Uterine fibroid embolization (UFE) is a minimally invasive procedure that shrinks fibroids by cutting off their blood supply. Instead of surgically removing fibroids or the uterus, an interventional radiologist threads a thin catheter through a small incision in the wrist or groin, guides it to the arteries feeding the fibroids, and injects tiny particles that block blood flow. Without blood, the fibroids gradually shrink. About 88% of patients report improved or stabilized symptoms within six months.
How UFE Works
Fibroids depend on a rich blood supply to grow. UFE targets that vulnerability. During the procedure, you receive sedation and local anesthesia. The radiologist makes a tiny puncture, usually at the wrist or upper thigh, and inserts a catheter no wider than a strand of spaghetti. Using real-time X-ray imaging, they navigate the catheter into the uterine arteries, the vessels that feed the fibroids.
Once in position, the radiologist injects microscopic particles, most commonly made of polyvinyl alcohol. These particles lodge in the small blood vessels surrounding the fibroids and trigger a clotting reaction. The combination of the particles and the body’s own clotting response seals off blood flow completely. Starved of oxygen and nutrients, the fibroid tissue dies and slowly shrinks over the following weeks and months. The uterus itself continues to receive adequate blood from other pathways.
At 12 months, fibroids shrink by an average of 37%, and total uterine volume decreases by roughly half. The entire procedure typically takes one to two hours.
Symptoms It Treats
UFE is used specifically for fibroids that cause symptoms. You might be a candidate if your fibroids are causing heavy menstrual bleeding (especially if it has led to anemia), pelvic pain or pressure, an enlarged abdomen, frequent urination from bladder pressure, constipation and bloating from bowel pressure, pain during sex, or back and leg pain from fibroids pressing on nerves. About 92% of patients report improvement in heavy bleeding after the procedure, and roughly 70% experience relief from pain and pressure symptoms.
UFE may not be recommended if your fibroids are very large, though the size threshold varies by clinical judgment.
Who Should Not Have UFE
A few conditions rule out UFE entirely. An active pregnancy is an absolute contraindication. So is an untreated pelvic infection, because blocking blood flow in the presence of infection creates a high risk of abscess. Suspected uterine cancer also makes UFE inappropriate unless it’s being done for symptom relief alongside other treatment.
Several other situations make UFE riskier but not impossible: blood clotting disorders, severe contrast dye allergy, kidney problems, a compromised immune system, prior pelvic radiation, or chronic uterine inflammation. The desire to become pregnant in the future is also considered a relative contraindication, since fertility preservation cannot be guaranteed.
Recovery Timeline
Most people go home the same day or the next morning. The first few days are the hardest, largely because of something called post-embolization syndrome: cramping, low-grade fever, nausea, and a general feeling of being unwell. These symptoms usually start within the first three days and last one to three days, though they can linger up to 10 days. Pain medication helps manage the cramping, which can range from moderate to intense in the first 24 to 48 hours.
For the first 48 hours, avoid lifting anything over 10 pounds. No baths or soaking in water for five days. Strenuous exercise, including yoga positions that increase blood flow to the abdomen, is off-limits for at least one week. Expect to feel tired for the first week or two, with energy gradually returning. Most people plan for two weeks off work to allow a full recovery, which is significantly shorter than the recovery from a hysterectomy or open myomectomy.
Risks and Complications
Major complications occur in about 3% of cases, based on a large systematic review. The most common issue is fibroid tissue passage, where fragments of the dead fibroid are expelled through the vagina, happening in roughly 5% of patients. This can cause cramping and is sometimes mistaken for a more serious problem, but it’s a normal part of the process.
About 4% of women experience permanent loss of menstrual periods after UFE, which is more common in women over 45. The risk of needing a hysterectomy to resolve a complication is low, around 0.7%. Readmission to the hospital happens in about 2.7% of cases. Serious blood clots (deep vein thrombosis or pulmonary embolism) are rare, occurring in roughly 0.2% of procedures.
UFE and Fertility
If you’re hoping to become pregnant in the future, the relationship between UFE and fertility deserves careful consideration. A meta-analysis covering 20 years of clinical evidence found that about 52% of women who attempted pregnancy after UFE conceived, with an average time to conception of roughly 15 months. Age matters significantly: pregnancy rates were highest in women under 30 (68%) and dropped to about 32% in women over 40.
However, pregnancies after UFE carry elevated risks. The miscarriage rate is about 18%, preterm delivery occurs in roughly 13% of cases, and postpartum hemorrhage happens in about 9% of deliveries. Placental abnormalities occur in about 3% of pregnancies.
Compared to myomectomy (surgical fibroid removal), UFE results in lower pregnancy rates (46% vs. 62%) and lower live birth rates (38% vs. 53%). Women who had myomectomy also conceived faster, averaging about 10 months compared to 16 months after UFE. For women who prioritize future pregnancy, myomectomy is generally the preferred uterine-preserving option.
How UFE Compares to Other Treatments
A Kaiser Permanente study tracking over 10,000 patients for up to seven years found that myomectomy had the lowest rate of needing a second procedure at 21%, followed by UFE at 26%. Endometrial ablation and hysteroscopic myomectomy had higher reintervention rates of 36% and 37%, respectively. This means about one in four women who have UFE will need additional treatment within seven years.
The tradeoff is recovery time and invasiveness. UFE requires no general anesthesia, no abdominal incision, and a recovery period roughly half that of surgical myomectomy. It treats all fibroids simultaneously regardless of their number or location, while myomectomy sometimes cannot reach every fibroid. For women who are done having children, want to keep their uterus, and are looking for the least invasive option with good symptom relief, UFE fills a specific and valuable niche.