Uterine Fibroid Embolization (UFE)

Introduction

If you have been diagnosed with uterine fibroids and are looking for a treatment that does not involve removing your uterus or making a large surgical cut, uterine fibroid embolization (UFE) may be one of the options your doctors have raised. UFE is a minimally invasive procedure performed by an interventional radiologist — a doctor who uses imaging to guide thin tubes through blood vessels to treat problems from the inside.

This article explains what UFE is, how it works, who it tends to suit, how it compares with other fibroid treatments such as myomectomy and hysterectomy, what the procedure day looks like, and what recovery involves. It also covers risks, the question of fertility after UFE, and the long-term outlook.

UFE has been used for fibroid symptoms since the 1990s and is now recognised in major society guidelines, including those of the American College of Obstetricians and Gynecologists (ACOG) and the Society of Interventional Radiology (SIR), as an established alternative to surgery for many women with symptomatic fibroids. Whether it is the right choice in any particular case is a decision to make with your gynaecologist and an interventional radiologist together.

What Is Uterine Fibroid Embolization?

Uterine fibroid embolization is a procedure that shrinks fibroids by cutting off their blood supply. It is also called uterine artery embolization, or UAE. The two terms refer to essentially the same procedure; “UFE” emphasises the target (the fibroids) while “UAE” emphasises the route (the uterine arteries). You may hear either name used.

Fibroids, also called myomas or leiomyomas, are non-cancerous growths of muscle tissue in the wall of the uterus. They are very common — the majority of women develop at least one fibroid by their late forties, although many cause no symptoms. When fibroids do cause problems, they typically grow because they have a rich blood supply feeding them through branches of the uterine arteries.

During UFE, an interventional radiologist threads a thin, flexible tube called a catheter through a blood vessel — usually in the wrist or the groin — and steers it into the uterine arteries on both sides of the uterus. Tiny particles, about the size of grains of sand, are then injected through the catheter. These particles lodge in the small vessels that feed the fibroids, blocking blood flow. Without their blood supply, the fibroids gradually shrink and soften over the following weeks and months. The surrounding healthy uterine tissue has additional blood supply from other vessels and generally recovers normally.

UFE does not remove fibroids. It treats them by starving them, so that they become smaller and less symptomatic. For many women, this is enough to relieve the heavy bleeding, pressure, and pain that brought them to seek treatment in the first place.

Why Is UFE Performed?

UFE is performed to treat symptoms caused by fibroids when those symptoms are significantly affecting quality of life. Fibroids themselves are not dangerous in most cases, but the problems they cause can be substantial. Common reasons doctors consider UFE include:

• Heavy menstrual bleeding — periods that soak through pads or tampons quickly, last longer than a week, or cause anaemia (low iron levels and fatigue)
• Pelvic pressure or a feeling of fullness — caused by the bulk of the fibroids pressing on surrounding structures
• Urinary symptoms — frequent urination or difficulty emptying the bladder when fibroids press on it
• Constipation or rectal pressure — when fibroids press backward on the bowel
• Pain — including period pain, pain during sex, or chronic pelvic discomfort
• Visible enlargement — an abdomen that protrudes because of large fibroids

UFE is generally considered when these symptoms are present and the woman wishes to avoid hysterectomy, wishes to avoid open surgery, or has medical reasons that make surgery higher risk. It is one of several options — not the only one — and the choice depends on the size, number, and location of the fibroids, the woman's age, her plans for future pregnancy, and her own preferences.

Who Is a Candidate?

UFE is most commonly offered to women who:

• Have fibroids confirmed on imaging (ultrasound and usually MRI)
• Have symptoms significant enough to want treatment
• Have completed childbearing or accept that fertility outcomes after UFE are not fully predictable
• Want to keep the uterus
• Prefer a minimally invasive option over surgery

UFE is generally not the first choice in certain situations. These include:

• Pregnancy — UFE is not performed during pregnancy
• Active pelvic infection — should be treated before any intervention
• Suspicion of cancer — if there is concern about uterine or ovarian malignancy, UFE is usually deferred until the question is answered, because shrinking a mass without a tissue diagnosis is risky if the mass turns out not to be a fibroid
• Pedunculated subserosal fibroids on a thin stalk — fibroids hanging off the outside of the uterus on a narrow base may detach after embolization, which can cause complications
• Very large submucosal fibroids protruding into the uterine cavity — some of these can pass out through the cervix after UFE, which can be painful and may require additional procedures
• Allergy to contrast dye — though this can sometimes be managed with pre-medication
• Severe kidney problems — because of the contrast required during imaging

The pre-procedure MRI is important because it shows the size, number, and exact position of fibroids, helps rule out other diagnoses such as adenomyosis (where the uterine lining grows into the muscle wall), and confirms that the fibroids have a typical blood supply pattern suitable for embolization.

