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Uterine Artery Embolization

Non-Surgical Treatment For Uterine Fibroids

Procedure Summary: A small tube called a catheter is guided through the blood vessels to reach the uterine arteries. Micro-sized beads are injected through the catheter into the fibroid, blocking the fibroid’s blood supply and causing it to shrink.

Uterine artery embolization diagram: non-surgical treatment for uterine fibroids
Uterine artery embolization (UAE) is used to treat fibroids. It is a minimally-invasive procedure offered at ProFibroidMD to relieve heavy bleeding, pain, and other symptoms in patients with uterine fibroids. A uterine artery embolization procedure has many unique advantages over conventional surgery:

  • Effective – 85% of women report that they are satisfied with the procedure or experience sustained symptom relief
  • Clinically Proven – UAE is supported by multiple clinical studies and nearly two decades of practice
  • Pregnancy & Fertility – pregnancy is possible after UAE
  • Fast Recovery – hospital stay not required, most women return to their normal activities within 1 week

In this article, our Fibroid Specialists go in-depth on uterine artery embolization. You’ll learn:

Uterine artery embolization specialist Dr. Lalezarian provides fibroid symptom relief in Los Angeles, California

Fibroid Symptom Relief
in Los Angeles

ProFibroidMD is a leading provider of uterine artery embolization (UAE), the least invasive treatment option for uterine fibroid symptom relief. Our Fibroid Specialist, Dr. Michael Lalezarian has helped countless women overcome their fibroids and get back to their happy, healthy selves.

5-star fibroid symptom relief
“Absolutely awesome service from everyone I encountered! I had been suffering from severe pain from Fibroid issues, I had been offered hysterectomy from other doctors. I just wasn’t comfortable taking that route. I had my UFE at this location in April 2021 and I couldn’t be happier. My symptoms have dramatically decreased and I am ecstatic about my results! This procedure REALLY changed my quality of life and I am forever indebted.”

Dawn S, October 2021

What is Uterine Artery Embolization?

Uterine artery embolization is used to treat fibroids. Fibroids receive the majority of their blood supply directly from the uterine arteries. This blood supply is required for fibroids to grow and maintain their size. Uterine artery embolization, also called uterine fibroid embolization (UFE), is a minimally invasive procedure in which tiny particles are injected into the uterine artery to cut off blood supply to the fibroids. After embolization, the fibroids shrink and symptoms are relieved.

Why Would Uterine Artery Embolization Be Used to Treat Fibroids?

Compared to surgical options like hysterectomy and myomectomy, uterine artery embolization offers the fastest recovery time, the shortest hospital stay, and the lowest risk of procedural complications. It is clinically proven to be just as effective as surgical options when it comes to symptom relief and patient satisfaction. Uterine artery embolization has the added advantage of keeping the uterus healthy and intact, so pregnancy after uterine artery embolization is still possible. In summary, uterine artery embolization is the preferred fibroid treatment for women that want to minimize downtime and / or would like to maintain the viability of their uterus.

How is Uterine Artery Embolization Done?

Uterine artery embolization is a minimally-invasive image-guided procedure. The procedure begins with a tiny puncture in the upper thigh or the forearm that allows your interventional radiologist to insert small tubes (called catheters) and wires into your artery. Using real-time fluoroscopic (x-ray) imaging, the interventional radiologist guides a catheter to the arteries that feed your fibroids. With the catheter in place, the interventional radiologist injects micro-sized beads through the catheter to stop blood flow to the fibroids. When the interventional radiologist sees that blood flow to the fibroids has stopped, the catheter is removed from the body and the tiny puncture is sealed.

Watch this short animated video to see how uterine fibroid embolization is performed.

Visuals of how uterine artery embolization works
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Uterine Artery Embolization Procedure

Fibroid Screening

Your visit to ProFibroidMD will begin with a review of your medical history, followed by a physical exam. Usually uterine fibroids can be diagnosed with a simple ultrasound exam of the lower abdomen. Read our article on questions to ask your doctor before fibroid surgery.

Evaluation for Uterine Artery Embolization

An MRI scan may be used to rule out other conditions and confirm that any anomalies observed during your ultrasound are indeed fibroids. Your Fibroid Specialist may also use an MRI or other imaging techniques to get a good look at your vascular anatomy and prepare for your uterine artery embolization procedure.

Day of Uterine Artery Embolization Procedure

On the day of a uterine artery embolization procedure, you will check in with our receptionist. The staff at ProFibroidMD will provide you with a disposable gown and will be able to answer any questions you may have. You will have an IV placed in your arm for fluids and medications. You will be moved to a bed surrounded by large imaging equipment that allows your Fibroid Specialist to take live X-ray images of your major blood vessels during the procedure. Unless you request it, you will not require general anesthesia and will not be “put to sleep.” You will be provided with conscious sedation to relax you and minimize any pain during the procedure.

There are no major incisions required for the uterine artery embolization procedure, but a tiny puncture will be made in the forearm or the upper leg. Your Fibroid Specialist will then proceed to navigate a small tube through this puncture to the blood vessels that supply your uterine fibroids and deliver therapy. The procedure usually takes less than an hour. Although you will be awake throughout the procedure, a specialized nurse will be monitoring you to keep you comfortable.

