After the UFE Procedure: What to Expect

  • Pain:
    • You may experience several hours of moderate to severe pain after the procedure. 
    • It is believed that this pain is due to the death (infarction) of the fibroids. A temporary decrease in the blood supply to the normal portions of the uterus may also contribute to the pain. 
    • The severity of pain is quite variable. Approximately 20% of patients have little or no pain after the procedure. 
    • About 20% of patients will have severe pain that may last for several hours. 
    • Most patients have pain some where in between the two extremes. 
    • The severity of pain is not predictable based on the size of the uterus or the size of the fibroids.  Some patients with very large fibroids have minimal pain and some with small fibroids have severe pain. The pain usually begins to diminish after 4 to 8 hours after its onset.
    • Also, the severity of the pain also does not predict outcome. Severe pain does not necessarily  suggest a better outcome.
    • We use a combination of anti-inflammatory medications and narcotics to control the pain.    

          

  • Nausea and Vomiting
    • Another frequent side effect of UFE is nausea and vomiting.           
    • This may be caused by the necrosis of the fibroid tissue or as a result of the pain control medications. 
    • The nausea can usually be controlled by medications and we provide standing orders for nausea medication if needed. 
    • Because the severity of the symptoms from UFE is very variable, thus we routinely observe patients in the hospital overnight.          

 

After Discharge From the Hospital: What to Expect

  • Pain:
    • Most patients will have recurrent cramping pelvic pain over several days after discharge, this pain usually feels like menstrual cramps. On occasion, the pain may become severe. 
    • It is recommended that you take the anti-inflammatory medications continuously for four days as prescribed.
  • Nausea:
    • Nausea may also recur and medication is also provided for this. 
  • Fever:
    • Fever (mild grade) is common and is a side effect of the necrosis (death) of the fibroid tissue.
    • Many of the patients feel as if they have the flu for several days. All these symptoms begin to improve after 4 to 5 days and most patients are ready to return to work 7 to 10 days after the procedure. 

 

  • Vaginal Discharge or Bleeding:
    • You may encounter vaginal spotting or discharge after the procedure which may last a few days and variable in amount. This is an expected finding and nothing to worry about in the first few days. 
    • However, these discharges should not have a offensive oder nor associated with local pain or tenderness.

Going Home - Instructions

  • You will need someone to drive you home.
  • Arrange for extra help at home after the procedure, especially if you live alone or provide care for another person. 
  • You may go back to usual activity the day following the procedure and back to a normal healthy diet
  • Avoid any exercise or strenuous activity for a week.

      

Level of Activity:

  • Stair climbing: keep to a minimum the first week.
  • Exercise: Take it easy and slowly. You may start after the first week, start slow and gradually increase. While you will progressively feel better, you can anticipate the lack of energy and you should rest when you are tired.
  • Shower: You may shower only for the next 7 days (No baths), and until the groin punctures are healed completely.
  • Sexual Relations: You may have unrestricted activity (including sexual relations and exercise) starting 7 days after the procedure.
  • Returning to Work: You will need about 7 to 10 days off from work.
  • Other Limitations: No heavy lifting, pushing or pulling for 4 weeks.

 

Diet:

  • No Restrictions: Increase your fluids and fiber intake. Prune juice or mild laxative may be helpful to keep your bowels soft and reduce the chance of constipation.
  • Do not take iron supplements for the first week after the UFE procedure, as they aggravate constipation.

 

Groin Puncture site:

  • You may shower each day after the first 24 hours. However, you may only bash when the puncture sites are completely healed (7-10 days).
  • After you shower, remove wet bandage and replace them with a clean dry one. do this for the next two days after the UFE procedure until the skin incision is closed.
  • Observe the site. Some bruising is normal and as this heals, the bruising may spread out over several days. This is the normal way for blood to be absorbed under the skin.
  • you may feel a small knot, about the size of a large pea, under the skin of the puncture site. This is also normal and will fade over the next few months.
  • If you have continuing pain at the puncture sites, you may take Ibuprofen 600mg or Paracetamol 1gm. 
  • If you notice any swelling or active bleeding from the puncture site, lie down flat, apply direct pressure with your fingers over the top of the site for a minimum of 10 minutes, and call for help. This is very rare!
  • Call if you have a fever with a temperature over 38.5 C.