Alternatives to UFE

UFE sits among several treatment options for fibroids. Understanding the alternatives is important because each has different trade-offs, and what is best in one situation may not be best in another. Major societies including ACOG and the RCOG recommend that women with symptomatic fibroids be offered a discussion of the full range of options before any single one is chosen.

Watchful Waiting

If fibroids are present but symptoms are mild, doing nothing — with periodic monitoring — is a legitimate option. Fibroids often shrink on their own after menopause as oestrogen levels fall. For a woman close to menopause with manageable symptoms, waiting can sometimes spare her any intervention.

Medical Management

Several medications can reduce fibroid symptoms, especially bleeding, though most do not shrink fibroids permanently:

• Non-hormonal medications such as tranexamic acid (taken during periods to reduce bleeding) and non-steroidal anti-inflammatory drugs for pain
• Combined hormonal contraceptives — pills, patches, or rings — which can lighten bleeding
• The levonorgestrel intrauterine system (hormonal IUD) — often very effective for reducing heavy bleeding, though it may be less suitable when fibroids significantly distort the uterine cavity
• GnRH agonists and antagonists — medications that lower oestrogen and can shrink fibroids and stop bleeding, used mainly as a short-term measure before surgery or to bridge a woman to menopause; long-term use has side effects related to low oestrogen
• Selective progesterone receptor modulators — available in some countries with restrictions due to liver-related safety concerns

Medications can be a good option when symptoms are mainly bleeding, when surgery is not desired, or as a temporary measure. They tend to lose effect when stopped.

Myomectomy

Myomectomy is the surgical removal of fibroids while leaving the uterus in place. It can be done in several ways:

• Hysteroscopic myomectomy — for fibroids inside the uterine cavity, removed through the vagina and cervix with no skin incisions
• Laparoscopic or robotic myomectomy — for fibroids in the uterine wall or on its outer surface, removed through small abdominal incisions
• Abdominal (open) myomectomy — for very large or numerous fibroids, performed through a larger incision

Myomectomy is often considered when a woman wants to preserve fertility, because the uterus and its cavity can be reconstructed. New fibroids can grow after myomectomy in some women.

Hysterectomy

Hysterectomy — surgical removal of the uterus — is the only treatment that guarantees fibroids will never return, because the uterus itself is removed. It is a major option for women who have completed childbearing and have severe symptoms. It can be done abdominally, vaginally, laparoscopically, or robotically. Hysterectomy ends menstrual periods and the possibility of pregnancy.

Endometrial Ablation

Endometrial ablation destroys the lining of the uterus to reduce or stop bleeding. It addresses bleeding but not the fibroids themselves and is less effective when fibroids significantly distort the uterine cavity. It is not suitable for women who want future pregnancy.

Newer Image-Guided Treatments

Other minimally invasive treatments for fibroids include radiofrequency ablation (where heat is used to destroy fibroid tissue, delivered either laparoscopically or through the cervix) and MRI-guided focused ultrasound, where focused sound waves heat and destroy fibroid tissue without any incision. Availability of these technologies varies between centres.

Where UFE Fits

Compared with hysterectomy, UFE preserves the uterus and avoids major surgery, but it does not eliminate the possibility that some fibroid symptoms could return. Compared with myomectomy, UFE is less invasive and treats multiple fibroids at once, but it is generally considered less predictable for women specifically planning pregnancy. Compared with medications, UFE provides a more definitive result but requires a procedure. The right choice depends on goals, anatomy, and personal preference, and is a clinical decision made with your specialists.

How UFE Works: The Principle

Understanding what happens inside the body during UFE can help make sense of what the procedure day and the recovery look like.

