Uterine artery embolization
Uterine fibroid embolization; UFE; UAE
Uterine artery embolization (UAE) is a procedure to treat fibroids without surgery. Uterine fibroids are noncancerous (benign) tumors that develop in the uterus (womb).
During the procedure, the blood supply to the fibroids is cut off. This typically causes the fibroids to shrink.
Uterine fibroids are common, non-cancerous or benign tumors that can grow in a woman's womb, or uterus. You might be surprised to learn that one in five women may have this sometimes painful problem during their childbearing years and half of all women will probably have them by age 50. So, let's talk about uterine fibroids. Fibroids are abnormal growths made of smooth muscle cells. The cause of uterine fibroids is unknown, but their growth has been linked to estrogen, a hormone that plays a vital role in pregnancy and how your body uses calcium and maintains healthy cholesterol levels. As long as a woman with fibroids is menstruating, a fibroid will probably continue to grow, usually slowly. As many as 40% though will shrink on their own. Fibroids can be tiny, detectable only by microscope, or they may grow very large, even filling the entire uterus. Most fibroids are small and cause no symptoms at all. If you do have symptoms, the most common symptoms of fibroids is heavy or prolonged periods. Bleeding between periods is not typical of fibroids. Fibroids can also cause fullness, pressure, or pain. For instance, a fibroid pressing on the bladder can make the bladder seem smaller, or more difficult to empty. A fibroid pressing on the rectum, can cause constipation. Particularly painful periods are often reported by many women with fibroids, especially those who pass blood clots or who have very heavy flow. Fibroids that change the shape of the inside of the uterus can make it difficult to conceive, or to carry a baby to term. To treat uterine fibroids, your doctor will first perform a pelvic exam to see if you have a change in the shape of your uterus. You may need an ultrasound or a pelvic MRI to confirm the diagnosis of fibroids. Your doctor may take a sample of tissue called a biopsy to rule out cancer. Once your doctor diagnoses fibroids, treatments may include birth control pills to manage heavy periods, intrauterine devices that release the hormone progestin to help reduce heavy bleeding and pain, or iron supplements to prevent or treat anemia due to heavy periods. Women who have fibroids growing inside the uterine cavity may need an outpatient procedure to remove the tumors. A procedure called uterine artery embolization can stop the blood supply to a fibroid, causing it to shrink and die. Surgery called myomectomy removes fibroids, especially for women who want to have children. Finally, some women may need a hysterectomy, or the removal of the uterus, if medicines do not work and other surgeries and procedures are not an option. Most women with fibroids may have no symptoms at all and may need no treatment at all. During pregnancy, existing fibroids may grow due to increased blood flow and estrogen levels. But they usually return to their original size after the baby is born. Call your health care provider if you have changes in your periods, including heavier bleeding, increased cramping, or a feeling of fullness or heaviness in your lower belly area.
Fibroid tumors may not need to be removed if they are not causing pain, bleeding excessively, or growing rapidly.
Description
UAE is done by a doctor called an interventional radiologist.
You will be awake, but you will not feel pain. This is called conscious sedation. The procedure takes about 30 to 90 minutes.
The procedure is usually done this way:
- You receive a sedative. This is medicine that makes you relaxed and sleepy.
- A local painkiller (anesthetic) is applied to the skin around your groin or wrist. This numbs the area so you do not feel pain.
- The radiologist makes a tiny cut (incision) in your skin. A thin tube (catheter) is inserted into your femoral artery. This artery is at the top of your leg.
- The radiologist threads the catheter into your uterine artery. This artery supplies blood to the uterus.
- Small plastic or gelatin particles are injected through the catheter into the blood vessels that supply blood to the fibroids. These particles block the blood supply to the tiny arteries that carry blood to the fibroids. Without this blood supply, the fibroids shrink and die.
- UAE is done in both your left and right uterine arteries through the same incision. Multiple fibroids can be treated.
Why the Procedure Is Performed
UAE is an effective way to treat symptoms caused by fibroids. Discuss with your health care provider whether this procedure is likely to be successful for you.
Women who benefit from UAE may:
- Have symptoms of fibroids including bleeding, low blood count, pelvic pain or pressure, waking up at night to urinate, and constipation
- Have already tried medicines or hormones to reduce symptoms
- Sometimes have UAE after childbirth to treat very heavy vaginal bleeding
Risks
UAE is generally safe.
Risks of any invasive procedure are:
Risks of UAE are:
- Injury to an artery or to the uterus.
- Failure to shrink the fibroids or effectively treat the symptoms.
- Possible problems with a future pregnancy. Women who want to become pregnant should carefully discuss this procedure with their provider, since it may reduce the chances of a successful pregnancy.
- Lack of menstrual periods.
- Problems with ovarian function or premature menopause.
- Failure to diagnose and remove a rare type of cancer that can grow in fibroids (leiomyosarcoma). Most fibroids are noncancerous (benign), but leiomyosarcomas occur in a small number of fibroids. Embolization will not treat or diagnose this condition.
Before the Procedure
Always tell your provider:
- If you could be pregnant, or you plan to become pregnant in the future
- What medicines you are taking, including medicines, supplements, or herbs you bought without a prescription
Before UAE:
- You may be asked to stop taking aspirin, ibuprofen (Advil, Motrin), warfarin (Coumadin), and any other medicines that make it hard for your blood to clot.
- Ask your doctor which medicines you should still take on the day of your surgery.
- If you smoke, try to stop. Your provider can give you advice and information to help you quit.
On the day of UAE:
- You may be asked not to drink or eat anything for 6 to 8 hours before this procedure.
- Take the medicines your doctor told you to take with a small sip of water.
- Arrive on time at the hospital as instructed.
After the Procedure
You may stay in the hospital overnight. Or you may go home the same day.
You will receive pain medicine. You will be instructed to lie flat for 4 to 6 hours after the procedure.
Follow any other instructions about taking care of yourself after you go home.
Moderate to severe abdominal and pelvic cramps are common for the first 24 hours after the procedure. They may last for a few days to 2 weeks. Cramps may be severe and may last more than 6 hours at a time.
Most women recover quickly and are able to return to normal activities within 7 to 10 days. Sometimes portions of the treated fibroid tissue may pass through your vagina.
Outlook (Prognosis)
UAE works well to decrease pain, pressure, and bleeding from fibroids in most women who have the procedure.
UAE is less invasive than surgical treatments for uterine fibroids. Many women may return more quickly to activities than after surgery.
Similar to a myomectomy or any procedure where the uterus is not removed, there is a small risk of recurrence of bleeding from fibroids. If this occurs, the symptoms can be treated with hysterectomy (surgery to remove the uterus), myomectomy (surgery to remove the fibroid) or repeating the UAE.
References
Dolan MS, Hill CC, Valea FA. Benign gynecologic lesions: vulva, vagina, cervix, uterus, oviduct, ovary, ultrasound imaging of pelvic structures. In: Gershenson DM, Lentz GM, Valea FA, Lobo RA, eds. Comprehensive Gynecology. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 18.
Moravek MB, Bulun SE. Uterine fibroids. In: Jameson JL, De Groot LJ, de Kretser DM, et al, eds. Endocrinology: Adult and Pediatric. 7th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 131.
Spies J. Uterine fibroid embolization. In: Mauro MA, Murphy KP, Thomson KR, Venbrux AC, Morgan RA, eds. Image-Guided Interventions. 3rd ed. Philadelphia, PA: Elsevier; 2021:chap 43.
Version Info
Last reviewed on: 1/10/2023
Reviewed by: Jason Levy, MD, FSIR, Northside Radiology Associates, Atlanta, GA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
