Uterine Artery Embolization: Shutting Off the Supply
Uterine artery embolization (UAE) is one of those treatments that often comes up mid-conversation - mentioned quickly, sometimes vaguely, and rarely explained in a way that actually makes sense. It’s not surgery, it doesn’t remove anything, and yet it can dramatically reduce bleeding and symptoms for the right person. This article breaks down what UAE actually does, when it’s used, and what to know before deciding if it belongs in your treatment plan.
What Uterine Artery Embolization Actually Is
Uterine artery embolization is a minimally invasive procedure performed by an interventional radiologist. During the procedure, tiny particles are injected into the uterine arteries to block blood flow to the uterus.
Fibroids rely heavily on this blood supply to survive. When that blood flow is cut off, fibroids typically die and shrink over time, which is what leads to symptom improvement. Importantly, the uterus itself continues to receive blood through other pathways, which is why the uterus can be preserved.
There are no incisions in the uterus and nothing is surgically removed.
Why UAE Is Done
By far, the most common reason uterine artery embolization is performed is to treat uterine fibroids — especially when heavy or prolonged bleeding is the main symptom.
Because of this, you may also hear the procedure called uterine fibroid embolization (UFE). Same procedure, different name.
UAE is particularly effective at:
· Reducing heavy or prolonged menstrual bleeding
· Shrinking fibroids over time
· Decreasing overall uterine size
It can also help with pelvic pressure or bloating (though these symptoms may improve less predictably than bleeding).
Less commonly, UAE may be used to control uterine bleeding in other situations, such as severe bleeding after pregnancy (postpartum hemorrhage) or bleeding related to other uterine conditions, including adenomyosis. That said, fibroids remain the primary and most well-studied indication.
How the Procedure Works
A catheter is placed through a blood vessel in the wrist or groin (kind of like getting a large IV, but into an artery). Using imaging guidance, the catheter is guided into the uterine arteries. Tiny embolic particles are released to block blood flow (like clogging a drain). Imaging is used at the end of the procedure to confirm the arteries are adequately blocked.
Most people receive sedation and pain control medications; some centers use deeper anesthesia depending on the situation and patient preference.
The procedure typically takes 1–2 hours. Most people go home the same day or stay overnight for observation.
What Recovery Is Really Like
Cramping after UAE is common and can be intense, especially in the first few days. Many people experience what’s known as post-embolization syndrome, which can include cramping, fatigue, nausea, and low-grade fever.
Pain usually peaks in the first 24–72 hours and then gradually improves. Most people are back to normal daily activities within one to two weeks.
Fibroids don’t shrink immediately - they shrink slowly over the following months.
How Well It Works — and When More Treatment Is Needed
Most people who undergo uterine artery embolization for fibroids experience meaningful improvement in bleeding and overall symptoms, and many are satisfied with their results. In general, fibroids tend to shrink by about 50% over 6–12 months after the procedure.
That said, UAE isn’t always the final step. Over time, about 20–30% of patients go on to have a hysterectomy within the next several years, usually because bleeding, pain, or other symptoms persist or return.
Many people never need another procedure - but this possibility is an important part of deciding whether UAE is the right choice for you.
Fertility and Pregnancy Considerations
There are concerns about pregnancy after UAE, including higher rates of pregnancy complications such as miscarriage, issues with fetal growth, or placental abnormalities. Pregnancy can still occur after UAE, and many healthy pregnancies have been reported. However, if becoming pregnant is a clear priority, UAE is usually not the first choice. If fertility is not a concern, UAE may still be a reasonable option.
This decision deserves careful, individualized counseling.
How UAE Compares to Other Fibroid Treatments
Compared to hysterectomy: Hysterectomy is more definitive, meaning you don’t have to worry about fibroids or bleeding coming back. However, UAE preserves the uterus and is typically lower risk, with a shorter recovery.
Compared to myomectomy: UAE does not remove fibroids. It treats them by cutting off their blood supply so they shrink. Myomectomy is preferred for people prioritizing future pregnancy. Both procedures carry a risk of needing another procedure later, as fibroids and symptoms can recur.
Compared to radiofrequency ablation: Both treatments aim to destroy fibroids without removing the uterus. They differ in how fibroids are targeted, recovery timelines, and symptom relief.
There’s no universally “best” option — only the best option for your goals.
Who Tends to Be a Good Candidate
UAE may be a good fit for people who:
· Are done with childbearing or comfortable with fertility uncertainty
· Want to preserve their uterus
· Want to avoid major surgery
· Have fibroids causing heavy bleeding or bulk symptoms
Deciding whether UAE is the right option is a personal decision and should be made alongside an experienced gynecologist AND an interventional radiologist who can help weigh your symptoms, anatomy, future goals, and overall health.
Who May Want a Different Option
UAE may not be the best choice if you:
· Strongly desire future pregnancy
· Have an active pelvic infection
· Have certain fibroid patterns, such as fibroids largely within the uterine cavity (submucosal fibroids), which increase the risk of infection or expulsion
· Have concern for malignancy
Risks and Limitations
In general, the risks of UAE include pain, cramping, nausea, fatigue, infection, and the possibility that symptoms may not fully resolve.
In rare cases, a fibroid can begin to pass after the procedure, which may lead to severe infection. This can require urgent inpatient treatment and, in some situations, emergency hysterectomy.
The Bottom Line
Uterine artery embolization is a well-established, minimally invasive treatment that can dramatically reduce bleeding and improve quality of life for many people. It preserves the uterus, but it isn’t always a one-and-done solution. The best outcomes happen when the procedure matches the patient’s goals, anatomy, and expectations.
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