Fibroid expulsion is the term used when uterine fibroids are passed out of the body. A small percentage of women experience symptomatic fibroid expulsion after undergoing uterine fibroid embolization (UFE) for their fibroids. Here’s what you should know.
What causes fibroid expulsion?
The UFE procedure cuts off blood supply to fibroids in the uterus to shrink the fibroids and help alleviate their symptoms. In some cases, the blood-starved fibroid passes out of the body. This event is unusual and rarely causes serious problems, and can lead to drastically reduced symptoms and uterine size.
According to Richard Shlansky-Goldberg, MD, Interventional Radiologist and Professor of Radiology, Obstetrics & Gynecology, and Surgery at the Hospital of the University of Pennsylvania in Philadelphia, PA, as well as the leader of the study, the process can occur anywhere from weeks to years after UFE.
How often does fibroid expulsion occur?
A study published in the Journal of Vascular and Interventional Radiology sought to better understand fibroid expulsion and its impacts on patients’ health. The study examined the histories of 759 women who had undergone UFE between July 1999 and June 2009.
The study found that almost 4.9 percent of the UFE patients experienced fibroid expulsion within 3.5 months of the procedure. Of those 37 women, only 5 percent had any symptoms to go along with the expulsion. Symptoms include cramping and vaginal discharge.
It’s significant to note that the determining factor in whether or not a woman had symptoms during fibroid expulsion was whether or not it was a “bulk expulsion.” During a bulk expulsion, large pieces of the fibroid (or even the entire fibroid), passed from the body. In total, eighty-nine percent of the women who had symptomatic fibroid expulsion experienced bulk expulsion.
“Fibroids that have a higher likelihood of expulsion include the pedunculated and submucosal types of fibroids,” Dr. Shlansky-Goldberg says.
Does fibroid expulsion require medical intervention?
Importantly, fibroid expulsion often safely occurs without medical intervention. Almost half of all cases studied occurred at home or in the doctor’s office with a minimally invasive transvaginal procedure. Women who have had children tend to have greater success with fibroid expulsion than those who have not.
That said, there are times when further medical intervention becomes necessary. For example, fibroids that are only partially expelled may need to be removed with gynecological treatment.
In the study, 27 percent of women who experienced a fibroid expulsion required an operative transvaginal myomectomy. A further eight percent required a hysteroscopic fibroid resection, in which a scope is used to guide the removal of the fibroid.
Fibroid expulsion only poses a risk to a woman if the fibroid does not completely leave the body through the vagina, either naturally or through surgical means. In that rare case, there can be a risk of infection that may require a hysterectomy.
In the study, only 4 women (11 percent) out of the 37 who experienced fibroid expulsion required an urgent hysterectomy, and only 2 women (4 percent) elected to have a hysterectomy in order to alleviate symptoms such as chronic vaginal discharge.
Most of the time, the discharge and cramping that occur with fibroid expulsion only lasts for weeks or months, according to Dr. Shlansky-Goldberg. Notably, he reports that many women are delighted to have the fibroid out, because the removal of the fibroid can lead to a smaller or normal sized uterus.
What should I do if I think I’m experiencing fibroid expulsion?
Patients who think they are experiencing fibroid expulsion should first contact the interventional radiologist who performed the UFE. According to Dr. Shlansky-Goldberg, that doctor will order an MRI to confirm. Then, the doctors can work with the patient to come up with a plan of care.
Of course, successfully managing any medical condition requires collaboration among the patient and doctors. Communication between interventional radiologists and the gynecologists is especially important if the patient has a history of fibroid expulsion.
At VIVA EVE, we’re experts at treating uterine fibroids. VIVA EVE we provide high-quality, personalized care for every patient and we’ll partner with you to determine your best treatment options.
Sources for information referenced in this post
- McLucas, B., Voorhees Iii, W. D., & Elliott, S. (2015). Fertility after uterine artery embolization: a review. Minimally Invasive Therapy & Allied Technologies, 2: 1-7.
- Shlansky-Goldberg, R., Coryell, L., Stavropoulos, W., et al. (2011). Outcomes following fibroid expulsion after uterine artery embolization. J Vasc Interv Radiol, Nov; 22: 1586-1593.
- Office on Women’s Health, US Department of Health and Human Services. (2017) “Uterine Fibroids” retrieved January 28, 2017.