What are the risks of UFE?
From a risk profile, UFE is safer than the surgical options. The main risks of the procedure are as follows:
1. Menopause: Roughly 2% of women will go into menopause after UFE. The large majority of these women are over 45 years of age. A much smaller percentage of women enter menopause after UFE that are between 40 and 45 years of age. No one in our experience under 40 years of age has experienced this.
2. Fibroid slough: Roughly 5% of women will slough fibroid tissue with menses after UFE. The material is from a fibroid that is near the lining and falls into the cavity and passed in pieces after the UFE. This is not concerning, except that it is important to tell patients about this so that they are not alarmed if they see this after UFE. On very rare occasions (~1 in a 1,000 patients), the material is in the cavity, but a woman cannot pass it. Symptoms of sudden, sharp pain, fever, and a foul malodorous discharge alert the women of this occurrence and the Interventional Radiologist is immediately notified. The patient is placed on antibiotic therapy and watched closely for ~24 hours. If she passes the material, no further steps are taken. If she cannot pass the material, an elective outpatient D&C with her gynecologist may be necessary.
3. Allergy to the contrast: Rarely, patients will be allergic to the x-ray contrast. In the very rare event that a reaction occurs, patients are given medicine to reverse and stop it.
4. Fertility: Myomectomy adversely affects fertility such that after one myomectomy the fertility rate drops to ~50% and after 2 myomectomies to ~10%. We don't know yet what the drop is with UFE. That is because while the UFE procedure has been performed since 1995, it is only more recently that patients who desired fertility have been treated. A number of patients have delivered full-term babies after UFE (we have even had a set of twins) without difficulty. Small recent papers show higher fertility rates after UFE compared to myomectomy, but the numbers are still too small. Patients need to weigh all the risks before deciding on UFE if they desire fertility. In general, patients with single fibroids (simple myomectomy) may be better served with myomectomy until the fertility risks are known, whereas patients with multiple fibroids and a complex myomectomy favors UFE.