Fibroid embolisation with X-ray guidance

What are fibroids?

Fibroids are benign (non-cancerous) growths of the uterine muscle occurring in 30–40% of women. Most fibroids do not cause any problems and do not require treatment. Some fibroids, however can cause heavy periods which can lead to low iron levels in the blood. If the fibroids grow large enough they can press on other organs such as the bladder, causing the need to frequently pass urine. They can also press on the bowel leading to constipation and bloating. They may also cause back ache and pain down the legs.

What is a fibroid embolisation?

Fibroid embolisation is a way of treating fibroids. The arteries that feed the fibroids are blocked off. This causes the fibroids to shrink over a few months after the procedure.

Risks and benefits

The benefit is that we can treat your symptoms while avoiding the risks of surgery. It is a safe and short procedure which means you will have a quick recovery. Fertility is maintained and a number of women have had successful pregnancies after embolisation.

It is common to feel some pain during embolisation and to have some bruising in your groin after this procedure. There is a very small risk of bleeding or damage to the blood vessel, or a reaction to the dye such as nausea or a rash.

There is a small risk of infection relating to the fibroid dying for which surgery (a hysterectomy) may sometimes be necessary.

Pre Assessment Consultation

A few days before the procedure you will meet the nurse and the radiology consultant doing the procedure. We will explain the procedure and answer any questions you may have. At this point you will sign the consent form. You will also be sent for a blood test on this day and have swabs taken for your admission.

Day of your procedure

Do not have anything to eat or drink for 6 hours before your procedure.

Please do not take aspirin, metformin or warfarin but continue with your other medication. If you are diabetic, please take your regular insulin.

Before the procedure

You will be admitted to hospital. On the ward your nurse will ask you several questions about your health and current medication and they will check your blood pressure and pulse. You will change into a gown. Your nurse will bring you to the X-ray department on your bed.

During the procedure

In the procedure room you will be seen by the doctor; this is another opportunity to ask any questions you may have.

In the procedure room you will lie on a special X-ray table.

Your pulse and blood pressure will be monitored and you may be given oxygen throughout the procedure. You will also be given some strong pain relief and sedation through a cannula in your vein.

We will puncture the large artery in your groin under sterile conditions so please shave the groin area if needed the day before. The doctor will give you an injection of local anaesthetic to numb the skin in your groin, which will cause some stinging and then go numb. The doctor will insert a catheter (fine plastic tube) into your artery. Dye will be injected through this catheter while X-ray pictures are taken. The doctor will move the catheter into your uterine artery (the artery that supplies the blood to the uterus). Small particles will be injected into the arteries that supply the fibroid. This will block the blood supply to the fibroid and cause it to shrink.

Following the procedure

You will go back to the ward where the nurse will record you pulse and blood pressure as well as check you wound site regularly. After 2 hours they will assist you to sit up. If there are no concerns after a further 4 hours of bed rest you will be able to walk around. If you feel unwell at any time please tell your nurse.

You will usually experience pain over the next 12-24 hours. This ranges from very mild pain to severe cramping like period pain. This will be treated with a combination of pain relieving tablets and strong pain relief through your vein.

You can usually return home after 1-2 nights in hospital. You will be given some pain relieving tablets to take home with you.

Post Procedure Advice

Following your procedure you will be require to rest for 3-4 days. It is advisable to take two weeks off work. Please ask your nurse for a medical certificate if you need one.

Do not have a bath for 3-4 days, only shower until the skin site is healed.

Gently clean the site with mild soap and water. Gently dry area and cover with a plaster changing daily until the skin heals. It is normal to have mild oozing from the wound; tenderness that lasts up to a week, bruising that can last up to two weeks or development of a small lump which may last up to 6 weeks.

It is common to have a slight fever after the procedure. This is a good as it shows the fibroid is breaking down.

It is also common to have a bloody vaginal discharge for two weeks. Occasionally this can last for several months.

To reduce the chance of infection avoid using tampons for four weeks and if you are sexually active please use condoms or a diaphragm (cap).

If you experience any of the following please attend your local Accident and Emergency department as soon as possible as you may have an infection in your uterus:

• Feel unwell
• Intense pain
• Fever and sweating
• Pelvic tenderness
• Bad smelling vaginal discharge