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Uterine fibroid embolisation

Information for patients

Interventional Radiology and Fluoroscopy

What is a fibroid embolisation?

Fibroid embolisation is an image-guided procedure that uses a catheter to inject tiny particles in a blood vessel to block the blood flow that feeds the fibroid. This causes the fibroid to shrink.

Uterine fibroids are common growths of the uterus. They often appear during the years you’re usually able to get pregnant and give birth. Uterine fibroids are not cancer, and they almost never turn into cancer. They aren’t linked with a higher risk of other types of cancer in the uterus either. They’re also called leiomyomas (lie-o-my-O-muhs) or myomas.

Your gynaecologist will have told you about fibroids and discussed treatment options with you. Previously, most fibroids have been treated by an operation to remove the fibroids individually (myomectomy) or by removing the womb (hysterectomy).

In your case, it has been decided that embolisation is a suitable treatment option.

Are there any risks?

Serious risks and complications of having a fibroid embolisation are very rare. However, as with any procedure, some risks or complications may occur.

  • Any procedure that penetrates the skin carries a risk of infection. The chance of infection requiring antibiotic treatment appears to be less than one in 1,000.
  • There is a very slight risk of an allergic reaction if the procedure uses an injection of contrast material.
  • Any procedure that places a catheter inside a blood vessel carries certain risks. These risks include damage to the blood vessel, bruising or bleeding at the puncture site, and infection. The doctor will take precautions to mitigate these risks.
  • There is always a chance that an embolic agent can lodge in the wrong place and deprive normal tissue of its oxygen supply.
  • There is always a slight chance of cancer from exposure to radiation. However, the benefit of this treatment outweighs the risk.
  • Most patients feel some pain afterwards, which ranges from very mild to severe crampy, period-like pain. It is generally worst in the first 12 hours, and is controlled by painkillers. You will be given painkiller tablets to take. Most patients get a slight fever after the procedure. This is a good sign as it means that the fibroid is breaking down. The painkillers help control this fever. Vaginal discharge can occur afterwards and may be bloody, due to the fibroid breaking down. This can persist for up to two weeks or can be intermittent for several months. If the discharge becomes offensive, and if associated with a fever, there is the possibility of infection and you should ask to see your gynaecologist urgently.
  • There is a 2 to 4% chance that the procedure will lead to premature menopause. This occurs usually in women who are 45 years or older. Most women find it takes about six to nine months to resume a regular menstrual cycle.

The radiologist or radiographer will discuss the possible risks with you before you have the procedure. Please ask them if you have any concerns or would like any further information.

What do I need to do to prepare for the procedure?

Attend Gynaecology and IR clinic for assessment. Plan date of procedure.

  • Please let us know if you are taking any medicines that thin the blood (for example Warfarin, Rivaroxaban, Dabigatran, Apixaban), as these may need to be withheld temporarily before the procedure. Call the Radiology Day Unit Sister for advice as soon as you get your appointment letter on 01642 854332.
Take your other medicines as normal, unless your doctor or nurse tells you not to.

You do not have to stop eating before the procedure, but you will be lying flat, so you should have a light breakfast. You may drink water up to the procedure.

What happens before the fibroid embolisation?

You will be admitted to the ward in the morning of the procedure and will undergo some blood tests and receive antibiotics and pain killers. In the radiology department, you will be seen by a Radiologist (a health care professional who uses imaging machines to diagnose and treat illnesses) who will discuss the procedure with you. You will be given the opportunity to ask any questions you have.

Day of admission

  • Light breakfast before 8 am
    Nil by mouth after that

  • Admission to Gynaecology Ward early morning

  • Blood tests (full blood count, coagulation, renal function test)

  • Pregnancy test (pre procedure)

  • Urethral catheterisation (pre procedure)

  • Suppository pain relief (pre procedure)

  • PCA setup in ward

  • IV antibiotic – 1 hour prior to the procedure (12.30 pm)

  • Transfer to Radiology Department for procedure
    (1st case on afternoon list – 1:30pm)

  • Consent with Radiologist

  • Review by IR Nurse for PCA
    Please note: This is not a General Anaesthetic

  • Transfer to Day unit post procedure for any pain management

  • Transfer back to the Gynaecology Ward

  • Removal of catheter

The staff caring for you will ask your permission to perform the procedure. If you decide to go ahead, you will be asked to sign a consent form that says you have agreed to the procedure and that you understand the benefits, risks and alternatives. If there is anything you don’t understand or you need more time to think about it, please tell the staff caring for you.

Remember, it is your decision. You can change your mind at any time, even if you have signed the consent form. Let staff know immediately if you change your mind.

How is the fibroid embolisation carried out?

The procedure will take place in the X-ray department and you will lie flat on your back. You may have monitoring devices attached to your chest and finger. Your groin or wrist will be swabbed with antiseptic solution and you will be covered with sterile drapes. Local anaesthetic will be injected in the skin in your wrist or groin and a needle will be inserted into the artery. Sometimes both groins are used. A fine plastic tube called a catheter is placed into the artery.

The radiologist uses X-ray equipment to guide the catheter into the arteries, which are feeding the fibroids. A special dye, called a contrast agent, is injected down the catheter into these uterine arteries, and this may give you a hot feeling in the pelvis. Fluid containing thousands of tiny particles is injected Catheter Fibroids through the catheter into these arteries to block them.

The catheter is then removed and a closure device is applied to stop the bleeding.

Will I feel any pain?

As you are given a local anaesthetic, you should not feel any pain during the procedure at the place where the tube is put in the artery. You may however feel cramping pain at the end of the procedure because of the embolisation starting to take effect. You would receive pain killers for the pain. You may also have a little bruising.

Once at home, you should refrain from strenuous exercise for about a week. One to two weeks off work is advised.

Day 1 – Post procedure

  • Removal of pain pump

  • Review by Gynaecology Team, for discharge home

  • Take regular paracetamol and ibuprofen for 1 week
    Oral antibiotics for large size fibroid >10 cm

Follow up

  • If you have any concerns once home
    Please contact Radiology (Monday to Friday upto 5 pm)
  • If on the weekend
    Please contact Gynaecology Ward for review or attend A & E
  • 6 months
    MRI and face to face consultation with performing doctor.

Useful websites

Radiation dose and risk

X-rays use ionising radiation which can cause cell damage that may, after many years or decades, turn cancerous. The risk of this happening is very small compared to the normal lifetime risk of developing cancer which is 1 in 2.

We are also all exposed to background radiation every day. The risk of long-term effects is considered when the healthcare team decide whether someone needs an x-ray examination and radiation doses are kept as low as possible.

For this examination radiation dose levels are typically equivalent to around 1 to 2 years of background radiation. The associated risk is less than 1 in 1000 – Low.

Is there anything I should tell the staff?

For patients who have ovaries and are between the ages of 12 and 55, the x-ray department has a legal responsibility to ensure that this examination is performed within TEN DAYS of the first day of your menstrual period.

Please contact the x ray department if you are pregnant or if this appointment is beyond the 10 DAY requirement, and another appointment will be arranged for you.

Patient experience

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This service is based at The James Cook University Hospital but also covers the Friarage Hospital in Northallerton, our community hospitals and community health services.

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T: 01642 835964
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The James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW.
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