What to Expect After a Uterine Fibroid Embolization
For a rapid and worry-free recovery from your uterine fibroid embolization, we have put together this set of instructions to answer the most common questions that patients have. As always, we are happy to answer any questions!
Contact Us
Speak to our clinical coordinator for any of your treatment concerns.
Hours: Mon-Fri 8 am–5 pm
Phone: 801-581-2967
After-Hours
Hospital paging operator: 801-581-2121
Ask for the interventional radiology resident on call.
After Your Procedure
Over the next several days you are likely to have cramps that come and go as well as feeling as if you have the flu, with low energy, intermittent nausea, and possibly fever. These are all normal side effects of the procedure as your body reacts to the death of the fibroid tissue.
Usually these symptoms are most pronounced the the first two or three days, and by the fourth or fifth day after the procedure you will start to feel better. It is unusual for these symptoms to last longer than seven days. The cramps may continue for a few days longer.
Because of the flu-like symptoms, most patients will need about one week off from work. While you will progressively feel better over several days, you should anticipate a generalized lack of energy and should gauge your activity accordingly.
We do not recommend travel plans for two weeks and would not advise overseas travel for one month or until you feel completely recovered. With this overview, we discuss specific problems below.
Follow-Up Care
We will call you the day after your discharge to check your progress and to answer any questions. At this time, we will schedule a follow-up visit the following week. We will call you in 30 days after the procedure to be sure that there have not been any problems.
At three months post-procedure, we will send you a brief questionnaire and a prescription for an MRI. We would encourage you to have a brief follow-up visit at that time to review the films and your symptom status.
You should also continue your normal gynecologic well-woman care with your gynecologist. This includes monthly self-breast exams and yearly pelvic exams with pap smear as suggested by your gynecologist.
Puncture Sites
Arterial punctures were performed at the top of the leg, and Band-Aids or a clear tegaderm dressing are in place over the puncture site. You may shower in 24 hours, but we ask you not to bathe in a tub for five to seven days until the puncture site is well sealed.
For the next two days replace the Band-Aid with a dry, clean one after your shower. This will promote healing.
Bleeding
If you notice any swelling or active bleeding form the puncture site, you should use direct pressure by placing your fingers and a clean cloth or paper towel over the site. Immediately call for assistance and report to the nearest emergency room for evaluation.
Post-procedure bleeding is extremely rare after discharge, but we want you to be aware of what to do should this occur.
Bruising
There may be some bruising at the puncture site, and this is normal. This bruising may spread out over several days. This is the normal way in which a small amount of blood under the skin is reabsorbed. Don’t be concerned.
You may also notice a small knot under the skin at the puncture site, usually about the size of a large pea. This too is part of the healing process and will usually fade away within a few months.
Sometimes, patients will notice continuing pain at the puncture site or in the upper thigh. This is usually due to irritation of the nerve branch that passes by the puncture site. If this is bothersome, you may continue to take Motrin of Advil, which will usually reduce the discomfort.
While it is possible for this discomfort to continue for several weeks or longer, this is very rare. Should this occur, please contact us.
Diet and Activity
You can resume your normal diet and medications. You should slowly increase your activity over the next three to four days. Seven days after the procedure, you may have unrestricted activity, including sexual activity and exercise.
Do not drive until you are no longer taking the prescription pain medications (Percocet or Dilaudid). These medications may make you sleepy. Because of this, do not operate any machinery or kitchen appliances while you are taking them.
Medications
You have been given a number of prescriptions to help manage pain and nausea that may occur in the first several days post-procedure. For convenience, we have provided the following table of the generic and trade names of the prescription drugs we usually use.
| Action | Generic Name | Brand Name |
|---|---|---|
| Anti-inflammatory | Ibuprofen | Motrin |
| Pain relief | Oxycodone | Percocet |
| Pain relief-severe | Hydromorphone | Dilaudid |
| Anti-nausea | Ondansetron | HCL Zofran |
| Anti-nausea | Promethazine | Phenergan |
Pain & Side Effects
Pelvic Pain and/or Cramps
You should expect to have pelvic pain and cramping over the next several days to two weeks. Usually this lasts for three to four days. It is most intense the day after the procedure and decreases each day thereafter. You have been given Motrin (Ibuprofen), which is an anti-inflammatory medication. Take 800mg every six hours for four days.
