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Uterine Artery Embolization for Fibroids

AMBULATORY CARE:

What you need to know about uterine artery embolization for fibroids:

This procedure may also be called uterine fibroid embolization. Embolization means creating a clot, or block, in a blood vessel. Your healthcare provider will block an artery that supplies blood to your uterus and the fibroid. This will make the fibroid shrink because it will not get nutrients and oxygen. The fibroid will not be gone, but it will become smaller and stop pressing on nearby organs and tissues. This may help relieve symptoms fibroids can cause, such as abnormal uterine bleeding, pain, and bloating. Embolization may be used if you cannot or do not want to have a hysterectomy to remove your uterus. Your uterus will not be damaged by a block to the blood flow.

Uterine Fibroid

How to prepare for the procedure:

  • Your provider will tell you how to prepare for this procedure. You may be told not to eat or drink anything after midnight the night before your procedure. Arrange to have someone drive you home. The person should stay with you to help you and watch for problems that may develop. Tell your provider about all your allergies. This includes if you have ever had an allergic reaction to contrast liquid, anesthesia, or antibiotics.
  • Give your provider a list of your medicines. Include all medicines and supplements you take. You may need to stop taking blood thinners or aspirin several days before your procedure. This will help decrease your risk for bleeding. Do not stop taking medicines unless your healthcare provider tells you to stop. Your provider will tell you which medicines to take or not take on the day of your procedure.
  • You may need blood tests to check how well your blood clots and to check your kidney function. You may also need an MRI. An MRI may show that you have more than one fibroid. Each fibroid will be checked for size, location, and how it is attached to your uterus. Do not enter the MRI room with anything metal. The metal can cause serious injury. Tell your provider if you have any metal in or on your body.
  • You will be given a blood or urine test to make sure you are not pregnant. This procedure is not used during pregnancy. Talk to your provider about your plans for pregnancy in the future. You may have a harder time becoming pregnant or carrying a baby to term after this procedure.
  • Talk to your provider if you use an intrauterine device (IUD) if he or she did not place it for you. Tell him or her when it was placed and what kind it is. It is okay to have an MRI and uterine artery embolization with an IUD. You may need an antibiotic to prevent an infection caused by bacteria. Tell your provider if you had an allergic reaction to an antibiotic.

What will happen during the procedure:

  • You may be given general anesthesia to keep you asleep and pain-free. More commonly, moderate sedation is used. This means you will be awake during the procedure, but you should not feel any pain. Your provider will put numbing medicine on your skin where the procedure will be done. A small incision will be made over an artery in your leg, near your groin. A catheter (thin tube) will be guided into the artery. Contrast liquid will be used to help your healthcare provider see your arteries more easily.
  • Your provider will use a type of x-ray that gives a moving picture of the arteries. This will help him or her move the catheter into the right place. The catheter is moved up until it reaches the uterine artery. The artery supplies blood to the fibroid. Liquid that contains small pieces of material is put into the artery. The pieces block blood flow to the uterus and fibroid. This keeps the fibroid from getting nutrients and oxygen. The fibroid stops growing, dies, and becomes smaller. This procedure is repeated on the uterine artery on the other side. If you have more than one fibroid, they can all be treated during the same procedure.
  • Your provider will remove the catheter when both sides are finished. Pressure will be put on your skin over the catheter site to stop any bleeding. The incision area does not need to be closed with stitches. It will be small and close on its own. The area will be covered with a bandage to prevent infection.

What to expect after the procedure:

  • You will probably have pain and cramping for a few days in your uterus. You may also have pain, bleeding, or bruising where the catheter went into your leg. All of these symptoms are normal and should get better soon.
  • You should expect to stay in the hospital overnight. You may be given medicine to relieve inflammation. You may also be given pain medicine through your IV or a pump. A pump allows you to control when the pain medicine is given. Pain usually lasts 24 to 72 hours, but you may have pain for up to 1 month. You should also expect some discharge from your vagina. This should not last longer than 1 month.
  • Healthcare providers will help you walk around after your procedure. This will help prevent blood clots. Do not get up until healthcare providers say it is okay. They may want you to lie in one position for a certain amount of time. When they say it is okay to walk, they will help you stand and walk safely.
  • Your body will need to break down the fibroid. This will take a few months. You should start to notice relief from your symptoms within a few weeks.

