Fibroid Embolization

Fibroids are benign tumors that develop from the muscle tissue of the uterus. They are very common in women of reproductive age; many cause no symptoms while some seriously affect quality of life. Fibroids are not cancer and the likelihood of malignant change is very low.

Symptoms vary with the number, size and location of the fibroids: prolonged or heavy menstrual bleeding, anemia, pelvic and back pain, abdominal swelling and pressure, frequent urination, constipation, painful intercourse and in some cases pregnancy problems.

In fibroid embolization (uterine artery embolization) a thin catheter is passed through a small entry at the groin or wrist to the vessels feeding the uterus. Very small particles are delivered into the vessels supplying the fibroid to reduce its blood flow. The fibroid with reduced blood flow shrinks over time and symptoms improve. Normal uterine tissue is spared because it is also supplied by other vessels.

The procedure is done under imaging guidance, usually with sedation or local anesthesia. No abdominal incision is needed and the uterus is left in place.

It can be an option for patients with symptomatic fibroids who want to keep the uterus or who have a high surgical risk. Suitability is determined by gynecological assessment and MRI. MRI shows the number, location and blood supply of the fibroids and helps exclude other conditions such as uterine cancer.

It is not suitable with active infection, pregnancy or suspected uterine cancer. In women who wish to have children the decision must be made carefully together with the gynecologist.

In the first hours after the procedure cramp-like lower abdominal pain is common and is controlled with painkillers. Some patients are observed overnight in hospital. Mild fever, nausea and fatigue can last a few days. Most patients return to daily life within a week. Shrinkage of the fibroid and improvement in menstrual bleeding become apparent over weeks and months.

Risks include post-embolization syndrome (pain, fever), infection, changes in the menstrual cycle, rarely earlier menopause, passage of fibroid fragments and, rarely, the need for further intervention. Alternatives include removal of the fibroid (myomectomy), removal of the uterus (hysterectomy), medication and other methods such as focused ultrasound or radiofrequency ablation.

A study (2020) in which the doctor is among the authors reported 52-week follow-up results of ultrasound-guided percutaneous radiofrequency thermal ablation in symptomatic uterine fibroids.

Not every fibroid needs treatment. Small fibroids that cause no symptoms can be observed. When there are symptoms, medication, surgery, embolization or ablation are considered according to age, wish for children, the number and location of the fibroids, degree of anemia and patient preference. Interventional radiology is one of these options and the decision is often made together with the gynecologist.

The MRI done before embolization shows the blood supply and likely suitability of the fibroids and also helps exclude other uterine pathology. An embolization decision should therefore not be made without an MRI.

At the first consultation your complaints, medical history, medications (especially blood thinners and diabetes drugs), allergies and previous imaging and test results are reviewed together. Your menstrual pattern and bleeding amount, history of anemia, pregnancy plans and previous gynecological interventions are asked about in particular. Please bring previous reports, films and CDs, your current medication list and any blood test results.

If needed, additional imaging or tests are requested. Whether the treatment is suitable, how the procedure will be done, the possible risks and the alternatives are explained in detail; your questions are answered and the procedure is planned after your consent is obtained.

Preparation instructions are given according to the type of procedure and the patient's condition. In general this involves fasting for a set time before the procedure, having tests that show kidney function and bleeding-clotting values and adjusting some medications as advised by the doctor. Always tell us if you are allergic to contrast material or medicines.

Having a relative with you on the day of the procedure is helpful for returning home after discharge.

Consultations and procedures are carried out in person at Ankara City Hospital, Neuro-orthopedics Building, Department of Radiology, Interventional Radiology Unit; online consultation is not offered. Appointments can be made on DoktorTakvimi via the Book button or by phone at 0850 333 0388. See the Contact page for the address and directions.

Myomectomy (surgical removal of the fibroid) and hysterectomy (removal of the uterus) need a longer hospital stay and recovery and are performed under general anesthesia with an abdominal incision or laparoscopy. Embolization usually involves only a needle puncture, recovery is shorter and the uterus remains in place. On the other hand, the fibroid is not expected to disappear completely after embolization; shrinkage and symptom improvement are the aim and further treatment may be needed in the future.

Which method suits you is decided jointly by the gynecologist and the interventional radiologist according to your age, the features of the fibroid, your wish for children and your general health. Seeking a second opinion for this decision is also entirely reasonable.