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Uterine leiomyoma (fibroid) embolization

Authors
Ducksoo Kim, MD
Stephen D Baer, MD
Section Editors
Deborah Levine, MD
Robert L Barbieri, MD
Deputy Editor
Sandy J Falk, MD, FACOG

INTRODUCTION

Uterine fibroid embolization (UFE) is a nonsurgical treatment option for premenopausal women with bothersome fibroid-related symptoms who wish to retain their uterus, escape side effects associated with prolonged medical therapy, and avoid surgery (eg, myomectomy) [1,2]. The procedure is based upon the hypothesis that bilateral reduction of uterine arterial blood flow will result in infarction of fibroids and control bothersome fibroid-related symptoms, while sparing normal myometrium [3].

INDICATIONS AND CONTRAINDICATIONS

Uterine fibroid embolization (UFE) is indicated for relief of bothersome bulk-related symptoms and abnormal uterine bleeding due to fibroids. (See "Epidemiology, clinical manifestations, diagnosis, and natural history of uterine leiomyomas (fibroids)".)

The procedure is rarely indicated in postmenopausal women since fibroids naturally regress after menopause [4]. Other relative contraindications to UFE include: current use of gonadotropin releasing hormone (GnRH) agonists, submucosal fibroids, extensive adenomyosis, previous internal iliac artery ligation, and plans for future pregnancy. Many of these relative contraindications are subjective, based on the judgment and experience of the clinician (see 'Pregnancy after UFE' below and 'Ovarian dysfunction' below).

Large fibroids do not appear to be a contraindication to UFE. As an example, a series of 71 women with a large fibroid burden (dominant fibroid of >10 cm and/or a uterine volume of >700 cm) who underwent UFE had no serious complications after an average of 48 months [5]. However, some studies have found extremely large fibroids (>24 weeks uterine gestation size or multiple fibroids larger than 10 cm in diameter) to be a relative contraindication because of serious complications such as severe abdominal pain, infection, sepsis, and ischemic uterine injury requiring emergent hysterectomy [6-10].

Myomectomy is generally the preferred approach to pedunculated tumors since they do not respond well to UFE, and procedure-related complications (necrosis, separation, torsion) are more common than after UFE of intramural fibroids. However, some data suggest that UFE can be performed successfully in women with pedunculated fibroids [11].

                          

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Literature review current through: Nov 2016. | This topic last updated: Thu Jun 05 00:00:00 GMT 2014.
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References
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