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Non surgical treatment – Uterine artery embolization

What it is - Uterine artery embolization (UAE) is a procedure where an interventional radiologist uses a catheter to deliver small particles that block the blood supply to the fibroids. If the procedure is done for the treatment of uterine fibroids it is also called uterine fibroid embolization (UFE). The procedure is not a surgical intervention and allows the uterus to be kept in place.

Benefits of non surgical treatment -

1. It is performed under Local anesthesia. Not General anesthesia.
2. Requires only a tiny nick in the skin (No surgical incision of abdomen).
3. Recovery is shorter than from hysterectomy or open myomectomy.
4. Virtually no adhesion formation has been found. But in surgery adhesions are common.
5. All fibroids are treated at once, which is not the case with myomectomy.
6. Recurrent growth of treated fibroids is uncommon.
7. Uterine fibroid embolization involves virtually no blood loss or risk of blood transfusion.
8. If the presenting complaint was excess vaginal bleeding, 87-90% of cases experiences resolution within 24 hours.
9. Emotionally, financially and physically – embolization can have an overall advantage over other procedures for the patient as the uterus is not removed.

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Non surgical treatment vs. surgical treatment

FREQUENTLY ASKED QUESTIONS	Non-surgical – Uterine Artery Embolization	Surgical – Myomectomy/Hysterectomy	HIFU
1) When it can be done?	Any day	Just after period	Just after period
2) Type of anesthesia	Local or mild	General	Needed
3) Blood transfusion	Nil	Required	nil
4) Chances of uterus removal during surgery	Nil	5-10%	Nil
5) Hospitalization	One day	3-5 days	One day
6) Scar in abdomen	Nil	Yes	Nil
7) Blood loss	Nil	Yes	Nil
8) Multiple fibroid	One sitting, any type of fibroid	Difficult to remove all	Multiple sitting. Only for small & single fibroid
9) Recovery	1-2 days	3-6 week	1-2 days
10) Full recovery	1 week	3 – 12 months	1 week
11) Recurrence	0.5%	Up to 10%	More than 10%
12) Internal scar	Nil	Yes	nil
13) Cost	Less expensive	expensive	Very expensive
14) Treating associated condition like adenomyosis	Yes in same sitting	No	No
15) Death	Nil	Less than 1%	Nil
16) fertility	May women had successful pregnancies	It can be	It can be

 

Procedure - It is under local anesthesia, an interventional radiologist introduces a catheter into the femoral artery at the groin and uses radiographic guidance to advance the catheter into the uterine artery. Microparticles (spheres or beads) are then released, which will block blood flow through the vessel. Even if both uterine arteries are occluded, abdundant collateral circulation prevents the uterus from necrosing. The procedure is not a surgical intervention, and allows the uterus to be kept in place.
UAE is frequently used to relieve symptoms caused by uterine fibroids. It has satisfaction rates similar to hysterectomy and much shorter recovery times

After treatment - Studies have shown that uterine artery embolization reduces symptoms such as heavy bleeding, pain, urinary incontinence and abdominal enlargement.  Five years after treatment with uterine artery embolization, more than 85-97 percent of women maintain symptom control. These results are comparable to that of myomectomy, in which the fibroids are surgically removed and the uterus repaired.

Menstruation and menopause - Your menstrual period will probably resume as normal as before within a month. A small number of women, however, enter menopause after the procedure. The risk appears highest among women age 45 and older.
Women those have fibroids always have risk of fertility. Despite these risks, many women have had successful pregnancies following uterine artery embolization.

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Medications

Medications for uterine fibroids target hormones that regulate your menstrual cycle, treating symptoms such as heavy menstrual bleeding and pelvic pressure. They don't eliminate fibroids. Medications include:

Gonadotropin-releasing hormone (GnRH) agonists. Medications called GnRH agonists treat fibroids by causing your natural estrogen and progesterone levels to decrease, putting you into a temporary postmenopausal state. Many women have significant hot flashes while using this medication.

Androgens. This drug similar to male hormone testosterone, may effectively stop menstruation, correct anemia. However, this drug is rarely used to treat fibroids. Unpleasant side effects, such as weight gain, feeling depressed, anxious or uneasy, acne, headaches, unwanted hair growth and a deeper voice, make many women reluctant to take this drug.