptom improvement in greater than 90% of patients. Another recent study published LONG term follow up results over 7 years. In these adenomyosis patients treated with uterine artery embolization, during the long term follow up over 7 years, 82% of these patients were able to avoid hysterectomy.
Is it Necessary to Treat All Uterine Fibroids?
Uterine fibroids are benign tumors that arise from smooth muscle cells of the uterus. Fibroids are benign tumors, which means they are NOT cancer. It is not necessary to treat all uterine fibroids. Many patients with fibroids are completely asymptomatic and do not need to be treated. Newly discovered fibroids that are asymptomatic should be followed for a period of time to detect rapid growth which could be due to something other than a benign fibroid. Treatment of fibroids is usually reserved for patients who are experiencing symptoms such as heavy bleeding, pelvic pain, or bulk symptoms like urinary frequency.
Will Insurance Cover UFE?
Uterine fibroid embolization, abbreviated UFE, is a well established and accepted treatment option for ladies suffering from uterine fibroids. All of the major insurance carriers cover uterine fibroid embolization. We perform the majority of our UFE procedures in the office setting as an outpatient. This allows many patients to be treated with much lower out of pocket expense which for some patients may be as little as an office visit co-pay. Our team is very experienced at handling any insurance issues that come up in patients being evaluated and treated for uterine fibroids. We will contact your insurance company directly to address any coverage issues before treatment.
Do Fibroids Come Back after UFE?
UFE treats fibroids by injecting tiny particles which shut down their blood supply. After eliminating their blood supply, fibroids shrivel up and symptoms go away. Treated fibroids usually do not return. Rarely, the embolization can be incomplete and residual fibroid tissue may remain. Hormones produced by your body can cause sometimes cause residual fibroid tissue to grow, which could gradually cause your symptoms to return and require additional treatment. Even when all fibroids are completely treated at the time of uterine fibroid embolization, as long as your body continues to release hormones, there is a small chance that you could grow new fibroids. Once you reach menopause, your hormone levels decrease dramatically which greatly diminishes the chance of new or continued fibroid growth.
Can UFE Treat Multiple Fibroids?
Patients with multiple uterine fibroids are usually great candidates for uterine fibroid embolization. During UFE, tiny particles are injected into your uterine arteries. These particles flow downstream and shut off the blood supply to ALL of your fibroids simultaneously. Once the blood supply to your fibroids is eliminated, the fibroids shrink over time and your symptoms will improve or go away completely. All of the fibroids are treated equally at the same time during one outpatient, non-surgical procedure.
What Happens to Fibroids After UFE?
During uterine fibroid embolization (UFE), small particles are injected into the uterine arteries. These particles float downstream and shut off the blood supply to the fibroids causing them to shrivel up and the symptoms to go away. Once deprived of their blood supply, the heavy bleeding and pain caused by fibroids goes away quickly. Over time the fibroids will gradually shrink to about 1/3 of their original size. As these fibroids become smaller, they will no longer cause pressure on adjacent structures like the bladder. The particles we use for uterine fibroid embolization are completely inert and will not cause adverse reactions or migrate to other parts of your body. For patients suffering from fibroids, UFE is an extremely safe option with excellent long term results and high levels of patient satisfaction.
How Much Time Off from Work is Needed After UFE?
Patients often ask how long will they have to stay in the hospital following uterine fibroid embolization (UFE). Some centers routinely admit patients to the hospital for uterine fibroid embolization which is inconvenient and rarely necessary. With modern techniques and state of the art protocols, the vast majority of uterine fibroid embolizations can be performed without admission to the hospital. In our practice, we schedule all of our UFE procedures as same day outpatient procedures, either in our office based endovascular interventional suite or at the hospital.
An outpatient procedure means you go home the same day and recover in the comfort of your own home. You are with us for about 6 hours on your procedure day, and we send you home with medications to treat any discomfort you may feel after treatment.
The first 24 hours after the procedure significant discomfort is expected, though generally well controlled with prescribed pain medication. You may continue to experience some cramping, similar to menstrual period cramping, that lasts a few days after the procedure. Most women are able to return to light activity within a few days of the uterine fibroid embolization treatment and are often able to go back to work within 1 week of treatment. On average, post-procedure discomfort completely resolves within 11 days. Our team will follow up with you frequently after your procedure to ensure an uneventful recovery.
What Are Possible Complications of UFE?
Uterine fibroid embolization, abbreviated UFE, is an extremely safe non-surgical outpatient treatment option for women suffering from uterine fibroids. Complications after UFE are un-common. The most common complications are permanent loss of the menstrual cycle and prolonged vaginal discharge. During uterine fibroid embolization, some of the particles that are injected into the uterine arteries may also affect the ovaries which can lead to premature menopause. Early menopause is usually seen in patients over the age of 45 and can occur in up to 15% of patients in this age group.
