Interventional Radiology in Focus: A Closer Look at Uterine Fibroid Embolization

Fibroids are very common in women, and they can cause debilitating symptoms, which include heavy menses and irregular bleeding as well as bulk symptoms that may include cramping, pressure and increased urinary frequency.

While there are a variety of first-line treatments for mild symptoms, moderate to severe symptoms have led to more invasive treatments including hysterectomy and myomectomy in a more select group of patients.

In the 1990s, uterine fibroid embolization started originally as uterine artery embolization, which involved embolization of the uterine arteries to address bleeding. Over the last few decades, we've noticed that this procedure can also help with fibroids, and multiple studies have shown improved outcomes in patients. Conversely, compared to surgical intervention like hysterectomy and myomectomy, uterine fibroid embolization is minimally invasive. It's usually done with femoral access or radial access. The outpatient procedure allows quick recovery in a couple of hours in contrast to surgery, which may require a couple of days in the hospital and recovery that may take up to several weeks.

While we used to think that myomectomy had superior fertility outcomes to uterine fibroid embolization, multiple meta-analyses and randomized controlled trials have shown there is no difference in outcomes between myomectomy and uterine fibroid embolization.

There have also been several studies showing improved outcomes with adjunct techniques such as hypogastric nerve block. These patients not only have less pain, but they also have improved outcomes, which I have noticed in my practice.

In terms of other pearls, it all starts with patient evaluation. It is very important to listen to the patient and understand what the nature of their complaints. Sometimes the primary issue is fibroids. Sometimes fibroid patients may have other issues that are contributing to their symptoms.

There should also be a strong understanding of their goals. Uterine fibroid embolization might take several months for the patient to get the full effect versus hysterectomy, which may offer immediate relief of bleeding symptoms albeit with a more prolonged overall recovery. Some patients may want to get pregnant in the future. Others may not. Tailoring the treatment plan to the patient's needs is key, and it's also important to set realistic expectations.

(Editor’s note: For related content, see “Study Explores Impact of Insurance on Treatment and Referrals for Patients with Uterine Fibroids,” “Survey Shows Lack of Awareness for Uterine Fibroid Embolization Procedures Commonly Performed by Interventional Radiologists” and “Ultrasound-Derived Fibroid Mapping Technology Gets FDA Nod.”)

Dr. Makary is a vascular and interventional radiologist. He is an associate professor of radiology at the Ohio State University Wexler Medical Center.

(Editor’s note: The first graphic in the video is courtesy of Adobe Stock.)