Uterine Artery Embolisation
Uterine Artery Embolisation (UAE) is a fibroid treatment that is performed without surgery. Dr Crowe carries out this minimally invasive fibroids treatment in hospitals across Birmingham and London.
What is Uterine Artery Embolisation?
Uterine Artery Embolisation (UAE), also known as uterine fibroid embolisation (UFE) is a procedure which aims to shrink the fibroids by blocking their blood supply. Dr. Crowe was one of the first interventional radiologists to offer embolisation treatment in the UK, starting a service at Birmingham Heartlands Hospital over 25 years ago.
Uterine Artery Embolisation is a minimally invasive procedure that is usually done under local anaesthetic with a little sedation. Even though this treatment is without surgery, you will need to stay in hospital for one night. Uterine artery embolisation for fibroids has a short recovery period and a rapid return to normal activities is expected.
What Conditions can Uterine Artery Embolisation Treat?
The Uterine Artery Embolisation procedure can be completed to treat fibroids and adenomyosis.
Uterine Artery Embolisation for Fibroids
Uterine artery embolisation is now a well established treatment for uterine fibroids, one of the most common gynaecological issues that can lead to problems such as heavy periods that interfere with daily activities, period pain and pressure symptoms.
Dr. Crowe and his teams at hospitals in Birmingham and London have been offering Uterine artery embolisation for over twenty years. He has performed over 7000 minimally invasive fibroid embolisations. Dr Crowe has been the leading individual contributor to the UK Fibroid Embolisation Registry run by the British Society of Interventional Radiology.
As each case is unique you should consider any information on this site in conjunction with your gynaecologist’s advice. You can download a patient information booklet and contact Dr. Crowe to make an appointment to discuss your individual situation in more detail.
Uterine Artery Embolisation for Adenomyosis
In uterine artery embolisation for adenomyosis, the procedure is essentially the same as that for uterine fibroids. When embolisation is being performed for adenomyosis, Dr Crowe will typically use a slightly smaller particle size for the embolisation as this has been shown to give a better result.
You can make an enquiry with Dr Crowe to find out if Uterine Artery Embolisation for Adenomyosis is right for you.
There is a higher recurrence rate of adenomyosis after embolisation than is the case with uterine fibroids. It is occasionally necessary to repeat the adenomyosis embolisation procedure a few years down the line. For women closer to menopause, however, this is not usually a problem.
How Effective is Uterine Artery Embolisation?
Uterine Artery Embolisation is a very effective fibroid treatment. The UK Uterine Artery Embolisation for Fibroids Registry documented between 2003 – 2008 highlighted that:
- 84% of UAE patients reported improvement in their symptoms 6 months post-treatment
- This improvement in symptoms was maintained at 12 months by 83% of patients
- Uterine Artery Embolisation was equally effective in terms of reported symptom outcomes when performed for bleeding or for pressure symptoms
Referral
You may have been referred to Dr. Crowe by your GP or gynaecologist. They may have performed an examination and possibly arranged imaging tests such as an ultrasound or MRI scan. Many women, however, make enquiries having done their own research on the treatment options available. If you are not currently under the care of a gynaecologist Dr. Crowe can recommend one of his gynaecology colleagues.
Consultation
Dr. Crowe first meets you in the out-patient department to discuss the procedure and answer any questions you may have. It is useful to have an MRI scan beforehand so all the required clinical information is available for discussion at the time of the consultation.
The day of your uterine artery embolisation
The hospital will send you information regarding arrival time and fasting on the morning of the procedure. You will be admitted to the ward where you will be clerked in by the nursing staff. A pregnancy test is routinely performed prior to the procedure. It is also routine to insert a bladder catheter, which for your own comfort as you will need to lie flat for several hours afterwards.
The procedure
The embolisation procedure itself is usually painless but pain can occur afterwards when the arteries have been blocked and spasm occurs. Medication is given at the start of the procedure aiming to prevent pain.
A PCA (patient controlled analgesia) pump is used which runs through a small drip and allows you to give yourself small doses of morphine as required for a few hours after the procedure. The advantage of a PCA pump is that you are in complete control and can use as much or as little as you need to control any pain you may have.
After the procedure
Following the embolisation procedure you will be taken back to your room where you will be looked after by nursing staff. You will need to lie flat for a few hours to reduce the risk of bleeding from the puncture sites in the groin. You will have the morphine pump to control any pain and the nursing staff can give medication to relieve any nausea caused by the morphine.
Next steps for uterine artery embolisation
Please contact Dr. Crowe’s secretary on 0121 448 1502. Procedures are performed at the following locations; The Priory Hospital, the Harborne Hospital in Birmingham and at the Princess Grace Hospital in London. Most private insurance companies now cover the procedure and for non-insured patients a self-pay package price quote can be obtained from the individual hospital.
Uterine Artery Embolisation Recovery
A one night hospital stay is the norm after fibroid treatment. You should be ready to go home the day after the procedure. You can return to normal activities almost immediately but you may experience some fatigue and crampy pain (like period pain) for up to a few weeks. You should not drive for 48 hours, we recommend having someone pick you up from the hospital. Although this fibroid treatment is without surgery advisable to book 7 – 10 days off work to allow you to recover.
What are the Risks of Uterine Artery Embolisation?
As with all medical treatments there are some risks to consider such as infection, changes to your periods and vaginal discharge. Dr Crowe will talk you through any uterine artery embolisation side effects you can expect after treatment and any risks of the treatment.