What to Expect After Uterine Artery Embolization

After your uterine artery embolization procedure, you will be taken to a recovery room for around 6 hours for monitoring. Throughout your uterine artery embolization recovery, ProFibroidMD staff will ensure that your puncture site is properly closed and any post-op pain is under control. How long you stay in monitoring is usually at the discretion of your physician, and an overnight hospital stay may be recommended if you are experiencing more severe post-op pain.

In most studies, recovery time for women who have undergone a uterine artery procedure averages between 9-12 days, however this will vary from patient to patient. You can plan for about 1-2 weeks for recovery, after which you can gradually return to normal activities like work and exercise. Use pain and discomfort as a general guide for activity, however avoid sex for at least 1 week post procedure. The normal course of recovery includes some vaginal bleeding (this may vary between women), which should become lighter in the months following the procedure. Avoid the use of tampons for 1 menstrual cycle post procedure.

Uterine Artery Embolization Pain

Uterine artery embolization pain is normal and is typically present for 3 to 4 days. Over-the-counter medications can help with this pain and are usually sufficient, but additional pain control may be prescribed. In most cases, a full recovery is made 1 to 2 weeks following the procedure, after which you can gradually return to normal activities like work and exercise. The normal course of recovery usually includes some vaginal bleeding, which should become lighter in the months following uterine artery embolization as the fibroids continue to shrink.

Woman getting ultrasound screening for uterine artery embolization
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Uterine Artery Embolization FAQs

Does uterine artery embolization work?

The main goal of fibroid treatment is to alleviate fibroid symptoms like heavy bleeding and pelvic pain. Several clinical studies have established that uterine artery embolization is as effective at alleviating fibroid symptoms as hysterectomy or myomectomy surgery. In these studies, treatment success is measured by asking women whether or not they are satisfied with treatment or by asking them about their experiences with fibroid symptoms. Two years after uterine artery embolization, around 85% of women report that they are satisfied with the procedure or remain free of fibroid symptoms. A similar percentage of women report that they are still happy with their results 5 years after treatment.

What are indications for uterine artery embolization?

Uterine artery embolization is indicated for women with uterine fibroids, specifically those that have any of the following symptoms:

  • Heavy bleeding (menorrhagia)
  • Pelvic pain or pressure
  • Enlarged uterus
  • Frequent urination, difficulty urinating, or urinary incontinence
  • Hydronephrosis (swelling of the kidneys due to the inability to drain urine)
  • Constipation or tenesmus (persistent feeling of having to evacuate the bowels)
  • Uterine fibroids with otherwise undiagnosed infertility

How much does uterine artery embolization cost?

The cost of uterine artery embolization can vary by provider and is dependent on your insurance plan. Uterine artery embolization is covered by most major insurers, but you can verify whether or not your plan covers the procedure by speaking with your fibroid specialist.

Where do they cut for uterine artery embolization?​

There are no major incisions involved in the uterine artery embolization procedure. Only one tiny puncture is made in the upper thigh or in the forearm. This tiny puncture allows the Vascular Specialist to access your fibroids through your arteries and deliver therapy.

Can uterine artery embolization be done when menstruating?

Yes, the uterine artery embolization procedure can be done while the patient is menstruating.

Can you get pregnant after uterine artery embolization?

Yes, you can become pregnant after uterine artery embolization. The uterus stays healthy and intact, which is why many women choose uterine artery embolization.

What happens to fibroids after uterine artery embolization?

After uterine artery embolization, the blood vessels feeding the fibroids are blocked, causing the fibroids to receive an insufficient blood supply. This leads to an ischemic reaction in the fibroids (injury from lack of oxygen), which causes them to undergo necrosis (death of cells) and shrink.

How long does the uterine artery embolization procedure take?

On average, the uterine artery embolization procedure takes about an hour from start to finish, but may be as quick as 30 minutes or take as long as 2 hours.

If the procedure is done in an outpatient setting (i.e. if the patient is discharged on the same day as the procedure), typically the patient will spend at least 6 hours in recovery after uterine artery embolization so operating room staff can monitor post-op pain and nausea. Depending on the interventional radiologist that performs the procedures, patients may be kept overnight to administer IV fluids and monitor post-op recovery.

What are the side effects of uterine artery embolization?

Uterine artery embolization side effects tend to resolve on their own within the first 30 days following the procedure. The most common side effects include: post-embolization syndrome (pain, nausea, mild fever, flu-like symptoms), hot flashes, vaginal discharge, fibroid expulsion, and hematoma formation (bruising). Less common side effects include UTI, urinary retention, urinary incontinence, thrombosis, thigh paresthesia, infection, and temporary amenorrhea (absence of menstruation).

What can go wrong with uterine artery embolization?

Though rare, complications are possible with uterine artery embolization, including vaginal infection, urinary tract infection (UTI), urinary retention, urinary incontinence, thigh paresthesia, absence of menstruation, uterine artery damage, and uterine artery thrombosis (clotting). Complications occur in less than 1% of treated individuals, and this figure is based on data from about 10 years ago when operators were generally less experienced than they are today.

