Uterine Fibroid Embolization (UFE) is a minimally invasive procedure designed to treat symptomatic uterine fibroids, which are common non-cancerous growths arising from the muscular wall of the uterus. This non-surgical treatment is a subtype of Uterine Artery Embolization (UAE) and offers an alternative to traditional surgical options like hysterectomy or myomectomy, allowing a woman to retain her uterus. UFE works by targeting the blood vessels that supply the fibroids, causing them to shrink over time and relieving symptoms such as heavy menstrual bleeding and pelvic pressure. The procedure is performed by an Interventional Radiologist, who uses imaging guidance to navigate the body’s vascular system.
How Uterine Fibroid Embolization Works
UFE is an image-guided procedure performed by an interventional radiologist, often under moderate sedation. The process begins with a small incision, typically in the groin or wrist, to access an artery. A thin, flexible tube called a catheter is then carefully threaded through the arterial system.
Using real-time X-ray imaging (fluoroscopy), the specialist guides the catheter until it reaches the uterine arteries, which are the main blood vessels supplying the fibroids. A contrast dye is often injected to map the vascular structure and confirm the exact location of the blood supply. The goal is to reach the arteries on both sides of the uterus.
Once the catheter is positioned correctly, microscopic embolic agents are injected through the tube. These agents are tiny particles, often made of plastic or gelatin, which travel into the smaller blood vessels directly feeding the fibroid tumors.
The particles physically block the blood flow, a process called embolization, which selectively deprives the fibroids of oxygen and nutrients. This induced lack of blood flow stops the fibroids from growing and causes them to shrink and undergo tissue death. The procedure aims to cut off the fibroid’s blood supply while preserving the blood flow to the healthy uterine tissue.
Determining Patient Suitability
The decision to proceed with UFE involves a thorough assessment of the patient’s symptoms, fibroid characteristics, and future reproductive goals. Patients who are experiencing significant symptoms such as heavy menstrual bleeding, chronic pelvic pain, or pressure-related issues are the most suitable candidates for the procedure. The severity of these symptoms is a primary factor in determining the need for intervention.
Fibroid characteristics, including their size, number, and location, also play a role in candidacy. UFE is generally effective for a wide range of fibroid types, including intramural (within the uterine wall) and subserosal (on the outer surface of the uterus) fibroids. However, certain types, like very large pedunculated subserosal fibroids, may require special consideration.
Patient-specific factors are equally important, particularly the desire for future pregnancy. While UFE preserves the uterus, it is generally not recommended for women who prioritize future fertility, as the procedure can potentially affect the blood supply to the healthy uterine lining. For women still planning to conceive, myomectomy (surgical removal of the fibroids) is often the preferred option.
Contraindications, or factors that rule out UFE, include active pelvic infection, which must be treated before the procedure. Known or suspected malignancy (cancer) of the uterus is a definitive exclusion criterion. Patients with significant kidney impairment or severe allergies to the contrast dye used during the procedure may also not be suitable candidates due to the medical risks involved.
Immediate Post-Procedure Care and Long-Term Results
Immediately following the UFE procedure, patients are monitored in a recovery area for several hours, and some may require an overnight stay in the hospital, particularly for pain management. The most common immediate side effect is intense pelvic pain and cramping, which is an expected response as the fibroids begin to die. This pain is managed with a combination of intravenous and oral analgesics.
Many women also experience a temporary constellation of symptoms known as post-embolization syndrome, which typically manifests as a low-grade fever, fatigue, and nausea. These flu-like symptoms are a normal reaction to the dead fibroid tissue and usually subside within the first two to seven days after the procedure. Most patients are able to return to their normal daily activities within one to two weeks, a significantly shorter recovery period than traditional open surgery.
The long-term results of UFE are focused on symptom resolution and fibroid shrinkage. Patients often begin to notice a significant improvement in heavy menstrual bleeding within the first one to three menstrual cycles. Relief from bulk-related symptoms, such as pelvic pressure and frequent urination, typically takes longer, with measurable fibroid shrinkage occurring over three to six months and continuing for up to a year.
UFE is highly effective, with approximately nine out of ten women reporting significant improvement or complete resolution of their fibroid symptoms. While the procedure offers durable relief, there is a small chance of fibroid recurrence or a need for subsequent treatment over time. Ongoing follow-up with the interventional radiologist and gynecologist is necessary to monitor long-term outcomes.