Have You Been Told You Need a Uterine Fibroid Embolization?

Uterine fibroids are non-cancerous growths that develop in the uterus. They are very common, affecting approximately 80% of women at some point in their lifetime. Many women with fibroids experience no symptoms. However, for some, fibroids can cause pelvic pain, heavy bleeding, and other complications.

If you have been diagnosed with fibroids and your doctor has recommended uterine fibroid embolization (UFE), it is essential to get a second opinion.

What is Uterine Fibroid Embolization?

Uterine Fibroid Embolization is a treatment method for fibroids in which plastic particles are injected into the arteries feeding fibroids in the uterus. These plastic particles can back up into the ovaries, affecting the blood supply to the ovaries. This can cause problems with fertility and early menopause. This is a minimally invasive procedure, usually done in the radiology suite of a hospital, and is performed by radiologists, not by gynecologists.

Have you been told you need UFE? Contact The Center for Innovative GYN Care (CIGC) today to schedule your second opinion consultation.

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Top 11 Reasons NOT to Have Uterine Fibroid Embolization

Your doctor may have recommended UFE as a way to treat your uterine fibroids, but is it the right treatment for you? Here are 11 reasons why you may want to consider another treatment option.

1. UFE can significantly affect the blood supply to the ovaries, leading to a decline in egg numbers, thereby increasing infertility.^{1,2,3,4,5,6,7,8,11,13,15}

Patients interested in maintaining their fertility options should avoid UFE as it can block the much-needed blood supply to the ovaries and significantly affect egg viability.

2. UFE does not remove fibroids.

Unlike fibroid removal surgery, UFE does not remove the fibroids, meaning they remain intact within the reproductive system.

3. UFE can increase the risk of miscarriage.^{1,2,3,4,5,6,7,8,11}

Studies have shown that women who get pregnant after receiving UFE have a higher chance of miscarrying. The UFE itself does not cause miscarriage, but because UFE does not remove the fibroids, it can lead to miscarriage.

4. UFE can decrease pregnancy rates.^{1,2,3,4,5,6,7,8,11,15}

Studies indicate that women have a harder time getting pregnant after receiving UFE.

5. UFE can increase the risk of complications in pregnancy since the fibroids are not removed.⁸

Pregnancy complications after UFE can include preterm labor, abnormal labor, pain during pregnancy as the fibroids continue to grow, increased blood loss and the need for a cesarean section.

6. UFE does not have support for use in those patients desiring to become pregnant.¹¹

There is limited data on UFE in fertility and pregnancy, meaning there is not enough evidence to support the use of this procedure in women who wish to become pregnant or are currently pregnant.

7. UFE can increase the risk of early menopause by decreasing the blood supply to the ovaries.^{1,2,3,4,5,6,7,11,13}

Without proper ovarian function, egg production is decreased, and the level of hormones produced by the ovaries diminishes, which can lead to early menopause.

8. UFE does not immediately treat fibroid symptoms since the fibroids are not removed.^5,7,9,10,11

UFE works very slowly and can take many months or even years to resolve symptoms of heavy bleeding, frequency of urination, pelvic pressure, back pain, leg pain, and abdominal swelling or bloating.

9. UFE patients have higher rates of re-intervention within 2-5 years of the procedure.^{5,7,9,10,11,14,16}

Patients treated with UFE will likely require additional intervention, such as a hysterectomy, repeat embolization, myomectomy or other medical treatment.

10. UFE patients have higher rates of unscheduled medical visits and readmission.^5,7,9,10,11

The chances of having to return to the hospital or see a doctor after treatment are increased for UFE patients.

11. UFE patients have a better option to treat fibroids.

Laparoscopically Assisted Abdominal Myomectomy (LAAM®) fibroid removal is a better option for treating fibroids. Benefits of LAAM include:

• Ovarian blood supply is preserved
• Patients maintain fertility
• Supported in pregnancy
• Fibroids are completely removed
• Symptoms are immediately resolved
• Pain and recovery time is between 7-14 days
• Requires only a 1.5-inch incision
• Published in peer-reviewed journals
• CIGC has performed thousands of procedures
• Hysterectomy is not required

Top 11 reasons to have LAAM® (Laparoscopically Assisted Abdominal Myomectomy) for Fibroid Removal

1. LAAM is NOT a hysterectomy.

LAAM is not a hysterectomy, nor does it require one. It simply removes the fibroids to preserve uterine and ovarian function.^18,19,20

2. LAAM patients recover much faster than any other form of fibroid treatment.^18,19,20 

Recovery with LAAM is much faster than the recovery of any other fibroid-removal surgery or treatment, including UFE.

3. LAAM surgery results in much less pain than UFE procedures.

Patients report much less pain for shorter durations with LAAM than with UFE procedures.

4. LAAM does not affect ovarian function or egg count. 

LAAM does not interfere with the ovaries or overall ovarian function, ensuring egg count and future egg production remains unchanged.

5. LAAM results in greater pregnancy rates and enhances fertility.⁵

By completely removing the fibroids, LAAM enables the greatest chance for a successful pregnancy as well as enhanced fertility.

6. LAAM does not decrease blood flow to the ovaries. 

LAAM removes fibroids. It does not add any foreign material to the body that would decrease blood flow to any essential reproductive organs.

7. LAAM does not increase the risk of menopause.⁴

LAAM does not affect ovarian function, nor does it remove the ovaries. That means there is no increased risk of menopause following the procedure.

