Uterine Fibroid Embolisation

Fibroid embolisation is an established alternative to hysterectomy for women suffering from fibroid related symptoms. It is a minimally invasive procedure, performed under light sedation that has the advantage of only requiring one night hospital stay and usually one week recovery before returning to normal activities.

Fibroids become troublesome if they cause very heavy, painful periods or press on the bladder or bowel to cause urinary frequency or constipation. In some women heavy periods from fibroids can sometimes be managed with tablets or a mirena coil, but if this is unsuccessful or if there are pressure symptoms then either surgery or embolisation is needed.

As recommended by NICE, all women considering surgery should be offered fibroid embolisation in discussion with their gynaecologist. However, the choice is not straight forward as each option has clear advantages and disadvantages.

Surgery or fibroid embolisation

Hysterectomy, complete surgical removal of the uterus and fibroids, will generally lead to complete resolution of symptoms, but requires a full operation and with it a slightly higher complication rate. Surgery has a significantly longer hospital stay and a recovery time taking several weeks or even months before resuming normal activities.

Myomectomy, an operation where the fibroids alone are removed and uterus is left in place, is good for those wishing to preserve their uterus, particularly if future fertility is important. However, it is similar in its complication rate and recovery times to hysterectomy.

Uterine fibroid embolisation, a procedure performed using X-ray guidance whereby a extremely thin plastic tube is inserted into a vessel in the groin and navigated into the arteries supplying the fibroids. These vessels are blocked up using tiny particles. The procedure takes approximately one hour and is well tolerated by patients. Following the procedure, women usually suffer with cramping pain, similar to intense period pains for up to 12 hours and are given strong pain killers to manage this. The following day, the pains are usually mild and patients go home.

Success rates

Fibroid embolisation causes the fibroids to die and gradually shrink over the next 9-12 months. During this period symptoms will gradually improve. The success rate is high at one year with approximately 85-90% of patients reporting good symptom control. At five years approximately 75% of patients have maintained symptoms improvement. For the minority of patients for whom the procedure is unsuccessful, they may undergo further embolisation and remain eligible for surgery.

A well designed study comparing surgery with fibroid embolisation over a 5 year period in which patients were randomly allocated to either treatment found that patients were very satisfied with both treatments (see fig 1). They found that surgery had higher adverse events, but patients who had embolisation required a significant number of further procedures over 5 years to control their symptoms than surgery.

Figure 1: REST Trial. New England Journal of Medicine. 5 year follow up.

Complication rates

Like any procedure or operation, there are potential complications with fibroid embolisation, although adverse events are generally lower than surgery. They include pain, discharge, passage of fibroid, infection, ovarian failure and missed malignancy. Please see the attached patient information sheet for more information.

Experience in Reading

Fibroid embolisation has been performed at the Royal Berkshire Hospital since the late 1990's when the hospital was one of the earliest adopters of the procedure and a centre that offered training courses to other Radiologists. We have now treated over 600 patients. The procedure is performed by Consultant Radiologists Dr Naid Rahim or Dr Archie Speirs both experienced Interventional Radiologists.

If you would like to discuss the procedure and your particular situation please call Berkshire Imaging.

Testimonial :

Mrs B from Reading

"It was much more straightforward than I expected, there was only pain for a few days, and it worked!

The service was very good but I might have got it done sooner if I had known how easy it would be."

Further Information

Patient information sheet

Berkshire Imaging LLP . The Forbury Clinic . 23 Craven Road . Reading . Berkshire . RG1 5LE . Telephone: 0118 921 3177
Click here to email us >