Uterine Artery Embolization

What is uterine artery embolization (UAE)?

Uterine artery embolization (UAE) is a minimally invasive procedure most commonly used to treat vaginal bleeding caused by uterine fibroids (noncancerous tumors inside your uterus). In addition to fibroids, UAE can also treat heavy bleeding in emergency situations due to trauma, malignant (cancerous) gynecological tumors or postpartum hemorrhage.

The terms uterine artery embolization and uterine fibroid embolization (UFE) are often used interchangeably. However, they’re different. UFE is a particular kind of UAE that treats uterine fibroids. UAE treats uterine fibroids as well as several other conditions that may cause vaginal bleeding.

Why is uterine artery embolization (UAE) treatment done?

The most common reason people need uterine artery embolization is to treat uterine fibroid tumors that are causing symptoms such as:

• Heavy menstrual bleeding.
• Pelvic pressure.
• Constipation.
• Painful intercourse.
• Frequent urination.

Your healthcare provider may recommend UAE for other conditions like excessive bleeding after childbirth, trauma or cancerous tumors.

Uterine artery embolization (UAE) shouldn’t be performed if you:

• Have uterine fibroids without symptoms.
• Are pregnant.
• Have a pelvic infection.
• Have a disease that affects your veins, arteries and blood vessels.
• Have an allergic reaction to contrast dyes (used for UAE).

How does uterine artery embolization (UAE) work?

In UAE, tiny particles (like grains of sand) are injected into the blood vessels leading to your uterus. These particles are guided into your uterine arteries through a thin, flexible tube (called a catheter) using fluoroscopy, a form of X-ray that captures moving images. When uterine blood vessels are blocked by these particles:

• Your provider can control excessive bleeding.
• Tumors or fibroids shrink because their blood supply is cut off.

What happens before a uterine artery embolization (UAE)?

Your healthcare provider will recommend UAE after a thorough medical history and evaluation. They’ll perform diagnostic tests to determine the source of your symptoms.

Some of the things that may happen before the procedure include:

• Your provider will review your health history, allergies, medications and menstrual history. You’ll also discuss your plans for pregnancy, as UAE could affect your ability to get pregnant.
• Magnetic resonance imaging (MRI), hysteroscopy or ultrasound of your uterus will help your provider determine the cause of the bleeding.
• A biopsy (tissue sampling) of the inner lining of your uterus may be taken to determine if cancer cells are present.
• Before UAE, your provider will ask you to stop taking aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs) and blood thinners.
• No eating or drinking is permitted before the procedure. Your provider will discuss exact fasting instructions with you.

What happens during uterine artery embolization (UAE)?

Uterine artery embolization (UAE) is typically an outpatient procedure that doesn’t require a hospital stay. The entire procedure usually takes about 90 minutes.

UAE is usually performed this way:

• An interventional radiologist performs the procedure. Interventional radiologists perform minimally invasive procedures using medical imaging guidance.
• You’ll lie down on an exam table and get hooked up to machines that monitor your vital signs, such as heart rate and blood pressure.
• An anesthetic (pain blocker) is applied to the skin around your groin to numb the area.
• You receive fluids and sedative medication through an intravenous (IV) line. The sedative relaxes you and may make you sleepy.
• A tiny puncture is made in your skin near your groin (in your femoral artery), and a thin needle is placed inside.
• An X-ray (fluoroscopy) and contrast dyes are used to guide a catheter to your uterine arteries. The dye glows under X-ray to show your provider the path of your arteries and how blood flows to your uterus.
• Once in place, the catheter delivers particles called embolic agents (typically made of gelatin or plastic) that will block blood flow from the arteries to your uterus.
• When finished, the catheter is removed. Any bleeding from the puncture location is controlled, and a bandage is applied.

What happens after a uterine artery embolization (UAE)?

Most people can leave the hospital within a few hours after a uterine artery embolization (UAE). Some other things to expect afterward include:

• You may be asked to lie down for several hours after the procedure.
• Your provider may prescribe pain medication and antibiotics to take at home.
• You can expect watery or mucus-like discharge for several weeks.
• Moderate to severe pelvic cramps are common for the first 24 hours after UAE.
• Most people can resume normal activities within one to two weeks after the procedure.
• You may not get your menstrual period for several cycles. When it does resume, the amount of blood may be less than normal. It will gradually increase in the next cycles to a level that shows improvement from pre-procedure levels.
• In the case of treatment for fibroids, symptoms should begin to disappear in about two to three weeks. Some people pass fibroid tissue through their vaginas. Most people have complete relief after six months.

