Uterine Fibroid Embolization

Uterine fibroids (leiomyomas) are benign, non-cancerous growths of the uterine muscle wall. They are the most common tumor of the female reproductive tract — affecting 70–80% of women by age 50. In Black women, fibroids develop earlier, grow larger, are more numerous, and cause more severe symptoms. Fibroids range from microscopic to grapefruit-sized and can occur anywhere in the uterine wall. Symptoms depend on fibroid size, number, and location: submucosal fibroids (beneath the inner lining) cause heavy menstrual bleeding and anemia; intramural fibroids (within the wall) cause bulk symptoms; subserosal fibroids (on the outer surface) cause pelvic pressure and urinary frequency. Despite being nearly ubiquitous, fibroids are dramatically undertreated — millions of women suffer unnecessarily or are offered only hysterectomy.

Uterine fibroid embolization (UFE) is a minimally invasive procedure performed by an interventional radiologist that cuts off the blood supply to fibroids, causing them to shrink and die. Under fluoroscopic guidance, a microcatheter is advanced through the femoral or radial artery to the uterine arteries bilaterally. Tiny polyvinyl alcohol (PVA) or tris-acryl gelatin microspheres are injected, selectively blocking the arteries feeding the fibroids. Because fibroids have a disproportionately high blood supply compared to normal uterine tissue, the embolic particles preferentially accumulate within fibroid vessels. Normal uterine tissue is preserved via collateral circulation. Over 3–6 months, treated fibroids undergo avascular necrosis — they shrink by an average of 50% in volume, and symptoms resolve dramatically.

Hysterectomy (surgical removal of the uterus) is the only definitive cure for fibroids but eliminates any future pregnancy and carries the full risk profile of major abdominal surgery: 6 weeks of recovery, significant pain, blood transfusion risk, and the finality of organ removal. Myomectomy (surgical removal of individual fibroids while preserving the uterus) is appropriate for women desiring future fertility but has a 15–30% fibroid recurrence rate and also requires general anesthesia and recovery weeks. UFE requires only a tiny skin puncture, preserves the uterus and ovarian function, achieves equivalent symptom control to surgery, and allows return to work in 1–2 weeks. Multiple randomized trials (including the EMMY and REST trials) confirm non-inferior symptom outcomes between UFE and surgical treatment, with UFE patients reporting higher satisfaction with their treatment experience.

UFE is appropriate for premenopausal women with symptomatic uterine fibroids who wish to preserve their uterus and avoid surgery. Ideal candidates have heavy menstrual bleeding (soaking more than one pad/hour, passing clots, or having periods lasting more than 7 days), pelvic pressure, urinary frequency, pelvic pain, or anemia from fibroid-related blood loss. Women with multiple or large fibroids who are poor myomectomy candidates are also excellent UFE candidates. Contraindications include: active pelvic infection, desired future pregnancy (UFE is cautioned in women wishing to conceive — myomectomy is preferred in that setting), or concern for uterine or cervical malignancy requiring histologic evaluation.

You arrive at our facility, receive IV access, and are given conscious sedation and pain medication. The procedure is typically performed via a small femoral artery puncture in the groin (some centers use the radial artery at the wrist). Angiography maps the uterine arteries; the microcatheter is advanced to each uterine artery sequentially, and embolic particles are injected until blood flow to the fibroids is arrested. Most patients experience cramping during embolization — pain medication is given proactively. Post-procedure, you are monitored for 4–6 hours with IV pain control (typically patient-controlled analgesia). Most UFE patients stay overnight for pain management and go home the following morning.

UFE is associated with a predictable post-embolization syndrome: moderate-to-severe uterine cramping in the first 6–24 hours (similar to severe menstrual cramps), managed with IV and oral pain medications. Most women describe their first night after UFE as the most uncomfortable part — and report that the 6 months of improved quality of life afterward make it completely worthwhile. After the first 24 hours, pain drops dramatically. By day 3–5, most patients need only ibuprofen. Most women return to desk work in 7–14 days (compared to 4–6 weeks after myomectomy or hysterectomy). Light activity is fine after the first week; strenuous exercise is restricted for 2–3 weeks.

Most women notice lighter periods beginning with their very first post-procedure menstrual cycle, which arrives on schedule (typically 4–6 weeks after UFE). The improvement continues to deepen over 3–6 months as fibroids continue shrinking. At 6 months, 85–90% of women report significant reduction in menstrual bleeding, with many achieving normal flow for the first time in years. Bulk symptoms (urinary frequency, pelvic pressure) typically resolve in parallel with fibroid volume reduction.

UFE does not target the ovaries and in the vast majority of cases does not affect ovarian function. Premature ovarian failure (POF) is a known but rare complication of UFE, occurring in approximately 1–3% of cases, primarily in women over age 45 whose ovarian reserve is already diminished. The mechanism is inadvertent reduction of ovarian blood supply via uterine-ovarian arterial anastomoses. In women under 40, this risk is exceedingly low. Dr. Chahal carefully reviews ovarian blood flow during the procedure to minimize this risk.

UFE treats all fibroids present at the time of embolization simultaneously — a key advantage over myomectomy, which can only remove visible fibroids one at a time. Treated fibroids do not regrow. However, new fibroids can develop from previously microscopic seedlings. The risk of requiring a second intervention (surgical or repeat UFE) is approximately 15–20% at 5 years — lower than myomectomy’s 30% recurrence rate. Women who undergo UFE within a few years of natural menopause are at particularly low risk of symptom recurrence.

Yes. UFE has well-established CPT billing codes (37243 for uterine artery embolization, with supporting catheterization codes) and is covered by Medicare, Medicaid, and the vast majority of commercial insurance plans when symptomatic fibroids are confirmed by imaging and conservative management has been considered. Our team manages the prior authorization process completely, ensuring coverage is confirmed before your procedure date. UFE’s same-day or next-day discharge makes it significantly less expensive than inpatient surgery for most payers.