Ischemic Complications

Ischemic Complications

Ischemia (blockage of blood flow) is the intended result of embolization, depriving the fibroids of blood, oxygen, and nutrients. The uterus and/or ovaries are also potentially affected, although they have the capacity to recover and the fibroids do not.

Pelvic pain

Crampy pelvic pain occurs in almost every patient following UFE. Rarely, someone will have no pain. It is important to remember that the presence or severity of pain is not correlated with clinical failure or success. Pain is usually moderate to severe, sometimes as severe as labor pain. The pain after UFE usually peaks within hours of the procedure, but may occasionally be severe even into the second day, and rarely the third day or later. Most pain will usually be gone within a few days and rarely will it require more than a week to completely resolve.

Fever

Up to 1/3 of patients will have a temperature of 100.4°F or higher following embolization as part of a well-known post-embolization syndrome. You have been given a prescription for a medication that will prevent your temperature from reaching uncomfortable levels. Fever is only worrisome if it is associated with chills or is higher than 101.5°F and fails to respond to aspirin or Tylenol. Please contact us immediately if this occurs.

Nausea/vomiting

Nausea and/or vomiting are not uncommon following the procedure. Again, you have been given medications to help prevent this or treat it if it occurs.

Fibroid sloughing

In the weeks that follow UFE, approximately 5% of patients will pass fragments of necrotic (dead) fibroids, or even a whole fibroid. It is more likely to occur when the fibroids are submucosal. Your doctor will discuss whether this is the case with you. Passage of fibroid material can happen as late as 8 to 10 weeks afterward and occasionally even after that. Sloughing of a fibroid is often experienced as a sudden onset of intense crampy pain and an odorous vaginal discharge. In most cases it will pass within 36 to 48 hours, with prompt resolution of symptoms. The positive side of this is that there is often a noticeable reduction in uterine size and improvement in bulk-related symptoms. If the piece of fibroid does not pass on its own after a day or two, you may require a procedure to help remove it.

Non-target embolization

Non-target embolization occurs when the embolic agent passes into a circulation other than where it is intended; with UFE that would be outside the uterus. The ovary shares blood supply with the uterus in many women and is the organ most frequently affected by non-target embolization. Premature menopause or permanent loss of menses (periods) can occur in up to 5% of patients. It rarely occurs in women who are under 45 years of age. Approximately 5-10% of women have a decrease or even transient loss of menses, but their periods will return, usually lighter than before. Hot flashes and/or other menopausal symptoms may accompany this. Other, more rare examples of non-target embolization would be occlusion of adjacent branches such as to the bladder or rectum. Such instances have not been reported for UFE.

Fertility

As discussed above, some patients may experience premature ovarian failure. However, many patients have become pregnant and delivered health babies after UFE. Statistics on the affects of UFE on fertility are not known.

Sexual dysfunction

Approximately 15% of women normally report having sensations of strong uterine contractions during orgasm. There is one case report in the world literature describing a woman who lost this sensation following UFE. The authors of the case report hypothesized that this might have been related to non-target embolization of the cervix and/or the adjacent neural plexus. However, there were three studies on sexuality after UFE presented at a recent scientific meeting, which found no change and even an improvement in sexual experience after UFE. 

To date, there have been no reports of birth defects or intrauterine growth retardation. A note of caution should be made: there is one anecdotal case of a woman who had uterine rupture during labor at a point of weakness in the uterine wall where a transmural (through-the-wall) fibroid had infracted (died).