How common are uterine artery embolization complications?

Uterine artery embolization complications are uncommon during the procedure. The highest quality clinical studies have demonstrated that complications occur at a rate of 0% to 9%, and most complications can be managed during the procedure without long-term health consequences.

How long is uterine artery embolization recovery?

Women undergoing uterine artery embolization should plan for 1 to 2 weeks of recovery before returning to normal activities like work and exercise. Multiple studies have looked at how long it takes for women to make a full recovery after uterine artery embolization. In most studies, uterine artery embolization recovery time averages between 9 and 12 days, but exact recovery time will vary from person to person.

Why is uterine artery embolization painful afterwards?

Uterine artery embolization works by inducing ischemia (blockage of blood flow) to the fibroids and depriving the fibroids of blood, oxygen, and nutrients. Although ischemia is the goal of the UAE procedure, ischemia may also activate pain signals that respond to oxygen deficiency. This is thought to cause cramping pain around the site of treatment for a few days after the procedure. Pain typically lasts for 3-4 days, and less frequent cramping pain can occur for up to 2 weeks following the procedure.

When do you see results from uterine artery embolization?

Fibroids begin to shrink immediately after the uterine artery embolization procedure, and continue to shrink throughout the next year. Many women notice improvement in their bleeding symptoms immediately following the procedure, but it can take up to 3 months for fibroids to shrink enough for women to notice major symptom improvements. In one study of uterine artery embolization, 200 women were asked about their symptoms 3 months after treatment. 87% of the women described improvement in their bleeding symptoms, and 93% described improvement in pelvic pain and pelvic pressure symptoms.

How long does it take for the uterus to shrink after the uterine artery embolization procedure?

Fibroids begin to shrink immediately after the uterine artery embolization procedure, and continue to shrink throughout the next year. See additional detail in the question and response immediately above.

How much do fibroids shrink after uterine artery embolization?

Fibroids shrink by 40% to 75% in the first 6 months after uterine artery embolization, and continue to shrink over time. This causes the uterus to shrink by 26% to 59%, which is why uterine artery embolization is effective in alleviating fibroid symptoms.

How long does uterine artery embolization last?

For the majority of cases (around 65%), uterine artery embolization lasts indefinitely. However, clinical studies have shown that some women require an additional procedure (reintervention) following uterine artery embolization. Reintervention is often caused by the development of entirely new fibroids, or regrowth of existing fibroids that were only partially occluded during the first procedure. According to the highest quality clinical data, about 20% of women elect for reintervention within 2 years of their first procedure, increasing to 25-30% at 5 years.

What is the difference between uterine artery embolization and endometrial ablation?

Uterine artery embolization is a vascular procedure in which micro-sized beads are injected into the arteries that feed fibroids. Endometrial ablation is a procedure in which a device is inserted into the vagina to destroy tissue along the inner lining of the uterus. Uterine artery embolization shrinks fibroids, which helps to relieve pain, reduce bleeding, and shrink the uterus. Endometrial ablation, on the other hand, only helps to reduce heavy bleeding, and is only effective when fibroids are submucosal (along the inner lining of the uterus).
Woman consulting with nurse after uterine artery embolization
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References

[1] Gupta et al. (2014). Uterine artery embolization for symptomatic uterine fibroids (Review). Cochrane Library, (5).
[2] Younas K, Hadoura E, Majoko F, Bunkheila A. A review of evidence-based management of uterine fibroids. The Obstetrician & Gynaecologist 2016;18:33–42.
[3] Bulman, J.C., Ascher, S.M., Spies, J.B. (2012). Current Concepts in Uterine Fibroid Embolization. RadioGraphics, 32(6), 1735-1750.
[4] Khan, A. T., Shehmar, M., Gupta, J. K., & Gupta, J. (2014). Uterine fibroids: current perspectives. International Journal of Women’s Health, 6, 95–114.
[5] Spies, J. B. (2013). Current evidence on uterine embolization for fibroids. Seminars in Interventional Radiology, 30(4), 340–346
[6] Hehenkamp, W. J. K., Volkers, N. A., Donderwinkel, P. F. J., De Blok, S., Birnie, E., Ankum, W. M., & Reekers, J. A. (2005). Uterine artery embolization versus hysterectomy in the treatment of symptomatic uterine fibroids (EMMY trial): Peri- and postprocedural results from a randomized controlled trial. American Journal of Obstetrics and Gynecology, 193(5), 1618–1629.
[7] Pinto, I., Chimeno, P., Romo, A., Haya, J., & Cal, M. A. De. (2003). Uterine Fibroids : Uterine Artery Embolization versus Abdominal Hysterectomy for Treatment — A Prospective, Randomized , and Controlled Clinical Trial. Radiology, 226(2), 425–431.
[8] Mara, M., Maskova, J., Fucikova, Z., Kuzel, D., Belsan, T., & Sosna, O. (2008). Midterm clinical and first reproductive results of a randomized controlled trial comparing uterine fibroid embolization and myomectomy. CardioVascular and Interventional Radiology, 31(1), 73–85.

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