Rare complications of UFE include infection, fibroid expulsion, and non-target embolization.
- Infection is a risk with most medical procedures. With UFE the chance of infection is less than 1%.
- Fibroid expulsion and passage of fibroid tissue fragments is also a potential complication occurring in about 2% of patients. If a fibroid is located within the uterine cavity the risk for fibroid expulsion is much higher. With pelvic MRI prior to your procedure, we are able to identify patients at risk for fibroid expulsion and plan accordingly.
- Non-target embolization refers to particles ending up in places not intended during the procedure. This complication is exceedingly rare, occurring in less than 1 in 1,000 patients.
Are Your Patients Happy After UFE?
Our patients are extremely satisfied after treatment with uterine fibroid embolization (UFE). The most important way we achieve this high level of satisfaction is by properly educating our patients about ALL of their available treatment options as well as what to expect if they choose UFE.
Prior to treatment, patients with fibroids can have severe symptoms such as heavy menstrual bleeding, pelvic pain, and bulk symptoms including urinary frequency, pelvic pressure and bloating. Many patients suffer for years with these symptoms, believing their only option is to have a hysterectomy. Hysterectomy is a major surgical procedure which will require a 4-6 week recovery period, prolonged time off from work, and leave a large scar on your abdomen. Patients choosing UFE are very happy to have their fibroid symptoms eliminated without the long down time or surgical scar they would experience with hysterectomy. UFE is an excellent option for patients suffering from uterine fibroids who want to avoid hysterectomy.
How Successful is UFE?
Uterine fibroid embolization (UFE) is extremely successful in relieving the symptoms caused by uterine fibroids. Our patient satisfaction is extremely high after the procedure. In patients with heavy bleeding, the long-term success rate is around 95% following the embolization procedure. Bulk symptoms are caused by the size of fibroids and include urinary frequency, pelvic pain or pressure, constipation, and leg heaviness or swelling. These bulk-related symptoms are relieved in more than 90% of patients after UFE.
What is Radial Artery Access?
Uterine fibroid embolization (UFE) is performed through the arterial system. Radial artery access (also called transradial access) refers to using an artery in the left wrist for the procedure instead of the femoral artery in the upper thigh.
Historically, most angiogram type procedures are performed using the femoral artery in the upper thigh. Traditional femoral artery access requires the patient to lay flat on their back for 4 to 6 hours after the procedure. During this time, patients are unable to move or bend their legs which many patients find to be very uncomfortable.
Radial artery access has been proven to be safer and leads to faster recovery and higher patient satisfaction. Our Interventional Radiology physicians at Fresno Fibroid Center are experienced using this relatively new and advanced technique. Our patients find it much more comfortable to have the procedure performed through the radial artery in the left wrist, as there is less pain during and after the procedure. There are also fewer bleeding complications compared with access through the femoral artery in the upper thigh. Patients recover more quickly and are able to sit up in bed, sit in a chair and even walk around almost immediately after the procedure. After having UFE performed through the wrist, our patients are often able to go home in only 1-2 hours following the procedure.
Can I Get Pregnant After UFE?
Patients with fibroids in need of treatment who still desire future pregnancy may be faced with the options of having a myomectomy or uterine fibroid embolization. A myomectomy is a surgical procedure where often only 1 or 2 fibroids are removed from the uterus. Studies have shown improvement in fertility rates after myomectomy. Many patients wishing to avoid myomectomy want to know if they can become pregnant after uterine fibroid embolization. There have been reports of many successful pregnancies in patients after UFE. Many studies show that fertility rates and miscarriage rates in UFE patients are no different than patients of the same age with fibroids who have had no treatment. That being said, patients may be better off having a myomectomy if they are a good candidate and are willing to undergo surgery.
Although not many large studies have been performed to study this issue and the findings are not very clear, a few studies have shown that pregnancy complications may be slightly more common after UFE compared with myomectomy. These pregnancy complications can include pre-term labor and pregnancy induced hypertension, also known as pre-eclampsia. UFE may still be an option in patients who are not good candidates for myomectomy or who do not want to have surgery.
Can UFE Treat a Very Large Uterus with Multiple Fibroids?
During uterine fibroid embolization (UFE), tiny particles are injected into the uterine arteries which float downstream and shut off the blood supply to the fibroids. Once they lose their blood supply, the fibroids gradually shrink to about 1/3 of their original size. Reduction in the overall size of the fibroids and uterus usually takes around 3 months and sometimes even up to 6 months depending on the original size of the fibroids.
If a patient with a very large uterus has a primary concern of regaining a flat belly, hysterectomy is a more direct route. Most patients usually say that a flat belly is not the primary concern. Hysterectomy for a large uterus will usually require a midline vertical incision in the abdomen. Almost all patients are happy with the reduction in bulk following UFE, but it takes time for fibroids to reduce in size after embolization.