Risks of uterine artery embolization for fibroids:

  • You may bleed more than expected or develop an infection. Your arteries may be damaged from the catheter, or you may develop a blood clot. Your kidneys may be damaged from the contrast liquid. Your uterus may be damaged, and it may need to be removed. You may develop an abscess (pocket of pus) in your uterus. Your monthly periods may stop. You may develop a urinary tract infection (UTI) or have trouble urinating. The procedure may not relieve your symptoms. The fibroid may grow back. Fibroids can come away from the uterus. You may pass small pieces from your vagina if this happens. A procedure called a dilation and curettage (D&C) is used to make sure all pieces are removed.
  • If you become pregnant, your risk for a caesarian section (C-section) or miscarriage will increase. You may also bleed heavily from your uterus after you deliver a baby. If you are older than 45, embolization may cause menopause to start. Rarely, you may need to have ovarian arteries blocked during this procedure. This can affect the function of your ovaries.

Call your doctor or gynecologist if:

  • You have heavy vaginal bleeding that soaks 1 pad in 1 hour for 2 hours in a row.
  • You have bleeding from your vagina that is not your period, or you are past menopause.
  • You start to bleed more than usual during or between your monthly periods.
  • You have pain or vaginal discharge that continues for longer than 1 month.
  • You have foul-smelling vaginal discharge.
  • You have a fever higher than 100.4°F (38°C).
  • You have a fever along with pain and nausea lasting longer than 3 days.
  • You have signs of an infection at the catheter site, such as red streaks, pain, or swelling.
  • You suddenly have severe abdominal pain, or new or worsening abdominal pain or pressure.
  • You cannot urinate, or you urinate very little.
  • You have questions or concerns about your condition or care.

Medicines:

You may need any of the following:

  • NSAIDs help decrease swelling and pain or fever. This medicine is available with or without a doctor's order. NSAIDs can cause stomach bleeding or kidney problems in certain people. If you take blood thinner medicine, always ask your healthcare provider if NSAIDs are safe for you. Always read the medicine label and follow directions.
  • Prescription pain medicine may be given. Ask your healthcare provider how to take this medicine safely. Some prescription pain medicines contain acetaminophen. Do not take other medicines that contain acetaminophen without talking to your healthcare provider. Too much acetaminophen may cause liver damage. Prescription pain medicine may cause constipation. Ask your healthcare provider how to prevent or treat constipation.
  • Take your medicine as directed. Contact your healthcare provider if you think your medicine is not helping or if you have side effects. Tell him or her if you are allergic to any medicine. Keep a list of the medicines, vitamins, and herbs you take. Include the amounts, and when and why you take them. Bring the list or the pill bottles to follow-up visits. Carry your medicine list with you in case of an emergency.

Self-care:

Your healthcare provider will give you specific instructions. The following are general guidelines to help your body heal and to help prevent infection:

  • Rest as needed. Rest and sleep will help your body heal. You may be more tired than usual for the first 7 to 10 days. Your body will be breaking down the fibroids for a few months.
  • Follow your healthcare provider's instructions for activity. He or she will tell you when it is okay to return to your normal activities and to start driving. He or she may want you to wait 1 to 2 weeks to return to work.
  • Help prevent an infection. Do not use tampons, douche, swim, or use a bath or hot tub until your healthcare provider says it is okay. These may cause an infection in your uterus. Your provider may want you to wait 7 to 10 days. It may take longer if you had any problems during or after the procedure. It is okay to shower after the procedure. You will only have a small cut in your skin from where the catheter went into your leg. Check the catheter site for signs of infection, including red streaks, pain, and swelling.
  • Treat symptoms of postembolization syndrome. This syndrome is common after an embolization procedure. It usually starts within 72 hours of the procedure and may last a few days. The main symptoms are fever, pain, and nausea. You will probably be able to manage your symptoms at home. Acetaminophen or an NSAID, such as ibuprofen, can reduce a fever and pain. You may need to eat lightly to manage nausea. Drink more liquids for the first week after the procedure to prevent dehydration.
  • Ask about birth control or pregnancy. It may take a few months for your monthly period to return to normal. If you had an IUD before the embolization, you may be able to continue using it. Ask your provider if it is safe to become pregnant, and how long to wait before you try.

Follow up with your doctor or gynecologist as directed:

You will need to return for regular MRIs to check that your uterus and fibroid are smaller. A foul-smelling discharge from your vagina may mean a fibroid detached from the uterus. An MRI is used to check for this. A procedure called a dilation and curettage (D&C) is used to make sure all pieces are removed. Write down your questions so you remember to ask them during your visits.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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