Each side of the uterus is supplied with blood by a uterine artery, which branches off the larger internal iliac artery in the pelvis. As fibroids grow, they develop their own dense network of small vessels fed by these uterine arteries. Healthy uterine muscle also receives blood from these arteries but has additional connections from neighbouring vessels, including the ovarian arteries.

During UFE, the interventional radiologist injects tiny particles — typically made of polyvinyl alcohol or a similar material — into the uterine arteries. The particles are sized to lodge in the small vessels feeding fibroids while sparing the larger normal vessels. The fibroids' blood supply is cut off, so they begin to soften, shrink, and die. The uterine muscle around them maintains enough blood supply, through its alternative vessels, to recover. Over the following weeks and months, the dead fibroid tissue is gradually reabsorbed by the body or, in the case of fibroids close to the uterine cavity, sometimes passed out through the cervix.

This is why the symptom improvement from UFE happens gradually rather than immediately, and why most of the benefit is seen between three and twelve months after the procedure.

Preparing for UFE

Preparation usually begins several weeks before the procedure date.

Consultations and Imaging

You will typically meet both a gynaecologist and an interventional radiologist before UFE. The gynaecologist confirms the fibroid diagnosis, rules out other causes of your symptoms, and discusses the full range of options. The interventional radiologist reviews your imaging, confirms the procedure is technically feasible, and explains what to expect.

Pre-procedure imaging almost always includes a pelvic MRI. MRI shows the fibroids' size, number, and location more accurately than ultrasound and helps identify any features that would change the plan.

Blood Tests and Health Review

Standard pre-procedure tests usually include blood counts, kidney function, and clotting tests. Your team will review your medications. Blood thinners may need to be paused beforehand. Iron supplements may be started if your bleeding has made you anaemic, because correcting anaemia before any procedure is helpful.

Stopping Eating and Drinking

You will be asked not to eat for several hours before the procedure. Clear fluids are sometimes allowed up to a few hours before. Specific instructions vary between centres.

Practical Preparation

UFE typically involves an overnight hospital stay, though some centres now perform it as a day-case procedure with same-evening discharge. You will need someone to take you home afterwards and ideally to stay with you for the first day or two. Plan to take at least one to two weeks off work or normal activity.

What Happens During the Procedure

Anaesthesia and Sedation

UFE is generally not performed under general anaesthesia. Most centres use a combination of local anaesthetic at the access point and intravenous sedation, which keeps you relaxed and comfortable but not fully asleep. Some centres add epidural or spinal anaesthesia, particularly when significant post-procedure pain is anticipated.

Access

The interventional radiologist makes a small puncture in an artery — either in the wrist (radial artery) or in the groin (femoral artery). A thin catheter is passed through this puncture and steered, under continuous X-ray imaging with contrast dye, to the uterine arteries on each side of the uterus.

Embolization

Once the catheter is positioned correctly in the uterine artery, the tiny embolic particles are injected slowly. Imaging confirms that blood flow through the fibroid vessels has stopped. The catheter is then moved to the other side and the process is repeated. Both uterine arteries are usually treated in the same session because fibroids almost always have blood supply from both.

Finishing Up

The catheter is removed. Pressure is applied to the puncture site, or a small closure device is used, to prevent bleeding. You are taken to a recovery area for monitoring.

Many women experience pelvic cramping that begins shortly after the procedure as the fibroids lose blood supply. This is expected and is managed with strong pain relief, often through a patient-controlled pump that lets you give yourself medication within safe limits.

Recovery and Healing

The First Few Days

Most women stay in hospital for one night, sometimes two. Pelvic cramping is usually strongest in the first 6 to 24 hours and is managed with intravenous pain medication. Many women also experience nausea, low fever, fatigue, and a general feeling of being unwell — this is sometimes called “post-embolization syndrome” and reflects the body's response to the dying fibroid tissue.

You will be encouraged to get up and walk within a few hours, once it is safe given the access site. The puncture site is small and usually only needs a dressing.

The First Two Weeks

You will go home with oral pain medication, often a combination that includes anti-inflammatory drugs. Pelvic cramping typically settles over the first 5 to 10 days. Fatigue, mild fever, and a sense of being run-down can persist for up to two weeks. Light vaginal bleeding or discharge is common.