8. LAAM removes all fibroids in one session.^18,19,20 

With LAAM, all fibroids, regardless of size, are removed in a single surgery.

9. LAAM immediately treats symptoms of fibroids.^18,19,20 

By removing fibroids, LAAM removes fibroid symptoms. That means pelvic pain, heavy bleeding,  urinary frequency, and other symptoms are immediately improved or resolved.

10. LAAM patients have much lower re-intervention rates.^{5,7,9,10,11,14,16}

The rates of re-intervention, or needing another surgery or treatment, are much lower following LAAM than with any other form of fibroid management.

11. LAAM procedures provide patients with a better option. 

LAAM is the better option for fertility, pregnancy and treatment of symptoms with a faster recovery and less pain than other methods.

References & Breakdown

 

1. Hehenkamp W et al. (2007): Ovarian failure was reported in 12 percent and 18 percent at 12 and 24 months, respectively. Levels of AMH were significantly lower, indicating ovarian aging at each follow-up up to 24 months after UAE.
2. Volkers N et al. (2007): The EMMY trial reported one unplanned pregnancy after UAE at 24 months. 
3. Rashid S et al. (2010): A similar proportion of 73 women (11%) were observed to have menopausal levels of FSH at 12 months after UAE in the REST study.
4. Mara M et al. (2008): In a younger study population, the risk of elevated FSH >10 IU/L after the intervention was higher among those with UAE (13.8%) than myomectomy (3.2%). 
5. Edwards R et al. (2007): The REST trial reported seven pregnancies after UAE at 12 months which included four miscarriages, two live births, and one intrauterine fetal death at 33 weeks. For women with submucous fibroids, the group who underwent myomectomy had a greater pregnancy rate (40.4%) than those who did not undergo surgery (21.4 percent). 
6. El Shamy T et al. (2020): A meta-analysis of six studies and 353 participants demonstrated a significant decline at 3 months in antral follicle count after UAE. 
7. Hartmann KE et al. (2017): Rates of ovarian failure after UAE (defined as a follicle-stimulating hormone level greater than 40 IU/L at 1 year after treatment) have been reported to be as high as 12% and 18% at 12 and 24 months. Rates of reintervention (with hysterectomy, repeat embolization, myomectomy, medical management, or endometrial ablation) as high as 19–38% have been reported 2–5 years after UAE. Major complications of UAE have been reported in 1–12% of cases and may include unplanned hysterectomy, rehospitalization, ovarian failure, and pulmonary embolism. Minor complications occur in 21–64% of cases and are variably defined among different UAE studies. Minor complications may include pain, fever, and nausea associated with postembolization syndrome; vaginal discharge; and pelvic infection.
8. Homer H, Saridogan E. (2010): Compared with expectant management and matched for age and leiomyoma location, uterine leiomyoma treatment with UAE is associated with an increased risk of pregnancy loss (35.2% versus 16.5%; OR, 2.8; 95% CI, 2.0–3.8), a cesarean delivery (66% versus 48.5%; OR, 2.1; 95% CI, 1.4–2.9), and postpartum hemorrhage (13.9% versus 2.5%; OR, 6.4; 95% CI, 3.5–11.7).
9. Gupta JK et al. (2014): The risk of requiring further surgical intervention within 2 years after UAE has been reported to be twofold to fivefold higher compared with hysterectomy or myomectomy. Compared with any type of surgery for uterine leiomyomas, UAE is associated with similar rates of major postprocedural complications (OR, 0.65; 95% CI, 0.33–1.26); however, UAE has a higher rate of minor postprocedural complications (OR, 1.99; 95% CI, 1.41–2.81). The rates of unscheduled visits and readmission are higher in UAE than with surgical interventions.
10. Carrillo TC et al. (2008): Major complications of UAE have been reported in 1–12% of cases and may include unplanned hysterectomy, rehospitalization, ovarian failure, and pulmonary embolism. Minor complications occur in 21–64% of cases and are variably defined among different UAE studies.  
11. ACOG Practice Bulletin No. 228
12. AHRQ Publication No. 17(18)-EHC028-EF: Because of the small numbers and heterogeneity of methods, there is insufficient evidence to make any conclusions about uterine artery occlusion.
13. Sentilhes L, Vayssière C, Beucher G, et al. (2013): UAE has limitations, such as subclinical damage of the ovarian function (especially in women older than 45 years).
14. Van der Kooij SM, Bipat S, et al.(2011): UAE has limitations, such as the potential risk of reintervention or subsequent hysterectomy. 
15. Karlsen et al. (2018): Reported that UAE may lead to lower pregnancy rates and higher miscarriage rates than myomectomy. 
16. Davis MR, Soliman AM, Castelli-Haley J, et al. (2018): The reintervention rate for UAE was lower than that for EA but higher than that for myomectomy. Prior anemia, bleeding, pelvic inflammatory disease, and pelvic pain might increase the risk of intervention. 
17. Yuehan Wang1 , Shitai Zhang1 , Chenyang Li2 , Bo Li1 , Ling Ouyang: The UAE is not suitable for women who want to preserve their fertility.
18. MacKoul et al. Comparison of different myomectomy procedures (robotic, laparoscopic, open) with faster recovery and discharge from the hospital, lower complications, and less cost with LAAM
19. Danilyants et al. Comparison of LAAM performed in the outpatient ASC setting vs. hospital.
20.  MacKoul et al. Feasibility of LAAM