Uterine Fibroid Embolization

Your first visit includes a review of your symptoms, medical history, medicines, allergies and plans for having children. You will need an MRI scan, which shows the size, number and position of the fibroids and helps confirm they are suitable for UFE. If your bleeding pattern is unusual, we may also ask for a small tissue sample from the lining of the womb (an endometrial biopsy) to rule out other causes. Blood tests, including a kidney function check, are routine.

On the day of the procedure, you will be asked not to eat or drink for about six hours beforehand. We will do a pregnancy test, because the X-ray imaging used during the procedure is not safe in pregnancy. At RIVEA we generally work through the groin; we also check that the artery has good blood supply from both sides before we begin. A small area of hair at the top of the thigh will be clipped before the procedure. Please tell us if you take blood thinners, as these may need to be paused beforehand.

UFE takes about 60 to 90 minutes. You stay awake but relaxed, and you will not feel the procedure itself.

• You lie on the table and receive sedation and a dose of IV antibiotics. Pain relief is started early, before the particles are placed.
• The skin over your groin is numbed with local anaesthetic. Where the groin artery is unsuitable, we use the wrist instead.
• A tiny puncture is made in the artery and a thin catheter is passed through it. Using live X-ray imaging and contrast dye, we guide the catheter to the uterine arteries.
• Tiny particles, about the size of grains of sand, are released through the catheter to block the blood supply to the fibroids. They are made of medical-grade plastic or gelatin.
• The catheter is removed and a compression band is placed over the access site to prevent bleeding. Groin access needs firmer pressure and a longer period of lying down flat so the artery can seal

The groin route gives doctors a larger artery to work through and is the longest-established way of reaching the uterine arteries. The trade-off compared to the radial (wrist) approach is that you need to stay flat and keep your leg still for a few hours afterwards, so you will be on the ward for that time.

For the first day or two patients will experience the worst of the after-effects. Common occurrences include period-like cramping or sometimes stronger, along with tiredness, nausea or a low-grade fever. This cluster is called post-embolisation syndrome and is a normal response as the fibroids lose their blood supply. We manage it with a pain-relief protocol which includes regular oral medication, anti-sickness tablets, and so on. Patients can go home the same day or at most after one night of observation if necessary, with medicines to continue at home.

Cramping and discomfort settle over the next two weeks. A watery or mucus-like vaginal discharge is common and may last several weeks. Patients are usually back at their usual routines within 7 to 10 days, though some need up to two weeks, and tiredness can linger a little longer.

In the following weeks and months, your periods may pause briefly. When they return they are often lighter, though they may take a cycle or two to settle. Improvement in bleeding is noticeable within the first few weeks. Pressure and bulk symptoms ease more slowly as the fibroids shrink, with clear improvement by about three months and the full effect often seen by six. Occasionally a fibroid fragment is passed vaginally.

RIVEA schedules a follow-up check with patients 1 to 2 weeks after the procedure. A follow-up MRI or ultrasound at around three to six months will show how well the fibroids have responded.

Keep the groin puncture site clean and dry and follow the bathing instructions you are given [doctors may recommend showering only after 24 hours; avoid baths and swimming until completely healed]. If adhesive strips were applied, they usually fall off by themselves within a few days. For the first few days, avoid heavy lifting, straining and vigorous exercise, and avoid long periods of deep squatting or bending at the hip. When you cough, sneeze or strain, pressing gently over the site helps. Light walking is encouraged.

Drink plenty of water and eat fibre-rich food to avoid constipation, since straining is best avoided early on.

Contact us promptly if you notice:

• Bleeding from the groin that does not stop with firm pressure
• A growing, painful or throbbing lump at the groin
• Redness, warmth, swelling or discharge at the puncture site
• Numbness, coldness, pale or bluish colour, or new pain in the leg
• A high or rising fever, or chills
• Pain that is getting worse rather than easing
• Heavy vaginal bleeding, or foul-smelling discharge

• Keep the groin incision clean and dry once you are home. Follow your provider’s instructions for bathing.
• If adhesive strips were applied, keep them dry. They will typically fall off on their own in a few days.
• Use only the pain medications recommended by your provider. Avoid aspirin or similar medications unless approved, as they can increase bleeding risk.
• Light walking is usually encouraged, but avoid strenuous activities until your provider gives the all-clear.
• Stay hydrated and eat a fiber-rich diet to help prevent constipation. Straining during bowel movements can interfere with healing. A mild laxative may be recommended if needed.

Watch for any signs of complications and contact your provider if you experience:

• Fever or chills
• Redness, swelling, or unusual discharge from the incision site
• Increased pain near the incision
• Abdominal cramping, pain, or swelling
• Heavy vaginal bleeding or passage of tissue or unusual fluid

A follow-up appointment is usually scheduled 1 to 2 weeks after the procedure.

Your provider may order imaging tests such as an ultrasound or MRI about 6 months later to evaluate the outcome of the procedure.