Pregnancy after Uterine Artery Embolisation
It is not advisable to become pregnant within 12 months of the procedure, as the fibroids are still breaking down.
The official UK guidelines from the Royal College of Radiologists and Royal College of Obstetricians and Gynaecologists Joint Working Party (November 2000) recommended that women undergoing uterine fibroid embolisation should be advised not to try and conceive due to theoretical adverse effects on the embryo. These early recommendations were perhaps over-cautious and it is recognised that many women choose embolisation as an alternative to hysterectomy in order to preserve fertility and keep their options open.
FAQs
Uterine Artery Embolisation Frequently Asked Questions
Embolisation is a minimally invasive process of causing an organ or tumour to reduce in size by blocking its blood supply. This can be achieved using a number of different materials such as small foam particles, metal coils, glue or, as in the case of fibroid embolisation, polyvinyl alcohol (PVA) particles specially designed for the purpose.
Interventional radiologists performing the procedure have years of experience of embolisation in other parts of the body for problems such as cancerous growths or to stop bleeding following trauma or childbirth. Uterine fibroid embolisation applies these skills and techniques in the context of uterine fibroids.
Many women who have fibroids can have uterine artery embolisation, however Dr Crowe will ensure the procedure is the right treatment option for you. Please contact Dr. Crowe’s secretary, Lisa, on 0121 448 1502. Procedures are performed at The Priory Hospital and the Harborne Hospital in Birmingham and at the Princess Grace Hospital in London.
Your gynaecologist is the person best qualified to discuss the various treatment options with you. The choice of treatment is highly individual and tailored to individual circumstances. Treatments can include:
- Tablets or injections to manipulate hormones that affect fibroid growth
- Myomectomy is a surgical procedure that removes just the fibroids, not the entire uterus.
- Hysterectomy is the most common current therapy for women who have fibroids
- Endometrial Ablation is particularly suited to subendometrial fibroids which lie under the lining of the cavity of the uterus. It is performed by gynaecologists via a camera inserted through the cervix.
- Uterine fibroid embolisation (UFE), also known as Uterine artery embolisation (UAE) is a more recent fibroid treatment that is performed without surgery.
- MRI Guided Focused Ultrasound Ablation (MRgFUS), which focuses ultrasound waves on the fibroids and destroys them by heat treatment under MRI guidance.
Most of the major centres around the world performing uterine fibroid embolisation now have patients who have had normal pregnancies following embolisation. It is not advisable to get pregnant within 12 months of having uterine artery embolisation.
Choosing a treatment will depend on your personal preferences and circumstances. Many women choose uterine fibroid embolisation as an alternative to hysterectomy in order to preserve fertility.
Hysterectomy is the most common current therapy for women who have fibroids and is effective in essentially all cases in which bleeding is a problem. It usually resolves the pain or urinary symptoms that women may have. It is typically performed in women who do not wish to have any or more children.
Yes, uterine artery embolisation is a minimally invasive procedure that is performed without a general anesthetic. Instead a local anesthetic is used and morphine provided to control pain. The procedure is completed in a hospital but only a one night stay is required and recovery is relatively quick.
Local anaesthetic is injected in the groin. This may just sting a little for a few minutes but will then go numb. A small nick of only a few millimetres is made at the crease at the top of the leg to access the femoral artery, and a tiny tube (catheter) is inserted into the artery. The interventional radiologist steers the catheter through the arteries to the uterus using X-ray imaging to guide the catheter’s progress. The catheter is advanced into the uterine artery to a point where it divides into the multiple vessels supplying blood to the fibroids.
An angiogram (a series of images taken while radiographic dye is injected) is performed to provide a road map of the blood supply to the uterus and fibroids. The interventional radiologist slowly injects tiny plastic (polyvinyl alcohol or PVA) or gelatin sponge particles the size of grains of sand into the vessels. The particles flow to the fibroids first, wedge in the vessels and cannot travel to other parts of the body. Over several minutes, the arteries are slowly blocked. The embolisation is continued until there is nearly complete cessation of flow in the Vessel.
It is necessary to embolise the arteries feeding both sides of the uterus even if the fibroids are confined to one side. It has been shown that if we just block one side the artery on the opposite side will grow to take over and feed the fibroid. This may mean having to make small punctures in both groins. The x-ray dose is small but as the ovaries are very sensitive to radiation we take all possible measures to minimise the dose. You are awake during the procedure which normally takes 30-60 minutes but can have some sedation if you wish.
You will see the interventional radiologist Dr Crowe for a follow up ultrasound scan at 6 months (or earlier if required) and a repeat MRI scan at 12 months to assess shrinkage of the fibroid.
Costs for uterine artery embolisation for fibroids differs across the hospitals Dr Crowe works at. Please make an enquiry to find out more about how much private uterine artery embolisation is. Dr Paul Crowe accepts private medical insurance, self-paying patients and patients from overseas.
Yes, Dr Crowe accepts private insurance. Most private insurance companies now cover the procedure and for non-insured patients the individual hospital can offer a competitive all-in price. Note that hospital charges in central London are generally higher than in Birmingham. Please get in touch for more information.
If you wish to consider Uterine Artery Embolisation treatment please read the Fibroid Embolisation Patient Information booklet. You can also contact Dr Crowe for more information.