If the fibroids are infarcted (considered dead) in the woman's body why doesn't the body cause an infection to occur as a rejection process after the Uterine Artery Embolization procedure? - Carlisle, PA

The body has natural mechanisms to deal with infarcted tissue. The one that occurs in the uterus is called 'hyaline degeneration' which is a fancy term for scar formation. The process is exactly what happens naturally in every woman after menopause. UAE just precipitates the degeneration in a controlled fashion. - Robert Worthington-Kirsch, M.D.

How does the woman's body absorb the fibroid tissue after UAE? What will absorbing the fibroid tissue do to her body and how is it eliminated? - Philadelphia, PA

Again, this is a perfectly natural process. The fibroid tissue is not some foreign substance. The human body is always in a state of flux, with portions being remodeled, absorbed, changed, etc. The fibroid tissue is processed like any other tissue in the body that needs to be changed. This concern is based on an incorrect or poor understanding of how our bodies work. - Robert Worthington-Kirsch, M.D. 

Are there particular uterine fibroids that cause a UAE patient to slough uterine fibroid discharge during the recovery process?  How long does this process last?  What percentage of your patients experienced sloughing of fibroid discharge?  - Carlisle, PA

Many, if not most, patients develop a brownish discharge after the UAE. This represents small fragments of fibroid which migrate to the inner lining of the uterus and then are shed out. This typically lasts 1-3 weeks, but can last longer. It does not have an odor or cause any symptoms. This is not bad for the patient (although it may be inconvenient) and eventually clears. 

About 5% of women will have a larger portion of a fibroid similarly slough. This is analogous ‘miscarrying’ a fibroid. These patients develop cramping and an odorous discharge. I put all of these women on oral antibiotics, and most will pass the tissue and have relief of their symptoms in a day or so. If the material does not pass, the woman may need to have a D&C to clear out the uterine cavity. 

This may be unpleasant when it happens, but is usually associated with significant decrease in fibroid/uterine size and improvement in symptoms. Most women who have gone through this look back on it and view it as a good thing to have happened.  - Robert Worthington-Kirsch, M.D.

I have read that uterine fibroids located inside the uterus can be passed after having UAE?  How is the incident of uterine fibroid tissue getting “stuck” in the cervix or becomes secondarily infected (or both) handled?   How or why does this happen and how many cases have you experienced of uterine fibroid expulsion?  Is there a big difference on how the internal uterine fibroids are passed compared to the external uterine fibroids?

Fibroids on the outer aspect of the uterus do not pass or slough, they are just converted to scar. About 5% of women overall will slough a fibroid. Fewer than half of these will need to have a D&C. If the tissue does not pass it can get infected, and these infections can be difficult to treat. Rarely a woman in this situation will need to have an hysterectomy. This occurs in about 1 in 200-300 UAEs.  - Robert Worthington-Kirsch, M.D.

Did you ever have a patient go into early menopause after having the UAE procedure done?  If yes, what should the woman do if she no longer gets a period and what will the woman experience when this happens? - Mechanicsburg, PA

About 15% of women over the age of 45 will never have another period after UAE. About half of these will have new onset or worsening of the hot flashes and night sweats which represent the hormonal changes of menopause. The risk of never having a period again is less than 1-2% for women under 40. 

Menopausal symptoms can be treated with soy supplements, which give a lot of women relief. If needed, hormone replacement therapy can be prescribed by the gynecologist.  - Robert Worthington-Kirsch, M.D.

What causes the strong “wave-like” pattern of pain (similar to labor pain) to occur in some uterine fibroid patients? 

This is cramping from the fibroids infarcting or being altered by your body. It is often associated with passage of some tissue, which is a good thing. - Robert Worthington-Kirsch, M.D.

When is a UAE patient considered to be cured of the disease? - Millersburg, PA

When she has improvement in abnormal menstrual flow and pressure symptoms and is happy with that improvement. - Robert Worthington-Kirsch, M.D.

How do you keep the entire uterine artery from being clogged? - Harrisburg, PA 

This depends on the degree to which the artery is embolized and the material chosen for the embolization. It’s largely a matter of skill and experience with the embolization procedure. - Robert Worthington-Kirsch, M.D.

Have any women ever expelled the plastic particles with their fibroid tissue discharge? - Carlisle, PA

Once in place, the particles are 'locked' into the vessel by surrounding clot and eventually scar.  They can't become free in the vascular tree and go somewhere else in the body.

Yes, occasionally a few women will notify me that they have experienced expelling the plastic particles.  The expelling of the plastic particles is not harmful to the woman and it doesn’t cause any problems with the embolization. - Robert Worthington-Kirsch, M.D.

What is the longest period of time (months) that a woman could experience expelling fibroid tissue? - Carlisle, PA

I have two women who have reported expelling fibroid tissue at 14 months and 20 months.  These women are in the group (5-10%) who experience fibroid tissue discharge.  The other 90% or more of women will not experience expelling fibroid tissue. - Robert Worthington-Kirsch, M.D.

How long should women wait before using tampons after having the UAE procedure performed?

I recommend that women avoid tampons for 6 weeks after UAE. There is no science behind this as of yet.  I want to be sure that women get through the phase where they are likely to have a post-UAE discharge before wearing a tampon. - Robert Worthington-Kirsch, M.D.