Uterine Artery Embolisation

Uterine artery embolisation (UAE) is a minimally invasive medical procedure used primarily to treat uterine fibroids—noncancerous growths in the uterus that can cause significant symptoms such as heavy menstrual bleeding, pelvic pain, and pressure. UAE offers an alternative to traditional surgical treatments like hysterectomy or myomectomy, preserving the uterus and often allowing for quicker recovery. This procedure has gained importance due to its effectiveness, safety profile, and fertility-preserving potential, making it a valuable option for women seeking symptom relief without major surgery.

Anatomy / Background

Understanding the anatomy of the uterus and its blood supply is essential to grasp how UAE works. The uterus is a muscular organ located in the female pelvis, primarily supplied by the uterine arteries, which branch off from the internal iliac arteries. These arteries provide oxygenated blood to the uterine tissue, including any fibroids present.

Uterine fibroids (also called leiomyomas) are benign smooth muscle tumors that develop within the uterine wall. They vary in size, number, and location (submucosal, intramural, or subserosal), and their growth depends on hormonal influences, particularly estrogen and progesterone. Because fibroids are highly vascular, cutting off their blood supply can cause them to shrink and symptoms to improve.

Causes / Etiology

The exact cause of uterine fibroids is not fully understood, but several risk factors and contributing factors have been identified:

Hormonal factors: Estrogen and progesterone promote fibroid growth.
Genetic predisposition: Family history increases risk.
Age: Most common in women aged 30-50.
Ethnicity: Higher prevalence and severity in African-American women.
Obesity: Increased body fat can raise estrogen levels.
Early menarche: Starting menstruation at a younger age.
Other factors: Diet, lifestyle, and environmental exposures may play roles.

UAE targets the fibroids by blocking the uterine arteries that supply them, leading to ischemia and shrinkage.

Symptoms / Clinical Presentation

Many women with fibroids are asymptomatic, but when symptoms occur, they can include:

Heavy or prolonged menstrual bleeding (menorrhagia)
Pelvic pain or pressure
Frequent urination or difficulty emptying the bladder
Constipation
Pain during intercourse
Enlarged abdomen or feeling of fullness
Reproductive issues: Infertility or recurrent pregnancy loss in some cases

Diagnosis

Diagnosis of uterine fibroids and assessment for UAE involves:

Clinical history and pelvic examination: To identify uterine enlargement or masses.
Imaging studies:
- Ultrasound (transvaginal or abdominal): First-line imaging to detect fibroids.
- Magnetic Resonance Imaging (MRI): Provides detailed mapping of fibroids, vascularity, and suitability for UAE.
Laboratory tests: Complete blood count to check for anemia.
Other tests: Endometrial biopsy if abnormal bleeding is present to rule out malignancy.

A multidisciplinary approach involving gynecologists and interventional radiologists is essential for planning UAE.

Treatment Options

Treatment depends on symptom severity, fibroid characteristics, patient age, fertility desires, and overall health.

Non-Surgical Management

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Medications:
- Hormonal therapies (e.g., oral contraceptives, GnRH agonists) to reduce bleeding and fibroid size temporarily.
- Tranexamic acid for heavy bleeding.
Watchful waiting: For asymptomatic or mild cases.

Surgical Treatment

Myomectomy: Surgical removal of fibroids, preserving the uterus; suitable for women desiring future fertility.
Hysterectomy: Complete removal of the uterus; definitive treatment but not fertility-preserving.

Uterine Artery Embolisation

UAE is a minimally invasive alternative that blocks blood flow to fibroids, causing them to shrink and symptoms to improve, while preserving the uterus.

Procedure Details

UAE is performed by an interventional radiologist under local anesthesia with sedation:

Access: A small incision is made, usually in the groin, to access the femoral artery.
Catheter insertion: A thin catheter is guided through the arterial system to the uterine arteries using fluoroscopic imaging.
Embolic agent injection: Tiny particles (polyvinyl alcohol particles or microspheres) are injected to block blood flow selectively to fibroids.
Completion: The catheter is removed, and pressure is applied to the puncture site to prevent bleeding.

The procedure typically lasts 1-2 hours, and patients may stay in the hospital overnight for observation.

Postoperative Care / Rehabilitation

Hospital stay: Usually 24 hours for monitoring pain and complications.

- Pain management: Cramping and pelvic pain are common; analgesics are prescribed.
- Activity: Gradual return to normal activities over 1-2 weeks.
- Follow-up: Imaging (ultrasound or MRI) at 3-6 months to assess fibroid shrinkage.
- Menstrual changes: Periods may become lighter; some women experience temporary amenorrhea.

Risks and Complications

UAE is generally safe but carries some risks:

Post-embolisation syndrome: Fever, pain, nausea lasting a few days.
Infection: Rare but may require antibiotics or surgery.
Non-target embolisation: Unintended blockage of other arteries.
Uterine necrosis or scarring: Rare, may affect fertility.
Allergic reaction: To contrast dye.
Premature ovarian failure: Rare, especially in women over 45.
Fibroid expulsion: Passing fibroid tissue vaginally.

Prognosis

Most women experience significant symptom relief and fibroid shrinkage after UAE. Studies show:

Fertility outcomes after UAE are still under study; women desiring pregnancy should discuss options carefully.

When to See a Doctor

Seek medical attention if you experience:

Heavy or prolonged menstrual bleeding causing anemia.
Severe pelvic pain or pressure.
Rapidly enlarging pelvic mass.
Urinary or bowel symptoms affecting quality of life.
Signs of infection after UAE (fever, chills, severe pain).
Any abnormal vaginal bleeding or discharge.

Early consultation with a gynecologist can facilitate timely diagnosis and treatment.

Conclusion

Uterine Artery Embolisation is a valuable, minimally invasive treatment option for women suffering from symptomatic uterine fibroids. By understanding the anatomy, causes, symptoms, diagnosis, and treatment options, patients can make informed decisions in collaboration with their healthcare providers. UAE offers effective symptom relief with uterus preservation and faster recovery compared to traditional surgery. However, like all medical procedures, it carries risks and requires appropriate patient selection and follow-up. If you experience symptoms suggestive of uterine fibroids, consult a healthcare professional to explore the best treatment tailored to your needs.

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