Fibroid embolisation

Read our guide below about fibroid embolisation.

You can also download a PDF version of this patient information by following the link on the right.

What is fibroid embolisation?

It’s a way of treating fibroids by blocking off the arteries (the uterine arteries) that feed fibroids, and make them shrink. It’s an alternative to an operation.

The first fibroid embolisation happened in 1995. Since then over 400,000 women have had the procedure worldwide.

Why do I need fibroid embolisation?

You’ve had tests which show that you have fibroids. Your gynaecologist and GP will tell you about the problems with fibroids and how to treat them.

Operations can treat fibroids, either a hysterectomy to remove the womb or a myomectomy to cut the fibroids out of the uterus.

In your case, we’ve decided that embolisation is the better treatment.

Who has made the decision?

The doctors in charge of your case and the radiologist doing the fibroid embolisation will have discussed this decided that it’s most suitable treatment.

It’s very important that you have the opportunity to understand and discuss the options, and that you feel certain that you want to go ahead with the procedure. If, after a full discussion with your
doctors you don’t want the fibroid embolisation, tell your doctor.

Who will do the fibroid embolisation?

A specially trained doctor called a radiologist. They have special expertise in using x-ray equipment and interpreting the images produced. A fibroid embolisation involves inserting
needles and fine catheters into blood vessels, through the skin, and placing them correctly.

Where will the procedure take place?

Generally, in the x-ray department in a special screening room adapted for specialised procedures.

How do I prepare for fibroid embolisation?

You’ll have a consultation with a consultant radiologist and a radiology nurse several weeks before the procedure. They’ll help you prepare, answer any questions and get your consent. You’ll also need an MRI to plan and assess your suitability for the procedure.

Fibroid embolisation can be done as a day procedure but you should pack and prepare for an overnight stay. You must not eat for 4 hours before the procedure but we may tell you that you can drink some water.

What if I have any allergies?

You must tell your doctor. We’ll inject a special x-ray dye called a contrast medium through a catheter into your uterine arteries. This may give you a hot feeling in your pelvis.

If you’ve previously reacted to contrast medium which is the same dye used for kidney x-rays and CT scanning, you must also tell your doctor about this.

What actually happens during fibroid embolisation?

On the day of your procedure, we’ll ask you to put on a hospital gown, and lie flat on your back on the x-ray table. The radiologist will put a needle into a vein in your arm so they can give you pain relief or a sedative to relieve anxiety. Once in place, this won’t cause any pain. You may also have a monitoring device attached to your chest and finger, and may have oxygen through small tubes in your nose.

The radiologist will keep everything as sterile as possible and may wear a theatre gown and operating gloves. They’ll swab the skin with antiseptic near the point of insertion, probably the left wrist
and cover the rest of your body  with a theatre towel. They’ll also anaesthetise the skin and deeper tissues over the artery in the left wrist with local anaesthetic and insert a needle into this artery.

Once the radiologist correctly positions the needle, they’ll insert a guide wire through the needle and into the artery. They’ll then remove the needle so they can put a plastic tube called a sheath over the wire and into the artery.

The radiologist will use the x-ray equipment to navigate a separate, fine plastic tube called a catheter and a special wire into the correct position in the arteries which feed the fibroid.

They’re known as the right and left uterine arteries.

The radiologist will then inject contrast medium x-ray dye in the catheter into these uterine arteries. Once they identify the fibroid blood supply, they’ll inject fluid containing thousands of tiny plastic particles through the catheter which then flows into the small arteries that supply the fibroid. This silts up these small blood vessels and blocks them to starve the fibroids of their blood supply. The particles will remain there permanently.

Both the right and the left uterine arteries need blocking which the radiologist can usually do from the left wrist, but sometimes this may be difficult. In this case, they’ll insert a needle and catheter into one or both of the groins.

At the end of the procedure, the radiologist will withdraw the catheter and press firmly on the skin entry point for several minutes to stop any bleeding.

Will it hurt?

