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 couple of months.

Risks and benefits

Benefits

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 embolization.

Risks

It is common to feel some pain during embolization, 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.

Preassessment consultation

Two days before the procedure you will get to meet the nurse and the radiologist Consultant doing the procedure. We will provide you with more information explaining the procedure, order blood tests, take a MRSA swab and determine whether the embolization can proceed on health reasons. This will be an opportunity for you to ask questions.

On your appointment day

Do not have any food for 4 hours before the procedure, and nothing to drink for 2 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 and doctor will ask you several questions about your health and current medication and they will check your blood pressure and pulse. They will take some blood for a blood test, and ask you to 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 doctor; this is another opportunity to discuss the procedure before signing a consent form. Please ask any questions you may have as it is important that you understand what is going to happen.

In the procedure room you will lie on a special x-ray table. We will puncture the big artery in your groin, under sterile conditions, so if you could shave in 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 initially then go numb.

Your pulse and blood pressure will be monitored and you may be given oxygen.

You will be given some strong pain relief through a needle in your vein. Please let the staff know if you feel any discomfort. 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/ womb) and small particles will be injected into the arteries that supply the fibroid. This will cause the fibroid to shrink.

After the procedure

You will go back to the ward where your nurse will record your pulse and blood pressure as well as check your wound site regularly. After two hours they will assist you to sit up and if there are no concerns after a further four hours of resting in bed, you will be able to get up and 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 period-like pain. This will be treated with a combination of pain relieving tablets and strong pain relief injected into 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.

Please continue reading for post procedure advice.

Post-procedure advice

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.

Only shower for 3-4 days or until the skin site is healed. Gently clean the site with mild soap and water. Gently dry area. Cover the site with a plaster, and change 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 six weeks.

It is common to have a slight fever after the procedure. This is 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 risk of infection, avoid using

tampons or tampax for four weeks. If you are sexually active, please use condoms or a diaphragm (’cap’) for the next four weeks also.

Please go to your nearest A&E if you experience any of the following:

• feel unwell
• intense pain
• fever and sweating
• pelvic tenderness
• bad smelling vaginal discharge 

Contact information

Interventional Radiography
Imaging Department
Chelsea and Westminster Hospital
369 Fulham Road
London
SW10 9NH

T: 020 3315 8570 or 8582

If you need to change your appointment time or date, please contact the Imaging Department on 020 3315 8582/8572 as soon as possible.