Myoma / fibroid embolization - Medical specialists

Definition: What is myoma embolization?

Many women are affected by a fibroid. This is a benign tumor in the uterus that normally requires no treatment.

However,large fibroids can press on neighboring organs or cause other symptoms. Heavy menstrual bleeding or pain during menstruation are complaints that many patients with a fibroid have.

In these cases, surgery is performed . Thanks to myoma embolization, surgical removal is no longer necessary. This treatment method interrupts the blood flow to the tumors.

Most fibroids are small and are not noticeable @ Henrie /AdobeStock

When is fibroid embolization used?

In most cases, treatment of fibroids is not necessary. Many women do not even notice that they have such tumors in the muscle layer of the uterus.

Myomas are among the most common benign tumors in women. Around 25 percent of all women are affected. Treatment is only necessary if they cause symptoms. Myoma embolization is then a welcome alternative to surgical removal.

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

The three typical symptoms include

• Pressure on the kidneys or bladder
• Pain during menstruation
• A very heavy period

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

Myoma embolization is not suitable for all women:

• Myomas that growbelow the lining of the uterus are not suitable.
• This is also the case with fibroids that are located on the outer wall of the uterus.
• If there is inflammation in the genital area or an existing pregnancy, the treating doctor will also refrain from this procedure.
• The same applies to all patients with hyperthyroidism, as they cannot tolerate the iodine-containing contrast agent, so doctors also choose a different type of treatment for them.

How does a myoma embolization procedure work?

A fibroid embolization is performed under local anaesthetic. The doctor makes a small puncture in the patient's groin. From there, he inserts a catheter directly into the inguinal artery.

He then injects a contrast agent so that the doctor can clearly see the blood vessels on the X-ray image. During the procedure, the patient feels a sensation of warmth in the pelvis. An increased urge to urinate is also possible.

The doctor then pushes the catheter forward until it reaches the fibroid. He then inserts tiny plastic balls into the blood vessel via the catheter . They ensure that the vessels are blocked and the fibroid no longer receives any blood.

Small collateral vessels continue tosupply the uterus. This means that only the fibroid is damaged, not the uterus.

The entire procedure is uncomplicated, but can take up to two hours. After myoma embolization, the patient receives a pressure bandage on the puncture site. She can remove this the next morning.

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

What is the aftercare after a myoma embolization?

After myoma embolization, patients must remain in bed for around twelve hours. This is necessary so that the puncture site in the groin can close.

During this time, cramp-like pain in the abdomen, nausea or vomiting may occur. These symptoms can last for several days. However, they can be treated very well with medication.

In around three out of 100 patients, side effects such as inflammation of the uterus or leg vein thrombosis are possible.

In four out of 100 patients, myoma embolization leads to a permanent absence of menstruation.

Another undesirable side effect: recent studies have shown that the procedure can impair a woman's fertility. The reason: the pellets used can reach the blood vessels in the ovaries and significantly impair blood flow.

Women who wish to have children should therefore not undergo myoma embolization.

The doctor will only be able to tell whether the procedure is successful after a few weeks. The check-up is carried out using MRI.

Here the doctor can see whether the blood supply to the fibroid has been completely cut off. If this is the case, the fibroids shrink on their own over time and the symptoms are automatically alleviated.

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

Complications, risks and prognosis of myoma embolization

As mentioned above, the chances of successful treatment are very good.

The success rate is 80 to 90 percent. However, statistics also show that myoma embolization may not help some women sufficiently.

They may require further treatment. This may involve repeated myoma embolization or a myomectomy, which is the surgical removal of the fibroids. Myomas can also form again afterwards.

On average, patients recover more quickly after myoma embolization. Compared to the other two methods, women can leave hospital three days earlier on average.

General anesthesia is also not required. This also speaks in favor of this procedure. The disadvantage, on the other hand, is that statistically speaking, follow-up treatment is more frequent.

Myoma embolization is generally recommended for women over 40. Younger women who still wish to have children should opt for an alternative treatment in consultation with their doctor.