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Home Treatment Options Embolisation Benefits and Disadvantages of UAE

Benefits and Disadvantages of UAE for Patients

Embolisation may offer women patients many benefits over other treatment option depending upon the particular circumstances. There are also potential disadvantages which must be considered.

 

Benefits of UAE

Less Invasive with Quicker Recovery Time

Uterine embolisation is carried out under conscious sedation; no general anaesthetic or surgery is involved therefore: -

  • There is no surgical wound to heal and muscles are not cut - only a tiny incision site that heals completely and leaves no scar
  • Only the fibroids are affected
  • The uterus and all reproductive organs remain intact
  • Hospital stay is normally overnight compared with 5-10 days for surgery
  • The recovery time is much shorter than surgery 2-5 weeks compared with 2-3 months
  • Return to work and normal life is much quicker 1-3 weeks
  • There is no restriction on lifting or driving after embolisation

Women remain fertile and can have a successful pregnancy after embolisation. Dr Woodruff Walker an Interventional Radiologist with a particular interest in fertility and embolisation has had 60 successful pregnancies to date amongst the women he has treated.

Greater Safety

Because there is no surgery and no reproductive organs are removed, there is less likelihood of serious complications because:-

  • The mortality rate for embolisation is much lower than hysterectomy
  • There is no possibility of surgical trauma to the bladder, intestines or ureter [tubes which carry urine from the kidney to the bladder]. This does occur with surgery.
  • Both hysterectomy and myomectomy are sometimes  associated with serious haemorrhage and a need for blood transfusion, especially with large fibroids
  • The entry site for the catheter used in embolisation is tiny so:-
    • The risk of infection is much lower than surgery
    • Recovery is much quicker because there is almost no muscle damage
  • There is no general anaesthetic.

Deep vein thrombosis can occur after surgery leading to pulmonary embolism, a blood clot on the lung that can be fatal. This is much less likely with embolisation as hospital stay and recovery is much shorter.

Less Long-Term Side Effects - Morbidity

  • Women remain fertile after embolisation, but are sterile after hysterectomy.
  • Menopause is 5 years earlier after hysterectomy and instantaneous if ovaries are removed (NICE guidelines forbid the removal of healthy ovaries)
  • Hysterectomy is the commonest cause for early HRT
  • HRT after hysterectomy requires the addition of testosterone, as well as female hormones, so prescription charges will be levied on each hormone i.e. you will pay at least twice the normal prescription charge each time.
  • There is less likelihood of long term complication because all organs and tissues remain in situ so:
    • There has been no documented case of urinary incontinence with embolisation.
    • The uterus and cervix remain intact and these play a part in the orgasm and women's enjoyment of sex.
  • Adhesions are common after both myomectomy and hysterectomy.
  • Fibroids usually re-grow after myomectomy
  • Gynaecologists are unable to advise women prior to hysterectomy what will need to be removed - uterus, cervix and in some cases ovaries. Some find this unacceptable.
  • Some women become clinically depressed after hysterectomy
  • Many women feel they are no longer 'feminine' after hysterectomy

Less Expensive for Patients Their Families and Their Employers

  • It only involves a short hospital stay - 1 night compared with 1-2 weeks for surgery.
  • Return to work after embolisation is normally 1-3 weeks (in US 1-2 days!) compared with 2-3 months for surgery.
  • Women running their own businesses or having considerable responsibility cannot afford to take this amount of time away from work.
  • This means that a partner does not need to use up the annual holiday allocation taking time off work and does not have to lose money.
  • HRT after hysterectomy requires the addition of testosterone, as well as female hormones, so prescription charges will be levied on each hormone i.e. you will pay at least twice the normal prescription charge each time

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Disadvantages of UAE

  • While embolisation is very successful in most women a few ~ 1 in 200 may need to have a hysterectomy usually due to infection.
  • Some patients have instantaneous relief from their symptoms, but others may have to wait up to 6 months for the symptoms to be relieved.
  • Periods can be affected for up to 6 months after embolisation – sometimes there is a period of heavy bleeding immediately after embolisation in others there may be no periods for a few months
  • Some women may have amenorrhea and/or early menopause after embolisation, but the rate is much lower than hysterectomy ~1% in women 45 or younger.
  • Some women may experience embolisation syndrome – a high temperature
  • A small number of women ~2.8% (BSIR Fibroid Registry) may expel their fibroid. A FEmISA member expelled three fibroids. It was not traumatic or painful and she was pleased to be rid of them, as they were large.
  • Some women can experience a vaginal discharge after embolisation. If this does not resolve spontaneously it can be treated by hysteroscopy a scope through the abdomen wall.

Pregnancy

Although many women have achieved successful pregnancies after UAE the results are not as good as women who have had no treatment for fibroids.  This is not surprising. The jury is still out on whether myomectomy or UAE is a better treatment for women wishing to become pregnant. There are on-going clinical studies comparing the two treatments. It is hoped that the clinical studies underway will help to show which treatment gives the best outcomes for which types of fibroids.  Results from clinical studies so far reported on the BSIR web site show -

  • 30% of patients wishing to become pregnant achieved pregnancy
  • 60% of these resulted in a live birth
  • 18% of these were premature
  • 30% had miscarriages
  • 2% had stillbirths
  • 18% had post partum haemorrhage
  • 72% had caesarean section.

However, women who have myomectomies also have reduced pregnancy rates which vary, but are around 40-50%. Most women will require a caesarean section and there are miscarriages associated with the procedure.  Most women who have had myomectomy go on to have a hysterectomy later, although some now opt for fibroid embolisation when their fibroids re-grow.

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