What are the pros and cons of uterine artery embolization?

During uterine artery embolization, the blood vessels that supply the fibroid are closed off under local anesthesia. The doctor makes a small cut in the groin and inserts a thin plastic tube ( catheter) into the femoral artery. A contrast medium (dye-like substance) is injected so that the blood vessels can be seen on the X-ray. The catheter is then pushed through to the fibroid using the X-ray to guide the way. Tiny plastic particles are then injected into the blood vessels in the fibroid via the catheter. These 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. Parts of the fibroid are broken down by the body. The particles remain inside the particles stay in the remaining fibroid tissue, but don't cause any long-term symptoms.

Embolization is generally an option for women who have been experiencing severe symptoms because of their fibroids for a long time. These symptoms improve in about 80 to 90 out of 100 women following treatment.

New fibroids may grow afterwards, though. In some women, uterine artery embolization doesn't work well enough, or the positive effect is only temporary. For this reason, about 20 out of 100 women needed further treatment in the first few years after the procedure. They either had the same procedure done again or another type of surgery.

Some fibroids can't be treated properly using embolization because of their location. 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 treatment 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.

People often have cramping abdominal pain after embolization. Nausea, vomiting and fever are also possible. These side effects may last for a few days, but they can be treated with medication. In 3 out of 100 women, embolization leads to complications such as an infection in the womb, damage to blood vessels or deep vein thrombosis in the legs. It is important to seek medical advice if you experience any signs of these problems, like fever or abnormal pain.

Embolization may also make your 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 leave the body through the vagina.

Research suggests 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.

This makes becoming pregnant after embolization somewhat less likely. There is also an increased risk of miscarriage. In studies, this happened in about 20 out of 100 pregnancies. Whether uterine artery embolization is an option if you still want to have a baby depends on what other alternatives you have and how bad the symptoms are.

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

Uterine artery embolization and myomectomy were compared based on the following:

• Quality of life: Quality of life was better after myomectomy than it was after uterine artery embolization.
• Symptoms: The women had fewer symptoms after myomectomy compared to embolization.
• 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 the hospital: Women who had uterine artery embolization recovered quicker and were able to leave the hospital about one day earlier than those who had a myomectomy.
• Fertility: 23 out of 100 women had children after the embolization procedure, compared to 48 out of 100 after a myomectomy.
• Serious complications: These occurred in about 1 out of 100 women in each group.
• Need for further treatment: 16 out of 100 women were treated again within two years of an initial embolization procedure, and 7 out of 100 women were treated again after a myomectomy.

But these results should be interpreted with caution. There isn't enough research comparing the advantages and disadvantages of uterine artery embolization with those of myomectomy. One likely benefit of uterine artery embolization is the faster recovery after the procedure. Plus, general anesthesia is not needed. It may be harder to have a child after embolization than after a myomectomy. Women are also more likely to need further treatments 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.

Uterine artery embolization and hysterectomy were compared in the studies based on the following:

• 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 the hospital: Women who had uterine artery embolization recovered quicker, and were able to leave the hospital about three days earlier than those who had had a hysterectomy.
• Serious complications: These occurred in about 1 out of 100 women in each group.
• Need for further 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 a hysterectomy.

One main advantage of embolization is that the womb is not removed. The treatment and recovery time is also shorter. Plus, general anesthesia is not needed. But further 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 two treatments.