Uterine artery embolisation (Embolization)

Uterine fibroids are benign lumps or growths in the uterus that are present in up to 70% of women. They are commonly asymptomatic, however, can cause debilitating symptoms such as heavy menstrual bleeding (menorrhagia), pelvic bloating, and urinary frequency. Current treatments for uterine fibroids include medical, interventional, and surgical options.

Adenomyosis is where the endometrial lining of the uterus grows into the muscular layer or wall of the uterus. This can cause heavy menstrual bleeding (menorrhagia) and painful periods (dysmenorrhea), among other symptoms.

Uterine Artery Embolisation (UAE), sometimes referred to as Uterine Fibroid Embolisation (UFE) is an evidence-based, safe and effective treatment option for uterine fibroids and adenomyosis, with a shorter recovery period and quicker return to usual activities compared to traditional surgical treatments (e.g., hysterectomy). Uterine Artery Embolisation has been performed for over 30 years and has proven to be safe and effective in large clinical trials and diverse cohorts of patients. 

Effectiveness

• 90% of women with heavy menstrual bleeding (heavy periods) experience improved symptoms after UAE
• 80% of women with pelvic bloating and/or urinary frequency experience improved symptoms after UAE
• While improvement in heavy menstrual bleeding (heavy periods) tends to occur within 1-2 months after the procedure, the improvement in pelvic bloating and/or urinary frequency symptoms is more gradual (over 6 - 12 months)
• There is a modest chance (up to 20%) that your fibroids or adenomyosis symptoms may recur after uterine artery embolisation. If this is the case, embolisation treatment can be repeated in certain circumstances, or other options may be considered.

1. A specialist interventional radiologist will first consult and examine you in the outpatient clinic to assess your suitability for uterine artery embolisation (uterine fibroid embolisation). If you are not suitable for ablation treatments, your Interventional Radiologist (IR) will discuss this with you and arrange referral to another specialist as appropriate.
2. Embolisation is performed under sedation and local anaesthetic, with passage of a small catheter tube into your right femoral artery in the groin. The tube is then navigated into the arteries that supply the uterus and fibroids, and a particle medication injected to diminish the blood flow.
3. You will be required to lie down and rest in bed for up to 4 hours post-operatively, which is to minimise bruising in the groin.
4. "Post-embolisation syndrome" refers to a constellation of dull pain, cramping, nausea and low-grade fever experienced by many patients in the 4 to 6 hours following uterine artery embolisation. This is managed with pain and anti-nausea medications, but can be severe or prolonged in a small percentage of women.
5. The procedure is performed with an overnight hospital stay and most patients are able to go home the next day, returning to usual activities including work within 1 or 2 weeks
6. You are likely to experience erratic or irregular period-type bleeding for up to 1 to 2 months after UAE, along with some mucous discharge

There was historically hesitancy to perform UAE/UFE in women who desired future pregnancy, which is a common caution exercised with new treatments. The most recent data and evidence over 30 years, however, now suggests that uterine artery embolisation is safe to perform in women desiring future pregnancy and has comparable pregnancy success rates and outcomes to myomectomy (surgical removal of the fibroid). It is important that you discuss your future plans for potential pregnancy with your Interventional Radiologist (IR) at your appointment.

The overall risk of complications is low (<3%), and comparable to surgical removal of a fibroid (myomectomy), but these can include:

• Groin bruising or haematoma (bleeding lump)
• Prolonged or severe "Post-embolisation syndrome"
• Vaginal passage of fibroid
• Incidental malignancy - this refers to the exceedingly rare scenario where one of the fibroids actually harboured cancer cells
• Non-target embolisation - this is where particle medication lodges into a nearby artery, such as a gluteal (buttock) muscle, which does not typically cause symptoms and self-resolves

Interventional Radiologists (IRs) are specialty trained in the care of patients undergoing uterine artery embolisation, including the pre-procedural assessment, operation and post-procedural care. Interventional Radiologists (IRs) are extensively experienced in embolisation procedures as they regularly perform embolisation in many areas of the body, including the lung, liver, spleen, kidney and pelvis.

Dr Matthew Lukies

Matthew has a particular interest in minimally invasive treatments for fibroids and adenomyosis, including embolisation, and has performed over 100 embolisation procedures. During time training as a resident doctor, Matthew completed an advanced certification in Obstetrics & Gynaecology with the Royal Australian and New Zealand College of Obstetricians & Gynaecologists (RANZCOG), with whom he maintains associate membership.

Matthew is the primary author of a number of scientific publications on the topic of uterine artery embolisation, including a key reference article about the minimisation of infection published by the Cardiovascular and Interventional Radiology Society of Europe.

https://pmc.ncbi.nlm.nih.gov/articles/PMC9225967/

It is important that you consider all main treatment options for uterine fibroids and adenomyosis, which includes medications and surgical options. After consultation with our interventional radiologist, your case may be discussed with or you may be referred to consult with a gynaecologist if you haven't previously seen one.

If you would like to consult with an Interventional Radiologist about uterine artery embolisation, please send a referral for consultation, including the following

• Ultrasound and/or MRI results
• Records of consultations with other doctors and specialists

Public eligible patients can undergo the treatment with no out-of-pocket expense in the public system.