Uterine artery embolization is a minimally invasive procedure. It blocks blood flow to noncancerous tumors called fibroids in the uterus, causing them to shrink and die.
These growths are almost always noncancerous (benign). They range from the size of a pea to the size of a melon. They do not always cause symptoms.
Uterine artery embolization (UAE) may be an option for people whose fibroids cause symptoms and who want to keep their uterus. Doctors may also use UAE to treat other conditions, such as postoperative and postpartum bleeding.
This article explores UAE, who might need it, and how the procedure works.
UAE is a minimally invasive procedure that helps manage serious pelvic bleeding. It involves delivering small particles to uterine blood vessels. This helps to block blood supply or stop heavy bleeding.
Doctors typically use the procedure to treat fibroids. A similar procedure is uterine fibroid embolization (UFE).
UFE is a specific form of UAE. It blocks the blood supply that nourishes fibroids, gradually causing them to shrink and die over weeks or months.
UAE may help people whose fibroids cause symptoms.
Fibroid symptoms may include:
- heavy menstrual periods
- pain in the abdomen or lower back
- pressure or feeling of fullness in the lower abdomen
- problems with urination and bowel movements
- enlarged uterus and abdomen
- issues with pregnancy and fertility
- pain during sex
The ideal candidates for UAE are people who:
- are of premenopausal age
- have heavy regular periods or pain during menstruation (dysmenorrhea) due to fibroids
- have no desire for future pregnancy
Doctors may also prescribe UAE to stop heavy pelvic bleeding
Doctors may recommend UAE as a preventive measure (prophylaxis) to reduce bleeding during certain operations.
They may recommend it for people who do not want to undergo other treatments or have already attempted other therapies to address their symptoms.
Here is a breakdown of what a person can expect before, during, and after the procedure.
Before the procedure
Before UAE, the doctor will ask about the person’s general health status and their gynecological, menstrual, and medical history. They will also ask if the person is currently pregnant or wishes to become pregnant in the future.
If a doctor suspects fibroids, they will likely use imaging techniques such as MRI and ultrasound to determine the cause of the symptoms and to assess the size, location, and the number of fibroids the person has.
They will also ask about the medications the person is taking and whether they have any known allergies to anesthetics, injected dyes, or contrast materials.
How to prepare
The doctor may ask the person to stop taking certain medications such as aspirin and nonsteroidal anti-inflammatory drugs for a specific period before the procedure. A person may wish to ask their doctor which medications they can still take on the day of the procedure.
Medical staff will likely also tell the person not to eat or drink anything in the hours before the procedure. Doctors will also ask people who smoke to stop smoking for a certain number of weeks before the procedure.
A specialist called an interventional radiologist will perform the procedure in a radiology room suite. The procedure takes about 2 hours. The person will be awake during the procedure and will not feel any pain.
The steps for a UAE procedure are as follows:
- A person will have an angiogram. This produces a series of X-ray images of arteries supplying the fibroid or fibroids in the uterus.
- The person’s groin area will be shaved and sterilized.
- A nurse will insert an IV line to deliver fluids into the hand or arms. This is also where the anesthesiologist will provide the sedative to make the person feel sleepy and relaxed.
- The doctor will inject a local anesthetic into the skin site to numb the area.
- With X-ray guidance, the doctor will make a small incision at the groin crease and insert a thin, flexible tube, called a catheter, into the large artery located in the groin.
- A medical professional will inject small particles, made of either polyvinyl alcohol or gelatin, through the catheter into the blood vessels supplying the fibroids.
- Finally, the doctor will remove the catheter, manage the bleeding, and apply a dressing to the puncture site. The person will not need stitches.
A person will likely go home the same day or the day after the procedure. They will need to stay on bed rest for several hours, lying flat on the bed with their legs straight.
A healthcare team will monitor the person and provide medications to manage pain and discomfort. A person may also feel moderate to severe abdominal and pelvic cramps for up to 2 weeks.
Most people recover quickly and can return to typical daily activities within a week.
Some people may experience less menstrual bleeding during their first period after the procedure. They may also notice some fibroid tissue pass through the vagina. It can take up to 3 months to experience noticeable relief from fibroid symptoms.
UAE is generally safe. However, as with any other procedure, it comes with risks. These include general surgical risks, such as:
Experts consider the procedure safe and effective.
Risks specific to UAE include:
UAE is typically effective in decreasing pain, bleeding, and pressure caused by fibroids.
Sometimes, the treatment may not shrink the fibroids or treat the person’s symptoms. In rare cases, people may need immediate surgery due to complications during the procedure. For example, arterial perforation occurs in
The younger a person is, the greater the risk that symptoms will return, eventually requiring surgery.
Doctors use UAE to treat various conditions that cause excessive pelvic bleeding, including uterine fibroids. It is a minimally invasive procedure that may be an alternative to more invasive procedures such as surgery.
UAE is generally safe and effective, with a low risk of complications. However, the procedure is not for everyone. People considering becoming pregnant in the future may choose to decline this procedure since it may lower their chance of becoming pregnant.