The local anaesthetic will sting to start with but this soon passes and the skin and deeper tissues should then feel numb.
The procedure itself may become painful but a nurse, or another member of staff will stand next to you and look after you. If the procedure becomes too painful, you can have some additional pain relief and sedatives through the needle in your arm.

As the dye or contrast medium passes around your body, you may get a warm feeling, which some people can find a little unpleasant. However, this soon passes and shouldn’t worry you.

Most patients will feel significant discomfort (crampy abdominal pain) during the first 12 to 24 hours after the procedure. This is normal and due to the blood supply to the fibroids
being cut off.

You’ll have strong pain relief medication to take after the procedure, as well as several other medications to reduce inflammation, constipation, and nausea.

How long will it take?

Every patient’s situation is different and it’s not always easy to predict how complex or straightforward the procedure will be. Some fibroid embolisations take around an hour. Other embolisations may be more involved and take over 2 hours.

As a guide, please expect to be in the x-ray department for about 2 hours.

What happens afterwards?

You’ll stay in the x-ray department recovery area on a trolley for 4 hours. Nurses will carry out routine observations for example taking your pulse and blood pressure to make sure you don’t have any unwanted effects.
They’ll also look at the skin entry point to make sure there’s no bleeding. Healthcare professionals in the department will assess you and decide if they can safely discharge you.

You might need to stay in hospital overnight.

When you get home, go to bed and rest for 3 or 4 days. The radiologist will arrange a follow-up MRI and consultation 6 months after the procedure to assess your symptoms and
determine if it’s been technically successful.

Are there any risks or complications?

Fibroid embolisation is a safe procedure, but there are some risks and complications that can happen.

There may occasionally be a small bruise called a hematoma around the site where the radiologist inserted the needle. This is quite normal. If it becomes a large bruise, there’s a risk of it getting infected which would need treatment with antibiotics.

Infection in the uterus is one of the most serious complications after embolisation. This happens in approximately 2% of cases and there’s an approximately 1% risk of needing an
emergency procedure to remove the womb (hysterectomy).

What else may happen after this procedure?

You may feel very tired or have flu-like symptoms for up to 2 weeks after the procedure. It’s known as post-embolisation syndrome, though some people feel fit enough to return to work 3 days later. We recommend you take at least 2 weeks off work following embolisation.

You may get a small amount of brown vaginal discharge after embolisation which may persist for several weeks or possibly months. Approximately 8% of people have spontaneously expelled a fibroid, or part of one, usually 6 weeks to 3 months afterwards. If this happens, you’re likely to feel period-like pain and have some bleeding.

Very few people have early menopause after this procedure. This probably happened because they were at this time of life to start with.

What are the results of fibroid embolisation?

The majority of people are pleased with the results and most fibroids shrink to about half the volume they were before. Once fibroids have been treated like this, they generally don’t grow back again.

Some people who couldn’t get pregnant before the procedure because of their fibroids get pregnant afterwards. If having a baby in the future is important to you, talk to your doctor as it may be that an operation is still the better choice.

Approximately 1 in 10 patients having fibroid embolisation need further intervention after the initial procedure. This can include further embolisation or surgery. Our own audit data shows this is more likely for patients with fibroids larger than 10 cm in diameter.

Consent

Make sure you get enough information about the procedure before you sign the consent form.

Fibroid embolisation is considered a safe procedure designed to improve your medical condition and avoid you having a larger operation. There are some risks and complications
involved, and because there’s the possibility of a hysterectomy, discuss all the options available with your doctors.

If you have any concerns

Call us on 01296 418111.

How can I help reduce healthcare associated infections?

Infection prevention and control is important to the wellbeing of our patients so we have procedures in place. Keeping your hands clean is an effective way of preventing the spread of infections.

You, and anyone visiting you, must use the hand sanitiser available at the entrance to every ward before coming in and after you leave. You may need to wash your hands at the sink using soap and water. Hand sanitisers are not suitable for dealing with patients who have symptoms of diarrhoea.

More help or advice

Contact our patient advice and liaison service (PALS) on 01296 316042 or bht.pals@nhs.net