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What is an interventional radiologist and why doesn't my gynecologist offer this procedure? |
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Interventional radiology is a rapidly growing area of medicine. Interventional radiologists are specially trained doctors who use their expertise in reading x rays, ultrasound, and other medical images to guide small instruments through blood vessels and other pathways to treat disease without an open surgical incision. Most all procedures performed by interventional radiologists are minimally invasive (that is they do not require an open surgical incision) and are performed using imaging guidance (x-ray fluoroscopy, CAT scan, ultrasound, and/or MRI). The procedures performed by an interventional radiologist are typically less invasive and much less costly than traditional surgery. Interventional radiologists are specially trained in performing these procedures and this training is certified by the American Board of Medical Specialties. While gynecologists are specially trained to performed hysterectomies, myomectomies and other less invasive laparoscopic and hysteroscopic surgical procedures, most of them have not been formally trained and therefore do not possess the skills necessary to perform uterine fibroid embolization.
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Do I need a referral from my gynecologist or primary care physician to make an appointment with Dr. Fischer? |
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Depending on your insurance plan, a referral from your primary care doctor or gynecologist may be necessary prior to scheduling an appointment with Dr. Fischer, performing an MRI, or the UFE procedure itself. In general, most HMOs require a referral, while PPOs do not. Please contact your insurance company directly or contact us so that we may assist you.
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What symptoms do fibroids cause? |
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Fibroids can cause many symptoms including heavy menstrual bleeding (menorrhagia), painful menstrual cycles (dysmenorrhagia), pelvic pain, pelvic pressure, pain during sexual intercourse, frequent urination (urinary frequency), and constipation.
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How are fibroids diagnosed? |
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Since a large majority of patients with fibroids are completely asymptomatic, most fibroids are never diagnosed. Fibroids are usually detected during a routine gynecologic exam when the patient's gynecologist feels an enlarged or lobulated uterus. The diagnosis is usually confirmed using ultrasound or less commonly MRI. In general, MRI is better than ultrasound in determining the exact size, number and location of the fibroids (see samples in web site). It also provides information concerning the blood supply to the fibroids that ultrasound cannot provide.
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How do I know if I am a candidate for uterine fibroid embolization? |
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Whether or not a patient is a candidate for UFE depends on the exact size, number and location of the fibroids as well as the patient's symptoms. A detailed medical history and pelvic MRI are necessary prior to making a final determination. The ideal candidate is a patient who no longer desires fertility, has multiple small to medium size fibroids and whose primary clinical symptom is heavy menstrual bleeding (menorrhagia).
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If I would like to maintain fertility, could I still be a candidate for UFE? |
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The ideal candidate for uterine fibroid embolization has no desire for future fertility. While there have been multiple anecdotal reports of normal pregnancies following uterine fibroid embolization in the medical literature, it is currently unknown whether there is any increase risk of infertility or pregnancy following this procedure. Therefore, UFE is generally not recommended in patients who still desire fertility unless:
The patient has failed other treatment options such as myomectomy and the only other option is hysterectomy;
and/or
Due to the size, number, and/or location of the fibroids, there is a relatively high risk of a myomectomy resulting in a hysterectomy or causing significant scarring within the uterus, thus eliminating or significantly decreasing the patient's fertility.
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Can UFE be used to treat other conditions such as endometriosis or adenomyosis? |
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Currently, UFE is only indicated for the symptoms caused by uterine fibroids. Patients with pain or abnormal bleeding caused by other problems such as adenomyosis or endometriosis are not candidates for UFE.
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Is UFE a safe procedure? |
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Uterine fibroid embolization has been performed safely in thousands and thousands women worldwide. While no procedure is without risk, fibroid embolization has been shown to have a lower major complication rate than traditional surgical treatment options such as myomectomy. The two most serious potential complications are infection and ovarian failure leading to premature menopause. Infections are extremely uncommon and can usually be treated with oral or IV antibiotics. Rarely (much less than 1 percent), a severe infection can develop and may require the patient to undergo a hysterectomy. Ovarian failure leading to premature menopause is also relatively uncommon occurring in 1 to 2 percent of most patients and 2 to 4 percent of women nearing menopause.
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What happens to the fibroids after embolization? |
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After losing their blood supply, the fibroids shrink an average of 50 percent in size and also change in composition. They change from a heavy muscular tissue to a much lighter spongy, scar-like tissue that no longer has a blood supply. Small fibroids are very rarely completely re-absorbed or disappear.
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What happens to the normal uterine tissue after uterine fibroid embolization? |
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After UFE, the fibroids shrink and die while the normal uterus and uterine tissue lives. It is thought that the normal uterine tissue survives due to its ability to recruit new blood supply from other areas of the pelvis, while the fibroids rely solely on blood supply from the uterine arteries.
