Fibroids & heavy periods

Dr Marios Agathangelou performs uterine fibroid embolization (UFE) in Nicosia and Limassol, Cyprus — covered by GESY, €0 for GESY beneficiaries. Uterine fibroid embolization (UFE) reaches the fibroids through a catheter inserted via a 1–2 mm incision in the wrist or groin. Tiny particles block the small arteries feeding each fibroid, cutting off its blood supply.

Starved of blood, fibroids soften and shrink over the following months. Heavy bleeding, pelvic pressure and pain progressively ease — without a hysterectomy, and with all fibroids treated in a single session.

Uterus preserved One session for all fibroids 1–2 mm incision Short recovery

The procedure is fully covered by GESY. It is done as an inpatient admission, and that admission includes the treatment — you pay nothing for the procedure.

Separately, the outpatient visit — the initial assessment, where it is decided whether the treatment suits you — may carry a small co-payment, usually €0–10, as any specialist visit within GESY does.

The co-payment is per activity, and it stops once your total co-payments for the year reach €150 — past that you pay nothing. Some categories of beneficiary have different limits.

Both need a valid referral, from your personal doctor or from a specialist.

Outside GESY, or with private insurance? We provide the documentation your insurer asks for, and a clear cost estimate at your consultation, before you decide anything.

Fibroids do not always cause symptoms. When they do, the usual ones are heavy or prolonged periods, pelvic pain or pressure, needing to pass urine often, constipation, back pain, and the tiredness that comes with anaemia from blood loss. Size alone does not decide treatment — how much the symptoms affect you does.

Fibroids are not something that has to be dealt with urgently. They are usually slow, and in many women they stay much the same for years.

How fast do they grow? Slowly. In an American study that measured 262 fibroids by MRI over a year, the usual rate of growth was about 9% in six months — at that rate a fibroid takes around four years to double in volume.

And they do not all grow. In that same study 7 in every 100 shrank on their own, two fibroids in the same woman grew at different speeds, and size did not predict what any of them would do next.

What troubles women is usually the bleeding rather than the size. Heavy periods month after month drain iron, and the tiredness of anaemia is what most notice long before anything begins to press on a neighbouring organ.

The question people carry is whether it is cancer. Fortunately, the answer is reassuring. In a review of 133 studies, about 1 operation in 2,000 done for presumed fibroids turned out to be a sarcoma; counting only the prospective studies, about 1 in 8,300.

There is also an end to it. Fibroids shrink after the menopause, so if yours is close, waiting is a real option rather than a way of putting off a decision.

There is no rush. We will answer every question, as many times as it takes, and take the step when you decide to.

It is not for everyone, and you will be told so plainly at your consultation. Embolization is not appropriate during pregnancy, with an active infection of the uterus, where malignancy is suspected, or with post-menopausal bleeding that has not been investigated.

It is also unsuitable or doubtful for pedunculated subserosal fibroids on a narrow stalk, for cervical fibroids, for very small fibroids, and for a uterus above a certain size. Where that is the case, the right answer is a different treatment — and we will tell you which.

If you want to become pregnant, that changes the conversation. The international data comparing embolization with myomectomy for fertility is limited and of low quality, and for that reason myomectomy is usually recommended first where pregnancy is the priority. Embolization is not ruled out — but it is a discussion to have properly, not a detail.

Most women see heavy bleeding settle and pressure symptoms improve; symptoms from bulk generally respond less well than bleeding does. Against surgery, embolization is associated with a lower chance of transfusion, a shorter hospital stay and a faster return to normal activity.

There is another side, and it is worth knowing: a proportion of women need a further procedure later — a higher proportion than after surgery. In the ten-year follow-up of the EMMY trial, roughly one woman in three had eventually had a hysterectomy.

The most common experience afterwards is post-embolization syndrome: pain, a low fever, nausea and tiredness for a few days. It settles on its own, and pain relief is given alongside it.

The serious risk worth knowing about is infection of the uterus. It is uncommon. It is treated with antibiotics, and only rarely does it lead to an operation. A fever that starts late, or will not settle, is a reason to telephone us rather than to wait.

The risk is not the same for every woman, and age is what changes it. After 45 the chance that periods stop for good is higher, because the ovaries are already near their own end; under 40 it is unusual. This is discussed before, not after, and for some women it is the reason to choose differently.

Less often, and less seriously: a bruise where the catheter went in, and fibroid tissue passing vaginally in the weeks afterwards — expected rather than alarming, though it is worth telling us when it happens.

Occasionally the arteries cannot be reached; the procedure is then stopped. This is not a complication, and the surgical route remains open.

The most important difference from hysterectomy is not a complication — it is that this may not be the last operation. In a Dutch trial that followed both groups for ten years, about 1 woman in 3 came to a hysterectomy afterwards. Two in three did not, and 78% said they were satisfied with the treatment they had.

Bear in mind that embolization is preceded by a diagnostic work-up, and that the diagnosis rests on the scans and the assessment made beforehand — which is why anything that does not look like an ordinary fibroid belongs on a different path.

Afterwards you are reviewed at one, three, six and twelve months. The first visit is about how you recovered; the later ones are about whether the periods have settled and how far the fibroid has shrunk, which are the two things that decide whether anything more is needed.

We will go through all of it before you decide.

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