Overview

This information is about having a procedure called a fibroid embolisation. The procedure involves staying in hospital overnight. We give you details about the hospital where you will be treated, how to get here and what to bring with you.

Fibroids are growths that you can get in the muscular wall of the womb (uterus). They are non-cancerous (benign) growths and can be different sizes. Sometimes, fibroids become very large.

Fibroid embolisation (also called uterine artery embolisation) is a minimally invasive procedure. It blocks the arteries (blood vessels) that supply blood to the fibroids and makes them shrink.

The aim of this information is to help answer some of your questions about having a fibroid embolisation. It explains:

• the benefits of the procedure 
• the risks of the procedure 
• how to prepare for the procedure 
• what happens during the procedure 
• what happens after the procedure 

If you have any questions or concerns, please speak to a doctor or nurse caring for you.

Causes of fibroids

Although fibroids are common, we still do not know what causes them. You do not get fibroids until you start your periods. They often get better when you reach the menopause (when your periods stop).

Fibroids are more common in African-Caribbean people. They may be larger and affect people earlier in this group.

Symptoms of fibroids

At least half of all people with fibroids (which have shown on a scan) do not have any symptoms. Any symptoms are usually connected with your periods or, if the fibroids are large, too much pressure.

Symptoms can include:

• heavy, long-lasting periods (sometimes with clots). This can cause anaemia (a lack of red blood cells or the chemical haemoglobin, which is found in blood). Anaemia can make you feel tired and weak or cause headaches 
• painful periods
• pain in the back and legs
• pressure on the bladder, which causes a frequent need to pee
• pressure on the bowel, which causes constipation and bloating (when your tummy feels full and uncomfortable)

In some people, fibroids make the womb expand so much that their tummy (abdomen) appears large and they look as if they are pregnant. This can cause back pain and make them feel bloated and uncomfortable.

Fibroids can also sometimes cause other complications, such as problems in pregnancy, infertility (when you cannot become pregnant) and miscarriages.

Your doctor has recommended treatment because your fibroids are causing problems.

About fibroid embolisation

A doctor called an interventional radiologist (IR doctor) does this procedure. They are trained to do minimally invasive, image-guided procedures on different parts of the body.

The IR doctor uses an X-ray camera to guide small particles to the womb and fibroids. They inject the small particles and a contrast agent (substance that shows clearly on scans) through a thin, flexible tube called a catheter. The particles and contrast agent go into an artery that supplies the fibroids with blood.

Fibroids grow from the wall of the womb. They get blood from the vessels coming out of the arteries that supply the womb. Fibroid embolisation blocks off most of these arteries. This makes the fibroids shrink. Your womb can get another blood supply and so is not seriously affected.

Benefits of the procedure

The embolisation procedure shrinks the fibroids by about half. This usually improves any symptoms caused by the size of the fibroids or pressure.

The symptoms of fibroids improve after the procedure in about 8 to 9 out of 10 cases. Unlike other treatments for fibroids, embolisation treats all the fibroids in your womb. It is rare for fibroids to grow back after the procedure.

Risks of the procedure

Fibroid embolisation is generally very safe. However, as with any procedure, there are some risks involved.

The most common risks are listed in this section.

Damage to a blood vessel, bruising or bleeding

Any procedure that involves putting a catheter inside a blood vessel (artery) has some risks. They include:

• damage to the blood vessel
• bruising or bleeding where we put in the catheter

When an experienced IR doctor does the procedure, these risks are very small.

Infection

There is a small risk of infection, but we can usually treat this with antibiotics. In about 1 out of every 100 cases, the infection is serious. You then need an operation to remove the womb (hysterectomy) or another procedure.

Injury to surrounding parts of the body

Very rarely, the small particles used during the procedure may become fixed in the wrong place. This may prevent normal tissue from getting its oxygen supply.

To avoid this complication, the IR doctor carefully examines the pattern of the blood vessels in the pelvis. The path of these vessels can be different for each person.

Allergic reaction

It is possible to have an allergic reaction to the contrast agent used during the procedure. This is a substance used to make structures in the body show clearly on X-rays.

Allergic reactions range from mild itching to severe reactions that can affect breathing or blood pressure. We monitor you carefully during the procedure. This means that we can notice and treat any allergic reaction immediately.

Early menopause

Very rarely, you may have menopausal changes after the procedure (changes to the body when your periods stop). This is more likely to happen if you are:

• in your mid-40s or older
• already near the menopause

Vaginal discharge

Most people get leaking fluid from the vagina called vaginal discharge. This usually lasts for up to 2 weeks after the procedure.

Fibroid expulsion

Bits of fibroid may pass out of your body (fibroid expulsion) for several months after the procedure.

Rarely, if a larger fibroid is passed, you may need to see your gynaecologist (doctor who specialises in conditions that affect the female reproductive system). They can help to remove the fibroid.

Procedure not working

There is a small risk that the procedure may not work. This happens in about 1 out of 10 cases (10%). In these cases, the fibroids continue to grow or grow again within 4 months of the procedure.

Radiation risks

During the procedure, you are exposed to X-rays. They are a type of radiation called ionising radiation. This may cause cancer many years or decades after you are exposed to it.

You might have some skin redness after the procedure that feels like sunburn. We do not expect this to be permanent. The redness might be harder to notice on brown and black skin.

Interventional radiology (IR) is when we use medical imaging guidance to do minimally invasive procedures. The amount (dose) of radiation from these procedures is generally low. More complex procedures might involve a medium (moderate) dose of radiation.

The IR doctor and radiographer (health professional who specialises in medical imaging) make sure that:

• your radiation dose is kept as low as possible
• the benefits of having X-rays during your procedure are greater than the radiation risks

Radiation and pregnancy

Radiation can be harmful for an unborn baby. If you are or think that you might be pregnant, it is important to tell a member of your medical team before the procedure. We cannot do any procedure that involves radiation if you are pregnant.

If you can become pregnant from sex, you need to use protection (contraception) from the first day of your period until your appointment. This means that you will not be pregnant when you have the procedure. If the first day of your period has already passed, please contact the department. We can then give you another appointment within the first 10 days of your period.

We ask you to sign a pregnancy declaration form before the procedure.

Other treatment options

You do not always need treatment for fibroids.

If you do need treatment, there are several options. Your gynaecologist talks to you about any other treatments that they think may be suitable, including medicines. These will not cure fibroids but can help with some of the symptoms.

It is possible that your symptoms will get worse if your fibroids are not treated.

There are different operations to remove fibroids.

Myomectomy

A myomectomy is when we surgically remove fibroids without removing the womb. The procedure may not be possible in all cases and you need to talk to your gynaecologist about this.

Hysterectomy

A hysterectomy is when we surgically remove fibroids by removing the whole womb. This means that you cannot have children afterwards.