During this time:

• Rest as much as you need to
• Drink plenty of fluids
• Take pain medication on a regular schedule rather than waiting for pain to peak
• Avoid heavy lifting and strenuous exercise
• Avoid tampons, sexual intercourse, and swimming for the period your doctor advises — usually around two to four weeks — to reduce infection risk

Most women return to office-type work within one to two weeks, and to more physical activity over the following weeks.

The First Year

The fibroids continue to shrink for several months. Heavy bleeding often improves with the first or second period after UFE; pressure and bulk symptoms improve more slowly, as the fibroids physically reduce in size. By three months, many women already notice a clear difference; by six to twelve months, the maximum benefit is usually reached. Major society reviews report that most women experience significant symptom improvement during this period.

Periods may be irregular for the first few cycles. Some women pass small amounts of fibroid tissue vaginally as the cavity remodels, especially if a fibroid was close to the uterine lining. This can occasionally cause discomfort or unusual discharge and should be reported to your doctor.

Risks and Complications

UFE is generally well tolerated, but, like any medical procedure, it carries risks. Knowing them helps you make an informed decision and recognise problems if they occur.

Common and Expected Effects

• Pelvic pain in the first days after the procedure (expected, not a complication, but can be substantial)
• Post-embolization syndrome — low fever, nausea, fatigue, malaise — usually settling within two weeks
• Vaginal discharge or light bleeding for several weeks
• Bruising at the access site

Less Common Complications

• Infection — can occur in the uterus and rarely becomes serious. Persistent fever, foul-smelling discharge, or worsening pain after the first week should be evaluated urgently
• Passage of fibroid tissue through the cervix, sometimes painful, occasionally requiring a procedure to remove it
• Premature ovarian failure or earlier menopause — uncommon overall, but the risk is higher in women over 45, because some embolic particles can reach the ovaries through small connecting vessels
• Persistent or recurrent symptoms — some fibroids may not shrink enough, or new ones may grow; further treatment, including repeat UFE or surgery, is sometimes needed
• Access site problems — bleeding, bruising, or, rarely, damage to the artery requiring repair
• Allergic reactions to contrast dye
• Damage to non-target tissue — very rare, when particles travel to vessels other than those intended

Rare but Serious Complications

• Serious infection requiring hysterectomy to control
• Blood clots in the legs or lungs
• Rarely, death — reported in major reviews as very uncommon

Overall complication rates are lower than for major fibroid surgery in most reported series, but the comparison depends on the specific risk being considered. Your interventional radiologist can discuss what is relevant to your individual situation.

UFE and Fertility

The effect of UFE on future fertility is one of the most discussed questions about the procedure. The honest summary is that the picture is incomplete and the evidence is mixed.

Pregnancy is possible after UFE, and many women have gone on to have healthy children. However, when UFE has been compared directly with myomectomy in women specifically wanting to become pregnant, some studies have suggested that pregnancy rates may be lower and miscarriage rates higher after UFE. There is also a small risk that UFE could affect ovarian function, particularly in women approaching their mid-forties.

For these reasons, ACOG and major interventional radiology societies generally describe myomectomy as the preferred fibroid treatment for women whose primary goal is future pregnancy, while noting that UFE may still be appropriate in selected cases — for example, when myomectomy would be very difficult, or when a woman fully understands and accepts the uncertainty.

If preserving fertility is important to you, this is a conversation to have in detail with both your gynaecologist and your interventional radiologist before making a decision. The answer can be different for different women depending on age, fibroid features, and other factors.

Life After UFE

For most women, life after UFE looks much like life before fibroid symptoms began — lighter periods, less pelvic pressure, more energy. The uterus remains in place, periods continue (until natural menopause), and pregnancy remains physiologically possible, though with the caveats above.

Follow-up Visits

You will usually have a check-up at around 4 to 6 weeks after the procedure to review healing, and a follow-up MRI or ultrasound at three to six months to assess how much the fibroids have shrunk. After that, follow-up is generally guided by symptoms.

If Symptoms Return

A small proportion of women have persistent or returning symptoms within a few years of UFE. This can happen because some fibroids did not respond fully, because new fibroids have grown, or because adenomyosis or another condition is also contributing. Options at that point include repeat UFE, myomectomy, hysterectomy, or medical management — the same range as before, considered again in light of what has changed.