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What happens to the small particles used during the UFE procedure? |
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The tiny particles used to block the blood supply in the uterine arteries are trapped within the small branches of the uterine arteries within the leftover fibroid tissue. They are too large to travel forward through the small capillary bed and they cannot move backwards in the uterine artery against the remaining incoming blood flow. These particles have not been shown to cause any long-term effects. The embosphere particles are currently the only embolization particles specially approved for uterine fibroid embolization by the Food and Drug Administration.
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Are there any types of fibroids that cannot be treated with UFE? |
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Most fibroids can be successfully treated using uterine fibroid embolization. Moderate-to-large pedunculated fibroids (those that hang from the uterus by a stalk) are the only types of fibroids that are generally not treated with UFE. This is because there is a small chance of the stalk breaking after the fibroid loses its blood supply after which the fibroid may fall into the pelvis and cause additional problems. Patients with these types of fibroids can be considered as candidates for joint procedures using a combination of uterine fibroid embolization and laparoscopic myomectomy.
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Do fibroids grow back after UFE? |
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There is no evidence at this time that adequately treated fibroids grow back after uterine fibroid embolization. If, however, a fibroid's blood supply is not completely eliminated, it could continue to grow and cause symptoms. By comparison, approximately 30 percent of patients have a recurrence of fibroids after myomectomy.
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Will my insurance cover uterine fibroid embolization? |
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Most major insurance companies are now covering uterine fibroid embolization. Depending on your plan, specific referrals or other preauthorization may be necessary. Please contact your insurance company directly, refer to our billing and insurance section of the website, or call us for further information or assistance.
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How long does the UFE procedure take? |
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The fibroid embolization procedure usually takes approximately one hour to perform. During the procedure, you will be awake but given IV medication to make you sleepy. We also give you a local anesthetic at the puncture site (like a shot at the dentist's office) so that you feel no pain.
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Is UFE painful? |
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The uterine fibroid embolization procedure itself is painless. The only pain encountered by the patient is the local anesthetic shot at the puncture site near the right hip (like a shot at the dentist's office). The procedure does not require general anesthesia (or for the patient to be put completely to sleep). Immediately following the procedure, however, a majority of patients develop pain as part of the post-embolization syndrome. This pain begins immediately after the procedure, increases for 8 to 12 hours, and usually improves significantly by the following morning. For this reason, we keep patients overnight in the hospital for pain control. Other symptoms which may be encountered as part of the post embolization syndrome include nausea or vomiting, low-grade fevers, a lack of energy, and vaginal discharge. The morning after the procedure, the symptoms have usually improved to a point were they can be easily controlled with oral medications provided for the patient at the time of discharge to take home.
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How long until I can return to work after UFE? |
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The average recovery time before patients return to work or their normal daily activities is approximately one week. The reason most patients are not able to return to work sooner is due to the post-embolization syndrome which causes a light flu-like illness lasting an average of five to seven days after the procedure. In addition to occasional pelvic pain, post-embolization syndrome can include low-grade fevers, a general lack of energy, and vaginal discharge.
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How long will it take for my symptoms to resolve following UFE? |
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Most patients notice a difference in heavy menstrual bleeding (menorrhagia) by their next cycle. Bulk related symptoms including pelvic pain, pressure, frequent urination and constipation make take up to three to five months to notice a significant difference. How quickly your symptoms resolve depends largely upon the exact size number and location and your fibroids. A patient's symptoms may continue to improve for up to 18 to 24 months after the procedure although most patients experience maximum benefit within one year.
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What type of follow-up is required after the UFE procedure? |
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After the procedure, we ask you to return to our office for routine follow-up in seven to 10 days. We also ask that you schedule an appointment to see your gynecologist in two to three weeks after the procedure for a routine gynecologic exam. Assuming that there are no problems or concerns after the follow-up visits, you will resume your normal gynecologic care and we will plan for follow-up MRI in six to nine months to assess the results of embolization and to insure that the blood supply to the fibroids is eliminated.
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How expensive is UFE? |
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While it varies significantly from hospital to hospital, in general, uterine fibroid embolization is similar in cost to hysterectomy and myomectomy. In many areas, it is reported to be less expensive due to the shorter hospital stay and no need for general anesthesia.
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Must I have a gynecologist to undergo UFE? |
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We require that each patient undergoing uterine fibroid embolization be under the care of a gynecologist. We work very closely with the patient's gynecologist to provide the best possible care to the patient. While most physicians are now familiar with the UFE procedure as a safe and effective treatment to symptomatic uterine fibroids, there are a few physicians that are either not familiar with UFE or are uncomfortable in referring their patients for this procedure. If this is the case, you may contact us directly and we will be happy to speak with your doctor and/or provide a recommendation for a second opinion from a gynecologist who is familiar with the procedure.
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How successful is UFE in controlling symptoms caused by fibroids? |
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Heavy menstrual bleeding (menorrhagia) is controlled in 85 to 95 percent of patients after their procedure. Bulk related symptoms such as pelvic pain, pelvic pressure, frequent urination, constipation, back pain and painful intercourse are controlled in 80 to 95 percent of patients undergoing UFE. Careful pre-procedure planning and evaluation are vital to increasing the chance of a successful outcome.
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