Myomembolization - Treatment of Fibroids

Definition: What is uterine fibroid embolization?

Many women have fibroids. These are benign tumors in the uterus that typically do not require treatment.

Large fibroids can press on neighboring organs and cause severe pain. Heavy menstrual bleeding or pain during menstruation are symptoms that many patients with fibroids experience.

In these cases, surgery was previously performed. Thanks to embolization, surgical removal is no longer necessary. This treatment method blocks blood flow to the fibroids.

Most fibroids are small and do not cause any noticeable symptoms @ Henrie /AdobeStock

When is fibroid embolization used?

In most cases, treatment for fibroids is not necessary, as many symptomatic fibroids do not cause any symptoms. Many women do not even realize they have such growths in the muscular layer of the uterus.

Fibroids are among the most common benign tumors in women. About 25 percent of all women are affected by them. Treatment is necessary only when they cause symptoms. Embolization is then a welcome alternative to surgical removal.

This type of treatment is also known as transcatheter embolization. Its goal is to alleviate the symptoms associated with a fibroid.

The three typical symptoms include:

• Pressure on the kidneys or bladder
• Pain during menstruation
• Very heavy menstrual bleeding

The advantage of myoma embolization over surgical removal is that patients recover more quickly after the procedure. However, it is possible that repeat treatment may be necessary in the foreseeable future.

Uterine fibroid embolization is not suitable for all women:

• Fibroids that grow beneath the uterine lining are not suitable.
• This is also the case for fibroids located on the outer wall of the uterus.
• The treating physician will also refrain from performing this procedure in cases of inflammation in the genital area or an existing pregnancy.
• The same applies to all patients with an overactive thyroid. Since they cannot tolerate the iodine-containing contrast agent, doctors will choose a different type of treatment for them as well.

How is a myomembolization performed?

Uterine fibroid embolization is a minimally invasive procedure in interventional radiology and is usually performed under local anesthesia. The doctor makes a small incision in the patient’s groin. From there, he inserts a thin catheter through the groin into the femoral artery. 

The doctor then injects a contrast agent so that the blood vessels are clearly visible on the X-ray. During this process, the patient feels a sensation of warmth in the pelvic area. An increased urge to urinate is also possible.

The catheter is then carefully advanced until it reaches the fibroid. Afterward, tiny particles are injected into the vessel. These particles block the affected arteries, ensuring that the fibroid no longer receives a blood supply.

Small collateral vessels in the uterus continue to supply blood, so no damage occurs. Thus, only the fibroid is affected, not the uterus.

The entire procedure is straightforward but can take up to two hours. After the embolization, the patient receives a pressure bandage over the puncture site. She can remove it the next morning.

Under X-ray guidance, doctors insert a catheter through the groin to the fibroid and block the blood supply @ Henrie /AdobeStock

What does post-procedure care look like after a fibroid embolization?

After uterine fibroid embolization, patients must remain on bed rest for about twelve hours. This is necessary to allow the puncture site in the groin to close.

During this time, patients may experience pain and cramping in the lower abdomen, as well as nausea or vomiting. These symptoms may last for a few days, but they can be effectively managed with medication.

In about three out of every 100 patients, side effects such as a uterine infection or deep vein thrombosis in the legs are possible.

In four out of every 100 patients, uterine fibroid embolization results in the permanent cessation of monthly menstrual bleeding.

Another potential side effect: Recent studies show that the procedure can impair a woman’s fertility. The blood supply to the ovaries may be restricted, which in rare cases can lead to infertility.

For this reason, the procedure is not recommended for women who wish to have children or who are struggling to conceive.

The doctor can only determine whether the procedure has achieved the desired outcome after a few weeks. A follow-up MRI is performed.

This allows the doctor to determine whether blood flow to the fibroid has been completely blocked. If so, the fibroids will shrink on their own over time, and symptoms will automatically subside.

The success rate of the treatment is between 80 and 90 percent. This means that 80 to 90 percent of women treated experience a significant improvement in their symptoms following myomembolization.

Complications, Risks, and Prognosis of Uterine Fibroid Embolization

As mentioned earlier, the chances of treatment success are very good.

The success rate is 80 to 90 percent. However, statistics also show that uterine fibroid embolization may not provide sufficient relief for some women.

In such cases, repeat treatment may be necessary. This may involve another uterine fibroid embolization or a myomectomy. A myomectomy is the surgical removal of the fibroids. In rare cases, certain fibroids may regrow, requiring further treatment.

A high percentage of patients report a quick recovery and significant symptom relief. Compared to the other two methods, women can leave the hospital an average of three days earlier. 

General anesthesia is also not required, which is another advantage of this procedure. Recent studies suggest that a second embolization may be necessary for a small percentage of women.

In general, myoma embolization is recommended for women aged 40 and older. Younger women who still wish to have children should consult with their doctor to decide on an alternative treatment.

FAQ

1. What is myoma embolization?
Myoma embolization is a minimally invasive procedure in which the blood supply to a myoma is cut off. As a result, the myoma shrinks over time and pain subsides.

2. How is the procedure performed?
Under local anesthesia, the radiologist inserts a thin catheter through the groin into the leg artery. Through this catheter, small particles are injected to block the affected blood vessels, thereby stopping blood flow to the fibroids.

3. Who is this treatment suitable for?
Uterine fibroid embolization is particularly suitable for women who wish to avoid a hysterectomy. However, it is not recommended for women who wish to have children.

4. What are the chances of success?
Many patients report significant relief from their symptoms after treatment. Studies suggest that most women who undergo this treatment are permanently free of their symptoms.