Menstrual Changes and Menopause

Periods after UFE are often lighter and shorter, which for many women is a welcome change. Some women notice their periods become irregular for a while before settling. UFE does not directly cause menopause in most women, but a small number experience an earlier menopause than they would otherwise have had, particularly if they were already close to that stage of life.

How to Think About Choosing UFE

The decision between UFE and other fibroid treatments is rarely a clinical emergency. It is worth taking time to:

• Understand the specific features of your fibroids — size, number, location, and how they relate to your symptoms
• Be clear about your own priorities — pregnancy plans, attitude towards surgery, tolerance of a longer or shorter recovery, willingness to accept some chance of further treatment in the future
• Meet both a gynaecologist and an interventional radiologist if you can — each brings a different perspective on the options
• Ask about the experience of the team performing the procedure with UFE specifically, since this is a specialised intervention
• Review your imaging together with the doctors so you understand what they are seeing

Major society guidance emphasises shared decision-making for fibroid treatment, because no single option is best for every woman, and the trade-offs are personal as well as medical.

Frequently Asked Questions

Is UFE painful?

The procedure itself is not painful because of sedation and local anaesthesia. The hours after the procedure typically involve significant pelvic cramping as the fibroids lose blood supply, and this is the most uncomfortable phase. It is managed with strong pain medication, usually intravenously at first and then by mouth. Most women describe pain as well controlled when treated promptly.

How long until I feel better?

Pelvic cramping settles within days. Tiredness and a flu-like feeling can last up to two weeks. Heavy bleeding usually improves within one or two menstrual cycles. Pressure and bulk symptoms improve over several months, with the full benefit usually seen between six and twelve months.

Will my fibroids come back?

The fibroids that are treated shrink and do not regrow if the embolization has worked fully. However, new fibroids can develop in some women, and occasionally a treated fibroid does not shrink enough. A small proportion of women need further treatment within several years.

Will UFE bring on menopause?

Most women's periods continue normally, often lighter than before, until natural menopause. A small number — more often women in their mid-forties — experience an earlier menopause after UFE, thought to relate to a small amount of embolic material reaching the ovaries through connecting vessels.

Can I have UFE if I want to get pregnant in the future?

It is possible to become pregnant after UFE, and many women have done so. However, when fertility is the main concern, current major society guidance generally describes myomectomy as the preferred surgical option. UFE may still be considered in specific situations and should be discussed in detail with both a gynaecologist and an interventional radiologist.

Is UFE a type of surgery?

UFE is a minimally invasive procedure rather than surgery in the traditional sense. There are no surgical incisions in the abdomen and the uterus is not cut or removed. The only skin opening is the small puncture for the catheter, in the wrist or groin.

How is UFE different from MRI-guided focused ultrasound or radiofrequency ablation?

All three are uterus-preserving, minimally invasive treatments, but they work differently. UFE blocks the fibroid's blood supply via catheter. Focused ultrasound uses sound waves to heat fibroid tissue without any incision. Radiofrequency ablation uses heat delivered through a small probe placed directly into the fibroid, either through the abdomen or the cervix. Availability and suitability differ; not every centre offers every option.

How soon can I return to work and exercise?

Most women return to desk-based work within one to two weeks. Light activity can resume within a couple of weeks; vigorous exercise is usually delayed for around four weeks or as advised by your doctor.

Can UFE be repeated?

Yes. If symptoms return because some fibroid tissue remains or new fibroids have grown, repeat UFE is possible in many cases. Whether it is the best next step depends on what has changed and on the woman's wider preferences.

Conclusion

Uterine fibroid embolization offers a uterus-preserving, minimally invasive way to treat fibroid symptoms for many women. It is a well-established option supported by major gynaecology and interventional radiology societies, with a generally favourable safety profile and good long-term symptom control. It is not the only option, and it is not the best option for every woman — particularly those whose main goal is future pregnancy, for whom myomectomy is more often preferred.

The most useful conversations happen when you can sit down with both a gynaecologist and an interventional radiologist, look at your own imaging, talk through what matters most to you, and weigh up the realistic outcomes of each option. Fibroids almost always allow time for that kind of considered decision — and that time is worth taking.