Principal Director & Unit Head, Obstetrics and Gynaecology, Max Hospital, Gurugram
Part 6 of 9 in Benign Growth in Uterus Causing Gynaecological Problems
Uterine Artery Embolization: When It Works and When It's Contraindicated
August 25, 2024
Uterine artery embolization treats fibroids without surgery or medication, by blocking the artery supplying the uterus with a jelly-like material, so the fibroid loses its blood supply and shrinks over time.
Who embolization is not appropriate for
Two groups should not have embolization. A calcified fibroid has essentially no blood vessels running through it, so blocking the artery achieves nothing. And a woman who still wants to conceive should not have embolization, since reduced blood flow to the uterus after the procedure can compromise a future pregnancy, restricting nutrition and growth to the developing baby. For patients wanting pregnancy later, myomectomy, not embolization, is the right procedure.
Why blood flow is the whole story
Asked to explain the mechanism behind that contraindication in more detail, Dr. Lal reiterated that blocking the artery reduces blood flow to the entire uterus, not just the fibroid, which is precisely why the procedure isn't offered to women who want to conceive afterward. Embolization is a good option for smaller, non-calcified fibroids in women who have completed their family and don't want another pregnancy.
This article is based on a Jivo Masterclass session conducted by Dr. Suman Lal, Principal Director & Unit Head, Obstetrics and Gynaecology, Max Hospital, Gurugram. The article has been summarised with the assistance of an AI tool from the original masterclass recording. Watch the full Masterclass recording
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This guide is based on a live Jivo Masterclass: Dr. Suman Lal taught doctors across Africa on August 25, 2024.
FROM THE LIVE Q&A
Moderator
What is the management of fibroids using medication without surgery, and what are the possibilities?
Dr. Suman Lal
If bleeding is heavy and the fibroid isn't inside the cavity, medical management with painkillers, oral contraceptive pills, and GnRH agonist injections is possible. GnRH injections reduce fibroid size but the effect reverses within six months to a year of stopping, so medical management is generally a one-to-two year bridge, not a permanent solution, and is most useful pre-menopause, pre-surgery, or pre-pregnancy attempts.
Frequently Asked Questions
What is the role of the gonadotropin agonists used in India, Lupron and Goserelin?▼
Both are effective at reducing fibroid size, by around 40-50%. Different centres use different ones, but either can be used.
Do you suggest that a scan measuring a 5cm fibroid should be surgically removed?▼
Not automatically. If the 5cm fibroid is inside the uterus causing heavy bleeding or obstruction, yes. If it's outside the uterus and not causing any problem, there's no need to operate. If it's in the muscle layer and the patient is trying to conceive or undergo IVF, removal is often needed. Symptoms, location and fertility goals all have to be weighed together, not size alone.
What is the relationship between fibroids and menstrual pain?▼
A fibroid inside the uterine cavity acts like a foreign body. When menstrual contractions begin, the uterus tries to expel the fibroid the same way labour contractions try to expel a baby, causing cramping. An intramural fibroid also increases the uterus's surface area, independently increasing both pain and bleeding.
What is the fate of myoma nuclei after embolization, and why is it contraindicated in women wishing to conceive in the future?▼
Embolization blocks the artery supplying the uterus, so blood flow to the entire uterus decreases, not just to the fibroid. That reduced blood flow is exactly why the procedure is contraindicated for women planning pregnancy afterward, since it can compromise the nutrition and growth of a future baby. For these patients, myomectomy (surgical removal) is the right choice instead.
In cases of infertility, is there any actual management in terms of medication?▼
Infertility has several possible causes, blocked tubes, inadequate egg count, or structural issues like fibroids, adenomyosis or endometriosis, and each needs a different treatment. For a woman with fibroids who wants to avoid surgery before conceiving, a GnRH agonist can shrink the fibroid over six to nine months, after which medication can be given to support pregnancy.
Who should not have uterine artery embolization for fibroids?▼
Women with a calcified fibroid (no blood vessels to block) and women who still want to conceive, since reduced uterine blood flow can compromise a future pregnancy.
What should a woman planning future pregnancy have instead of embolization?▼
Myomectomy (surgical removal of the fibroid), which preserves normal uterine blood flow.
In This Series: Benign Growth in Uterus Causing Gynaecological Problems
- 1.Uterine Fibroids
- 2.What Are Uterine Fibroids? Risk Factors and Symptoms
- 3.Diagnosing and Classifying Fibroids by Location
- 4.Fibroids, Fertility, Pregnancy Risk and Menstrual Pain
- 5.Medical Management: Painkillers, Progesterone and GnRH Agonists
- 6.Uterine Artery Embolization: When It Works and When It's Contraindicated
- 7.Surgical Removal: Hysteroscopic, Laparoscopic and Robotic Myomectomy
- 8.Beyond Fibroids: PCOS, Endometriosis and Infertility
- 9.Preventing Adhesions After Myomectomy: What Actually Works