What to Expect During a UFE Procedure

UFE (Uterine Fibroid Embolization) or UAE (Uterine Artery Embolization) are slightly different terms for the same procedure. They are nonsurgical alternatives to hysterectomy or other surgical alternatives in the treatment of uterine fibroids.

Fibroids are benign tumors growing from the muscle wall of the uterus. Most often, they are asymptomatic but sometimes cause unpleasant symptoms: heavy menstrual bleeding, pain in the pelvic area, pressure on the bladder or intestines, and others.

Currently, there is no ideal way to treat uterine fibroids; all options have their advantages and disadvantages. However, UFE is the safest and most effective method. It is a minimally invasive treatment option for uterine fibroids.

How Is UFE Procedure Performed?

Uterine fibroid embolization is not a surgical procedure, it does not require cutting or general anesthesia. But despite the fact that the procedure usually lasts only 30-40 minutes, it is quite complicated and requires the highest level of skill from the Interventional Radiologist performing it. The procedure is done in an outpatient facility with special medical equipment.

The doctor makes a small puncture in the upper thigh (or sometimes a wrist), inserts a thin catheter into the femoral artery and leads it into the uterine arteries under X-ray guidelines. Particles of a special medical solution are injected through a puncture of an artery on the thigh into the vessels that feed the uterine fibroids. These particles completely stop the blood flow of the tumor.

The catheter must be in the correct position so that the drug hits exactly the right vessel. For the purpose of control, a radiopaque solution of iodine is injected into the artery through a catheter, then the UFE solution is injected; it is microscopic balls (much similar looking to caviar) that block the blood flow.

It is absolutely painless because there are no nerve endings in vessels, and the doctor performs local anesthesia at the puncture site. You can only feel light heat in the lower abdomen when the doctor injects the radiopaque solution.

Pre-Procedure

You are encouraged to be well hydrated (drink lots of fluids) the day before the procedure. Nothing is to be taken by mouth after midnight the night before the procedure.

One exception to this is if you take blood pressure medicine in the morning, this can be taken with small sips of water. Prepare your bedside table the night before (tissues, heating pad, thermometer, loose-fitting nightgown, important phone numbers of doctors, pharmacy).

You will need to arrange that someone can drive you home mid to late afternoon on the day of the procedure.

During the Procedure

You will feel no pain during this 30-45 minute procedure, and you will sleep comfortably during this time. Intravenous sedation (fentanyl and versed) is used.

The doctor will remove the catheter and close the puncture site. In just two to three hours, you can bend your leg. After 6-7 hours you can get out of bed, and eat.

In the first hours after the procedure, you may be disturbed by some crampy pain like heavy menstrual cramps, a slight fever, weakness, and some spotting from the vagina. This is a good sign that fibroids are dying. Discomfort can last several hours and is significantly improved by the following morning.

Post-Procedure

If you are tolerating taking liquids by mouth, exhibit no bleeding from the point of entry in the groin, and the oral pain medicine is adequate in controlling the discomfort, you can go home.

In most cases, in the evening patients go home. However, sometimes it is recommended to spend the first day after the procedure under the supervision of your doctor. You will be discharged on an anti-inflammatory (like Motrin) which you need to take for 5 days and a pain pill which is taken only as needed. Oxycodone (a narcotic for pain) tends to cause constipation, so use a laxative if this occurs.

Patients are given a prescription for the following four medications upon discharge:

• Ibuprofen
• Oxycodone for pain, which is usually taken during the first 48 hours, and only when needed
• Docusate Sodium-stool softener to be taken 2X/day for 5 days
• Promethazine suppository for nausea as needed.

No aspirin or aspirin-like products should be used during the 5 days on the prescribed medications.

The discomfort of constipation can add to the expected post-procedural discomfort. You can resume your normal light activities as you feel able which should be within 48-72 hours after the procedure. Don’t overdo it, and use pain/discomfort as your guide. Eat healthy foods and drink plenty of fluids. Boxer shorts are recommended over briefs (less irritating). Heating pads can be helpful for discomfort.

Should you have any questions, day or night there is always an interventional radiologist on call to help you.

The recovery period is usually 3-4 days, although I suggest patients take 1 week off from work if possible. The only restrictions after the procedure are:

• No bathing for 2 weeks (you can shower).
• No sauna.
• No tampons for one cycle (use pads than can switch back).
• No intercourse for 2 weeks.
• No heavy lifting or exercise for 2 weeks.
• Airline and long car travel discouraged for 2 weeks.

Important: fibroids no longer exist. They are replaced by connective tissue, which is absolutely not harmful to health and cannot interfere with pregnancy.

After 3 months, the doctor should see you for a check-up. Usually, by this time, fibroids are reduced by 20-30%. After 6–8 months, the tumor decreases by 50–70%. It now looks like a grape or a raisin.

As a rule, patients can begin planning pregnancy and try to conceive 3-4 months after the procedure, if the doctor does not find any abnormalities.

Almost 90% of women experience a cessation of all unpleasant symptoms and menstrual irregularities after the UFE procedure. And in 99% of cases, patients do not need any other treatment after UFE.

Why Is UFE not Performed in All Gynecological Clinics?

Unlike the equipment needed for a fibroid surgery, equipment for the UFE procedure is very expensive, so not every clinic can afford it.

Also, today there are not many experienced radiologists, while doctors of other specialties cannot perform uterine fibroid embolization.

Atlanta Fibroid Center works under the highest standards of medical care, which requires great attention to every detail of the process: we use the most modern embolization preparations for the UFE procedure; we provide patients with post-procedure follow-up, including recommendations on when they can plan the conception of the baby.

If you have been diagnosed with fibroids and are experiencing symptoms, call Atlanta Fibroid Center at (770) 953-2600 or make an appointment online.