The vast majority of insurers recognize UFE as an established and necessary therapy and are willing to cover the procedure. But it is always best to ask them first rather than find out there is a problem afterwards.

The Society of Interventional Radiology (SIR) is our professional society. Go to our www site www.sirweb.org and you will see a link on the home page called Doctor Finder. This link takes you to a physician database that allows you to locate the Interventional Radiologists in your state. You can specify that you only want to see the list of doctors who perform UFE. The list will include addresses, e-mail addresses, and telephone numbers.

We do embolize the whole uterus. It is just that the arteries to the fibroids steal the majority of the incoming blood, so they get stopped-up with most of the particles we inject into the bloodstream. Also, the uterus has the ability to recruit blood from adjacent tissues, whereas the fibroids usually cannot. The first branch of the uterus usually supplies the cervix and vagina, as opposed to the uterus and fibroids. It is safe to embolize this branch, but it is also possible that blocking off this artery could result in decreased sensation and therefore less pleasurable sex. This subject is under investigation. If it is technically feasible to spare this branch we do so. None of our patients has reported sexual dysfunction after UFE.

The typical course is a day or two of requiring strong pain medicine to stay comfortable followed by a few days of intermittent crampy pain and /or nausea. We will make sure that you have the appropriate medications to keep these symptoms tolerable. You will not feel 100% normal, but you should not be miserable.

Some of our patients have noted that the procedure caused no more discomfort than their usual period.

Most women feel run down, tired, for a couple of days to two weeks following UFE, and rarely my patients have reported this sensation to last for a month or longer. Many women have a brown, tacky, odorless discharge for a period of time following UFE. Some women experience hot flashes and/or night sweats for a short time after UFE. Sexual function is usually unaffected by UFE, unless that fibroids have been causing painful intercourse in which case sexual satisfaction can be improved! None of my patients have reported a loss of sexual function but there are internet discussion groups that contain discussions by women reporting decreased sensation in the uterus or vaginal dryness. There is a case report of loss of uterine orgasms following UFE. If uterine orgasm is key to your sexual fulfillment, you may want to consider another alternative. We spare the first branch of the uterine artery if possible, as it mostly supplies the cervix and upper vagina. Some researchers believe that this may leave the ability to achieve uterine orgasm intact. That said, none of my patients have reported loss of uterine orgasm.

The X-ray dye (also known as X-ray contrast) injected during the procedure contains iodine. Being allergic to iodine is a hurdle that can be overcome many ways. The approach depends on the kind of reaction(s) you had previously. It might be as simple as giving you a medicine (steroid) to take by mouth the night before the procedure. On the other end of the spectrum, if you previously had a severe reaction to modern contrast, the procedure could be done under general anesthesia to ensure the highest level of control. And there are many in-between levels of management.

Regardless, we are all fully prepared to recognize and treat any reaction you might have.

The existence of severe narrowing of the arteries could theoretically be a problem but in practical terms does not occur. if your arteries were that small the fibroids would likely have already died from the lack of blood. UFE can induce menopause. While not yet proven, it is likely that the closer you are to entering menopause, the higher the chance that UFE will initiate menopause. In fact, one study found that 15% of women between the ages 45-50 enter menopause following UFE.

A woman who begins bleeding after menopause needs to be carefully evaluated. Of particular concern is the possibility that the lining of the inside of the uterus (the endometrium) is abnormal. The possibility of endometrial hyperplasia or cancer can be excluded by endometrial biopsy.

Fibroids typically die on their own after a woman enters menopause. Women who take hormone replacement therapy after menopause may continue to suffer from fibroids because the hormones can stimulate the fibroids. If this happens, sometimes a different type or dose of hormone is all that is needed to allow the fibroids to degenerate. If changing the hormones does not work and the endometrial biopsy shows no abnormality, UFE might be appropriate.

For all of our procedures, failures are categorized as either technical failures or clinical failures

A technical failure means something happened during the procedure that prevented success. Say you have anatomy that prevents my being able to embolize the arteries that feed the fibroids. Perhaps it would be too dangerous , or just "technically" impossible (meaning I can not safely get the catheter into the uterine arteries). Technical failures for UFE are very unusual; on the order of 1 to 2 in 1,000 patients.

A clinical failure means we had a technical success (the arteries feeding the fibroids were successfully blocked) but you get little or no relief from your symptoms. A clinical failure could happen if the fibroids do not shrink very much and the main symptom is pelvic fullness. Or they continue to cause heavy periods when that was the problem. We know from about 10,000 procedures in the US that around 90% of women will get significant improvement or complete resolution of their symptoms after UFE. That means 10% will say that the UFE did not help very much. We are working to decrease that number.

If the UFE does not resolve your symptoms and you elect to have a hysterectomy, the hysterectomy will be safer than it would have been before UFE. This is because there will not be as much blood loss, so the likelihood of your needing a transfusion is much less. In fact, that is how UFE gat started in the first place. A French Gynecologist was trying to reduce the risk of hysterectomy by having a radiologist embolize the uterus before surgery. But none of his patients wanted the hysterectomy after the embolization!

We could also consider performing UFE a second time to see if that takes care of the problem.

The term "fibroid" is actually a lay term for the benign leiomyoma of the uterus. A leiomyoma is a tumor of a type of muscle known as "smooth muscle". Any tissue with smooth muscle can form a leiomyoma. Since smooth muscle occurs in the gut as well as in the wall of every artery in your body, leiomyomata can form just about anywhere.

But it is unusual to hear of any outside the uterus and GI tract. And the uterus is by far the most common location. In fact, uterine fibroids are the most common tumor of any type found in women.

1. A woman with chronic endometritis or salpingitis (longstanding infection of the uterus or fallopian tubes) should not have UFE as her chances of developing a runaway infection is too great.
2. If a highly pedunculated fibroid is present (this is a fibroid attached to the uterus by a thin stalk; like a tether ball) that fibroid should be removed laparoscopically prior to UFE.
3. A woman with a condition that makes arteriography unsafe, such as renal insufficiency or uncorrectable coagulopathy.
4. If the MRI demonstrates a disease that is best treated by surgery, such as an abnormal ovary, the options of having both the surgery and the UFE versus having the surgery including hysterectomy will need to be discussed.
5. A woman whose main goal is to prepare her uterus for pregnancy should have a myomectomy rather than UFE. This relative contraindication will be reassessed when better data on the effects of UFE on childbearing is available. Of patients who come to us for UFE, this is our number 1 reason for recommending against UFE.