Southern Delaware Vascular Institute

Do you smoke or have you ever smoked?*
- Yes
- No
Do you have high blood pressure or are you on blood pressure medication?*
- Yes
- No
Do you have high cholesterol or are you on medication to lower your cholesterol?*
- Yes
- No
Have you ever been told that you have had a heart attack or stroke?*
- Yes
- No
Have you ever been told you have diabetes? Even borderline diabetes?*
- Yes
- No
Have you ever had an angioplasty or stent placed in the heart or leg?*
- Yes
- No

Have you noticed your walking pace has slowed?*
- Yes
- No
Do your legs ever feel tired causing you to stop and rest?*
- Yes
- No
When you walk, do you ever have to stop because you have pain or cramping in your calves or thighs?*
- Yes
- No
Do you ever experience cramping, tightness, "Charlie horse" or pain in the legs or feet when lying down that improves when you stand up?*
- Yes
- No

Do you have any chronic infections of your ankles, feet, or toes?*
- Yes
- No
Do you have any ulcers, or slow healing sores/wounds on your ankles, feet, or toes?*
- Yes
- No

Are you struggling with any of the following problems?*
These are the most common symptoms caused by Uterine Fibroid overgrowth. Choose as many as you’d like
- Bloating, pelvic pain, backache
- Heavy menstrual bleeding
- Anemia or cramping
- Unexplained weight gain
- Frequent urination/constipation
- Pain during sex or infertility
- No symptoms
- Other
Other*
Fibroids are benign tumors that grow in the uterus causing two main types of symptoms:
- Bleeding Symptoms
  The blood vessels that feed fibroids are “leaky” and cause excessive bleeding
- Bulk Symptoms
  As fibroids grow, they can push structures in the belly causing pain and bloating.

Have you been diagnosed with Uterine Fibroids?*
Fibroids are generally diagnosed by ultrasound or MRI.
- Yes
- No
Once diagnosed, fibroids can be treated with a same-day, non-surgical procedure called Uterine Fibroid Embolization (or “UFE”).

During UFE, tiny beads are injected into the fibroid(s) vessels, cutting off blood flow. Without blood flow, the fibroids shrink and die, and symptoms are reduced or eliminated.

Have you gone through menopause?*
Menopause is a time in a woman’s life when her period stops. It’s diagnosed after you’ve gone through 12 months without a menstrual period. Menopause can happen in your 40’s or 50’s, but the average age is 51 in the United States.
- Yes
- No
Are you currently pregnant?*
If you are currently pregnant, procedures or surgeries involving the uterus should be avoided until after the pregnancy is complete.
- Yes
- No
- Maybe

Are you planning to get pregnant in the future?*
- Yes
- No
- Maybe
Studies have shown that women can become pregnant and deliver healthy babies after Uterine Fibroid Embolization.

If you’re suffering from fibroids and are looking to maintain fertility, we recommend you talk to a specialist, and discuss your fertility goals. Your doctor will help you weigh the benefits of treatment against the possibility of pregnancy issues.

Any procedure performed on the uterus to treat fibroids -including UFE- can lead to potential issues with future pregnancy including low birth weight, premature delivery, and miscarriage.