What are the benefits and risks of uterine artery embolization?

Photo of patient and nurse after surgery (monkeybusinessimages / iStock / Thinkstock)

During uterine artery embolization, the blood supply to the fibroid is cut off in order to reduce its size. It is an alternative to operations to remove the fibroids (myomectomy) or the womb (hysterectomy).

The aim of uterine artery embolization (also known as uterine fibroid embolization or transcatheter embolization) is to stop symptoms caused by fibroids such as heavy menstrual bleeding, period pain or pressure on the bladder or bowel. The recovery time after embolization is faster than after operations to remove fibroids or the womb. But the procedure isn't suitable for all women. And it very often has to be repeated at a later stage.

What happens during uterine artery embolization?

During uterine artery embolization, the blood vessels that supply the fibroid are closed off under local anesthetic. The doctor makes a small cut in the groin and inserts a thin plastic tube (catheter) into the femoral artery. A contrast fluid is injected so that the blood vessels can be seen on the X-ray. The catheter is then fed through to the fibroid using the X-ray as a guide. Tiny plastic particles are then injected into the blood vessels in the fibroid via the catheter. The particles block the blood vessels, stopping the flow of blood to the fibroid.

The procedure lasts between one and two hours. Eight to twelve hours' bed rest are then needed for the cut in the groin to be able to close up again.

A few weeks after this procedure, magnetic resonance imaging (MRI) is used to check whether the treatment had the desired effect – in other words, whether the blood supply to the fibroid has been completely cut off. Only then do the fibroids gradually shrink and the symptoms go away. The particles stay in the remaining fibroid tissue.

How effective is uterine artery embolization?

Like surgery, embolization is generally an option for women who have been experiencing severe symptoms because of their fibroids for a long time. Symptoms improve in around 80 to 90 out of 100 women following treatment. Around 10 out of 100 women don't notice an improvement after the procedure.

New fibroids may grow afterwards. In some women, uterine artery embolization doesn't work well enough, or the positive effect is only temporary. Because of this, the procedure is repeated within a few years in around 20 out of 100 women.

When is uterine artery embolization not suitable?

Some fibroids can't be treated using embolization. They include submucosal fibroids (just under the lining of the womb), and pedunculated subserosal fibroids (on the outside of the womb). Surgery is the preferred methods for those kinds of fibroids.

There are other reasons not to use embolization, for example if the woman is pregnant or has a genital infection. Embolization is also not an option for women with a very overactive thyroid because they wouldn't tolerate the iodine in the contrast fluid.

What are the possible side effects?

Abdominal pain is a common side effect of embolization. Nausea, vomiting and fever are also possible. These side effects may last for a few days, but can be treated with medication. In 3 out of 100 women, embolization leads to problems that have to be treated, such as an infection in the womb, damage to blood vessels or deep vein thrombosis in the legs.

Embolization may also make a woman's period stop completely. This happens in about 4 out of 100 women. In about 5 out of 100 women the treated fibroids become detached and are passed through the vagina.

Does the treatment affect fertility?

Studies carried out so far suggest that uterine artery embolization can affect fertility. One explanation for that is that the tiny plastic particles sometimes mistakenly get into blood vessels in the ovaries, reducing the blood circulation there. Although some women become pregnant after embolization, it does become less likely. There is also an increased risk of miscarriage. So women who still wish to have children should perhaps choose other treatments.

How effective is uterine artery embolization compared to other procedures?

A small number of studies have compared uterine artery embolization with hysterectomy (surgical removal of the womb) and myomectomy (surgical removal of the fibroid/s). The participants in these studies were women who hadn't been through the menopause and had heavy menstrual bleeding because of their fibroids.

Uterine artery embolization compared to hysterectomy

Three studies with a total of 290 women compared uterine artery embolization with hysterectomy according to the following criteria:

  • Satisfaction with the treatment after two years: The participants in both groups were similarly satisfied with the outcome of the treatment.
  • Length of time spent in hospital: Women who had uterine artery embolization recovered quicker and were able to leave the hospital around three days earlier than those who had had a hysterectomy.
  • Severe complications: In both groups, these occurred in about 1 out of 100 women.
  • Repeat treatment: 22 out of 100 women were treated again within two years of an initial embolization procedure, and 9 out of 100 women were treated again after hysterectomy.

Summary: One main advantage of embolization is that the womb is not removed. The treatment and recovery time is also shorter than with hysterectomy. But repeat treatments are more likely to be needed after embolization. Side effects are also more common shortly after this treatment. No research has compared the long-term effects of the treatments.

Uterine artery embolization compared to myomectomy

Two studies with a total of 240 women compared uterine artery embolization with myomectomy according to the following criteria:

  • Satisfaction with the treatment after two years: The participants in both groups were similarly satisfied with the outcome of the treatment.
  • Length of time spent in hospital: Women who had uterine artery embolization recovered quicker and were able to leave the hospital around one day earlier than those who had had myomectomy.
  • Fertility: 23 out of 100 women had children after the embolization procedure, compared to 48 out of 100 after myomectomy.
  • Severe complications: In both groups, these occurred in about 1 out of 100 women.
  • Repeat treatment: 23 out of 100 women were treated again within two years of an initial embolization procedure, and 4 out of 100 women were treated again after myomectomy.

Summary: There isn't enough research on the advantages and disadvantages of uterine artery embolization compared to myomectomy. These results should therefore be interpreted with caution. One likely benefit of uterine artery embolization is the faster recovery after the procedure. A general anesthetic is also not needed. The chances of having a child after embolization are possibly lower than after myomectomy. Repeat treatments are also needed more often after embolization. Both procedures probably relieve the symptoms equally well in the short term. There is no research into whether this is also the case in the long term.