Uterine fibroid embolization (UFE) is a non-surgical technique that shrinks fibroids without removing them. The procedure is performed by an interventional radiologist, an M.D. with basic certification in radiology and special education and certification in interventional radiology. You do not need to be put to sleep, but sedating medications are given in the vein to help you relax during the one to two hours the procedure takes. A small (one-inch) incision is made in the groin directly over the artery carrying blood to the leg. The interventional radiologist guides a long thin catheter (tube) into the blood vessels that supply the uterus while monitoring the process under X-ray. Small plastic particles are pushed through the catheter until they form a blockade to the blood flowing to the uterus. Fibroids have a limited supply of blood vessels, and with the blood flow blocked, the fibroid cells start to die off. The surrounding normal uterine muscle has a better blood supply and is able to survive. Deprived of blood, nutrition, and oxygen, fibroids shrink like prunes for the three to six months following embolization, and the symptoms from the fibroids often lessen as well.

Recovery after UFE
Almost all women have moderate to severe pain for the first day or so after uterine artery embolization and are kept in the hospital for one day so that they can be given narcotic pain medication. Anti-inflammatory medications, like ibuprofen, are also given to keep the inflammation down in the uterus. Paracetamol is given for the fever that commonly follows the procedure.

However, most women are able to go home the next morning and only need to take oral pain and anti-inflammatory medications for the next few days. As with all medical procedures, the recovery varies from woman to woman. Many women feel back to normal within a few days and return to regular activity within a week or so. Other women have pain or discomfort for weeks and may not get back to normal activity for a few weeks or, rarely, even months.

Safety and Effectiveness of UFE
About 90 percent of women who were bothered by symptoms related to the size of their fibroids will have a significant improvement and be satisfied with the results. Likewise, about 85 percent of women who had heavy bleeding from their fibroids will have lighter and shorter periods and be satisfied with the results. About 10 to 15 percent of women who have UFE will continue to have bothersome symptoms and usually require other treatment. Many of the initial women who had UFE have now been followed for three years and are still symptom free. Because the procedure has only been widely available since 1997, we do not have longer follow-up on these women yet.

About 25,000 women worldwide have had UFE performed for uterine fibroids. To date, the procedure has been extremely safe. The Society of Interventional Radiology reports only four deaths from this procedure or 1 out of every 6,000 women who have had UFE. For comparison, the risk of dying from surgery or anesthesia for a hysterectomy is about 2 out of 6,000 women. Risks for an individual are related to your medical condition, your age, and the disease for which you are being treated. Comparing risks of UFE to hysterectomy for women of similar age and condition with fibroids, it appears that the serious risks may be slightly lower with UFE.

Following UFE, some women may develop fever, increasing rather than decreasing pelvic pain, and a vaginal discharge. This combination of symptoms is called post-embolization syndrome. Many of these women will also experience nausea and exhaustion. The symptoms may last for days or even weeks and cause concern because of the possibility that serious infection is present in the uterus. If the symptoms get worse over time, rather than better as would be expected, then an examination and evaluation for infection is important. Post-embolization syndrome will resolve over time, even if it takes a few weeks. However, if infection is present in the uterus, hysterectomy is usually necessary to prevent the spread of a very serious infection throughout the body.

What Are the Long-Term Risks of UFE?
Childbirth after embolization is now viewed with caution. Fibroids are an integral part of the uterine wall, and embolization destroys them. Therefore, the strength of the remaining tissue is uncertain.

Early Menopause
The problem of early menopause has been seen after hysterectomy in some women. If the blood vessels supplying the uterus also have a branch as the main supply to the ovaries, then suturing the uterine arteries during the hysterectomy will destroy the ovaries. Myomectomy, which does not disturb the uterine or ovarian blood vessels, has not been found to cause this problem.

Most interventional radiologists recommend that women who wish to have children not use UFE as treatment for their fibroids.