Uterine Artery Embolization
See also
What is uterine artery
embolization (UAE)?
Uterine artery embolization, also called uterine
fibroid embolization, is a new, less invasive
treatment for uterine fibroids performed by an
interventional radiologist. In this procedure,
blood supply to the fibroid tumors is blocked,
making them shrink. As an alternative to hysterectomy,
uterine artery embolization preserves a woman's
uterus, maintains her hormonal cycles, and requires
far less recovery time.
During uterine artery embolization, a thin tube,
called a catheter, is inserted through a blood
vessel in the leg and guided by fluoroscopic images
to the blood vessels that feed the fibroids of
the uterus. Tiny plastic or sponge-like particles
are injected to stop blood flow to the fibroids.
Once blood flow to the fibroids is cut off, they
shrink gradually over the next weeks and months.
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What
are uterine fibroids?
Fibroids are the most common type of abnormal
growth in the uterus and the most common reason
for hysterectomy in U.S. women. Although fibroids
are benign, or non-cancerous, their symptoms and
side effects can include pelvic pain, heavy bleeding
and infertility.
The exact cause of fibroids is unknown, but experts
suspect the female hormone -- estrogen -- plays
an instrumental role in the formation of fibroids.
Typically, fibroids worsen as a woman enters her
30s and 40s. Then, when estrogen levels drop at
menopause, fibroids may shrink.
Fibroids can range in size from smaller than an
apple seed (one quarter of an inch) to larger
than a cantaloupe (greater than 10 inches), and
can be found anywhere within or on the uterus.
The different types of uterine fibroids include:
- Submucosal fibroids, which grow inside the
wall of the uterus.
- Subserosal fibroids, which grow through the
outside wall of the uterus.
- Intramural fibroids, which grow within the
uterine wall itself.
- Pedunculated fibroids, which stem out from
the uterus.
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How
common are uterine fibroids?
Approximately 25% of premenopausal women suffer
from fibroids, while the overall prevalence of
these tumors could be as high as 77%. The incidence
of fibroids in African-American women is three
times that of Caucasian women. Fibroids may occur
at any age, but are most common in women over
the age of 40 years. After menopause, fibroids
usually regress (shrink) in size due to the lack
of hormonal stimulation.
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What
are the symptoms of uterine fibroids?
More than 50% of patients with fibroids do not
have any symptoms. Those who do have symptoms
may experience bleeding, pelvic pressure, or infertility.
Symptoms are usually caused by fibroids that compress
the bladder, sciatic nerve and bowel, resulting
in urinary frequency, pain, or constipation. Uterine
fibroids may impact fertility by distorting the
endometrium - the mucous membrane lining the uterus.
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How
are uterine fibroids diagnosed?
A woman’s medical history is very important
in diagnosing uterine fibroids. Typically, women
with uterine fibroids are premenopausal, and have
suffered from prolonged regular bleeding during
menstruation. The most common test for uterine
fibroids is magnetic resonance imaging (MRI) or
ultrasound. This noninvasive test shows precisely
the fibroid’s location within the uterus.
An endometrial biopsy, where a uterine tissue
sample is removed through a small tube and examined
surgically, may also be recommended prior to undergoing
the procedure to exclude other causes of bleeding.
When there are no symptoms, fibroids often are
detected only when your physician has manually
felt them during a regular pelvic exam. Often,
the preferred treatment for symptom-free fibroids
is to do nothing at all other than monitor their
growth. Because fibroids can interfere with fertility
and mask other, more serious problems, though,
regular monitoring and accurate diagnosis are
important.
Uterine artery embolization is a very effective
procedure with an approximate success rate of
85%. Most women who undergo UAE have a dramatic
improvement in their symptoms and a decrease in
size of their uterine fibroids. If menstruation
has been heavy, it will usually return to a more
normal flow after UAE.
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How
do I know if UAE is right for me?
You should discuss your treatment options with
your physician. Some questions to ask:
- Am I a candidate for UAE?
- What are the risks and benefits of uterine
artery embolization?
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Reviewed by
Richard Shlansky-Goldberg, MD
February 26, 2003
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