In addition, you have been given narcotic pain medications to assist with pain control. Percocet (Oxycodone) is a narcotic pain reliever and generally provides substantial relief for most patients. You may take one or two tablets every four hours as needed for pain.
You have also been given a stronger narcotic pain reliever called Dilauded (Hydodrmorohone). If you do not receive any relief from the Percocet, you may use Dilaudid instead of the Percocet. Take one Dilaudid tablet every four hours as needed for pain.
Nausea
It is not unusual to experience nausea after the procedure. You have been given a prescription for an anti-nausea medication. This is either Phenergan (Promethazine) or Zofran (Ondansetron Hydrochloride). You may take this medication according to the label directions every four to six hours as needed for nausea.
If the medication you have been given does not relieve the nausea, call us and we can prescribe an alternate medication.
Heartburn and Constipation
While taking the Motrin, it is important to protect your stomach from irritation. Try and eat some food before taking the medication and take it with a full glass of water. It is best to remain in an upright sitting position for at least 30 minutes after taking the Motrin.
A common side effect of the prescription pain medicine is constipation. Feel free to use Milk of Magnesia or a warm glass of prune juice prior to drinking your morning coffee or eating breakfast.
Also, remember to drink at least eight glasses of water a day. We have included a prescription for colace a stool softner for you to take daily for while you are taking pain medication.
Fever
A mildly elevated temperature is a common side effect of uterine fibroid embolization and occurs in approximately 20–25 percent of patients. The fever is a side effect of the fibroids dying and does not indicate infection in most cases.
This should be treated with regular Tylenol. You may take two tablets every four hours while the fever is present. Motrin will also relieve fever.
High temperatures (greater than 102), a fever that persists for more than three days, or a fever that arises more than a week after the procedure might indicate infection, and you should call the number above.
In general, infections that might develop would be much more likely to develop in a week to several weeks after the procedure.
Menstrual Periods, Vaginal Discharge, or Spotting
A brown or reddish brown vaginal discharge or spotting after the embolization is considered normal and may continue for a few weeks or until your first period. You may use a sanitary napkin until it resolves. We would prefer you not use a tampon for the first week after the procedure.
Occasionally, patients will have a clear watery discharge for several weeks or months after the procedure. This does not indicate infection. Of greater concern is a thick or foul smelling discharge, particularly if it is accompanied by fever or pelvic pain. This may indicate an infection and you need to contact us.
On occasion, the procedure causes you to start a menstrual cycle early or you may skip a period or two. If heavy bleeding was one of the symptoms caused by your fibroids, often your periods will be better right away. However, some patients will not improve for two or three cycles; so don’t be discouraged if there is no immediate improvement.
Regardless of whether bleeding or pressure and pain were symptoms, most patients will have improvement by the third month after the procedure. The first and possibly the second menstrual periods may be more uncomfortable than usual. Some patients tend to have increased cramps during these periods. This should resolve as the fibroids shrink.
The fibroids take several months to significantly shrink and may continue shrinking for up to a year. So short-term improvement in the size of the uterus should not be expected.
Hormonal Changes
Some patients may experience symptoms as a result of changes in their hormonal balance after the procedure. Because fibroids are estrogen driven, as they die there may be a sudden change in hormones.
Some women may experience mild depression, which usually subsides in a few days. Others experience hot flashes and/or night sweats that may persist for a few weeks. These symptoms are generally self-limiting and resolve without treatment.
Signs of Potential Problems
Symptoms that might indicate problems include the following:
- Swelling or active bleeding from the puncture site
- Pain that arises several days or weeks after the initial pain has resolved
- A temperature several days to weeks after the initial procedure
- An abnormal vaginal discharge (particularly if foul smelling or copious)
This might indicate either an infection or partial passage of a portion of the fibroid and may require gynecologic evaluation. If any of these symptoms occur, please contact the clinical coordinator to assess the symptoms and recommend further treatment recommendations.