 

Menstrual Periods, Vaginal Discharge & Spotting:

  • It is normal to have a brown, or brownish red vaginal discharge or spotting after the embolization procedure. This may continue for a few weeks or until your first period. Use sanitary napkin (e.g. Kotex) until it resolves. 
  • Occasionally, patients can have clear watery discharge for several weeks or months after the procedure. This does not indicate infection.However, a thick or foul smelling discharge, particularly accompanied by a fever of pelvic pain may indicate infection and you need to contact your gynecologist.
  • Your next menstrual period may start early or you may skip a period or two. The period may be better right away or some patients may not improve for 2 or 3 cycles. Don’t worry and don't be discouraged.  
  • You may have more discomfort with your first and possibly the second menstrual period. These cramps should disappear as the fibroids shrink over the next several months.
  • Any pain or discomfort you may experience represents the process of fibroid degeneration (which is good as it means the fibroids are dying).
  • Fibroids are estrogen driven, and as they die you may have sudden change in hormones that may cause mild depression to “hot flashes”. This is usually self-limited and requires no treatment.

 

Medications:

  • Ibuprofen 400mg or 600mg (e.g. Brufen, Sabofen) PO Q8h x 5 days (take with food).
  • It is not unusual to experience nausea after the UFE procedure, while taking Ibuprofen. It is important to protect your stomach from irritation by the pain medication, so eat food with each dose.
  • You may also take Paracetamol (Panadol, Fevadol) 1gm (2 tablets) PO Q6-8h x 5 days, for the pain.

 

Potential Problems:

  • Symptoms that may indicate problems include: 
    • Swelling or active bleeding from the puncture site.
    • Pain that arises several days or weeks after the initial pain has resolved.
    • Elevated temperature (>38,5C) several days to weeks after the procedure.
    • Irregular vaginal discharge that may be foul smelling or copious. 
  • These may indicate either an infection or partial passage of a portion of the fibroid and may require gynecological evaluation.
  • If these symptoms occur, please contact your gynecologist and you Interventional Radiologist.

Follow-Up

  • Follow-up care is a key part of your treatment and safety.
  • Follow up Appointments:
    • One Day after discharge: 
      • A follow-up phone call by our clinic.
      • We want to be sure that you have no unusual problems and to answer any questions you may have. 
    • One week after the procedure: IR clinic visit. 
      • At that visit we will check the puncture sites and intravenous site to be sure they have healed and we will review the progress of your recovery. 
      • At that time we usually release a patient to return to full activity. 
    • One month after the procedure: Follow-up phone call by our clinic. 
      • We call to be sure that no problems or gynecologic procedures have been required.   
    • 3 months after the procedure: MRI pelvis.
      • You will need to have an MRI of the pelvis, similar to the exam you had before the embolization, three months after the UFE.
      • If symptoms have improved and the images of the follow-up MRI demonstrate that the fibroids have become necrotic and are shrinking
    • After the MRI is completed: IR clinic visit
      • After your MRI of the pelvis, please call to schedule an appointment for the Interventional Radiology Clinic to discuss the findings and your progress.

 

  • Continue your normal gynecological care and follow-up suggested by your gynecologist.
  • Follow-up post-UFE is with your gynecologist for any issues after the first week post-UFE.
  • You may, however, contact the interventional radiology unit for any concerns or questions related to the procedure.

 

  • Be sure to make and go to all appointments, and call your doctor if you are having problems. 
  • It's also a good idea to know your test results and keep a list of the medicines you take.

 

   

Pregnancy After UFE

 

After the UFE procedure, you will have less blood flow to your uterus. 

Because of this, pregnancy is not recommended after uterine fibroid embolization (UFE) for at least 6-12 months after the procedure.

Speak with your gynecologist about birth control options during that time.  

 

 

 

 

Wishing you a quick recovery back to wellness!