How painful is uterine artery embolization (UAE)?

You will be very relaxed and sleepy during the procedure and shouldn’t feel pain. Once you return home and the sedative medication wears off, you may feel some discomfort. Your healthcare provider may prescribe pain medications or recommend over-the-counter (OTC) pain relievers during your recovery.

What are the advantages of uterine artery embolization (UAE)?

Nearly 90% of people treated with UAE for fibroids experience partial or full relief of symptoms. Other advantages of UAE include:

• It can be performed under local anesthesia as an outpatient procedure.
• Short recovery time because there are no large incisions or stitches.
• Little blood loss or bleeding afterward.
• Lower risk of complications as compared to invasive surgeries.
• It avoids the side effects of hormone therapies that are sometimes used to treat fibroids.
• It needs only a tiny puncture, so it’s less invasive than other treatments such as myomectomy (surgical removal of uterine fibroids) or hysterectomy (removal of your uterus).

What are the risks of uterine artery embolization (UAE)?

Most procedures carry some risks. For uterine artery embolization (UAE), the risks include:

• Infection: Inserting a catheter could damage other blood vessels in the area or cause an infection.
• Injury to healthy tissue: The embolic agent could be deposited in the wrong blood vessel, cutting off blood supply to healthy tissue.
• Allergic reaction: An allergic reaction to X-ray contrast dyes or sedative medications could occur.
• Loss of menstrual period: In about 1% to 5% of people, menstrual cycles will shut down permanently following uterine artery embolization.
• Surgery is unsuccessful: Your symptoms may return and a second UAE or hysterectomy is needed.
• Infertility: You lose the ability to get pregnant.

Is uterine artery embolization (UAE) safe?

Yes, uterine artery embolization is a safe procedure in most cases. Your healthcare provider will discuss the risks of UAE with you based on your medical history.

There’s still some question about whether uterine artery embolization (UAE) affects a future pregnancy. Some providers prefer to have fibroids surgically removed if a person wishes to have more children. Pregnancies after UAE can have higher rates of miscarriage, and are more likely to have a cesarean section and postpartum hemorrhage. If you’re pregnant or wish to become pregnant, speak with your provider about the risks of UAE.

What is the recovery time for uterine artery embolization (UAE)?

You can expect pelvic pain, cramps and discomfort for up to two weeks, with the most severe pain occurring within the first 24 hours. Some people pass fibroid tissue out of their vaginas during this time. Up to 90% of people return to normal activities within 10 days of uterine artery embolization (UAE). It may take up to three months to see a noticeable change in symptoms.

What is the long-term outlook for patients?

The outlook is good. Studies show that up to 92% of people who’ve had uterine artery embolization (UAE) have no symptoms of uncontrolled vaginal bleeding 12 months later.

How often should I have a uterine artery embolization (UAE)?

If you have a uterine artery embolization (UAE) to treat fibroids, there’s a chance the fibroids will come back. Studies show that 32% of people had symptoms of uterine fibroids after five years. A second round of UAE may be needed to treat your symptoms if your fibroids return.

Can I get pregnant after uterine artery embolization (UAE)?

There have been cases of healthy pregnancies after UAE, but the data is limited. Because the effects of UAE on fertility aren’t fully known, UAE is recommended for people who don’t wish to become pregnant. Be sure to discuss the risks of UAE with your provider to fully understand how it may impact your fertility.

When should I see my healthcare provider?

You can expect moderate to severe pelvic cramping for 24 hours to several days after uterine artery embolization (UAE). Fatigue, mild nausea and low-grade fever are also possible.

Most people return to their normal activities within 10 days. Contact your healthcare provider if you’re still feeling pain and discomfort two weeks after the procedure.

A note from Cleveland Clinic

Uterine artery embolization (UAE) is a minimally invasive procedure to treat fibroids, severe bleeding after childbirth and other gynecological tumors. UAE isn’t for everyone — so talk to your healthcare provider about the risks and benefits of the procedure. If you’re pregnant or wish to become pregnant, UAE might not be right for you. Most people who undergo UAE find relief from their symptoms within a few months. Severe complications from UAE are rare but can happen. Be sure to discuss your concerns with your provider so you feel comfortable with this procedure.