Surgical Options for Fibroids: Uterine Artery Embolization

Fibroids are very common. By age 50, most women have them, but many never have symptoms. They range from too small to see to larger than a grapefruit, and they are most common during the childbearing years.

This article explains when UAE is recommended, how it is done, and how it compares with other options.

Why choose uterine artery embolization?

UAE is recommended for fibroid symptoms such as:

• Heavy menstrual bleeding
• Pelvic pressure or bloating
• Frequent urination or constipation
• Pain, including pain with sex

Most women have significantly less bleeding and smaller fibroids afterward. It is a good option for women who want to avoid surgery and keep their uterus, and who are not planning a future pregnancy.

The same technique is also used in emergencies to stop severe bleeding, for example after childbirth or trauma.

How is UAE performed?

UAE is performed by an interventional radiologist, usually with moderate sedation rather than general anesthesia. Through a tiny puncture at the wrist or groin, a thin catheter is guided using X-ray imaging into the arteries that supply the uterus. Small particles are injected to block the blood flow to the fibroids. Deprived of blood, the fibroids shrink over the following months, while the rest of the uterus recovers its blood supply from other vessels.

Before the procedure, an MRI or ultrasound is used to map the fibroids and confirm UAE is a good fit.

Embolic materials

• Permanent particles, such as tris-acryl gelatin microspheres or polyvinyl alcohol (PVA) particles, are the standard for fibroid embolization.
• Gelatin sponge particles are temporary and dissolve over weeks. They are used mainly to control acute bleeding, such as after childbirth, rather than to treat fibroids.

Pain control and recovery

Cramping pain is common for the first day or two and is managed with anti-inflammatory and other pain medicines. Many women have "post-embolization syndrome" for several days: pelvic pain, low fever, nausea, and fatigue. Most return to normal activity within one to two weeks, faster than after surgery.

Risks and trade-offs

• Fibroids can regrow or new ones can form; some women eventually need another procedure.
• Rarely, a fibroid breaks off and passes through the vagina, which may need treatment.
• Infection is uncommon but can be serious.
• Ovarian function can be affected, especially in women over 45, occasionally bringing on menopause.
• Pregnancy after UAE is possible, but information on its safety is limited. For women who want to become pregnant, myomectomy is generally preferred.

Who performs UAE?

An interventional radiologist performs the procedure. Your gynecologist plays an important role too: evaluating the cause of your bleeding, ruling out other conditions, and helping you compare UAE with medications, myomectomy, radiofrequency ablation, and hysterectomy.

The bottom line

Uterine artery embolization shrinks fibroids and relieves heavy bleeding and pressure without surgery, with a faster recovery than surgery. It is best suited to women who want to keep their uterus but are not planning a pregnancy.

Talk with your gynecologist about whether UAE fits your symptoms, fibroid size and location, and future plans.