Uterine Fibroid Embolization, or UFE (pronounced "you-fee"), is a minimally-invasive, non-surgical procedure performed by a doctor trained as an interventional radiologist. During UFE, also called uterine artery embolization (UAE), the blood vessels feeding the uterine fibroids are blocked with millions of tiny plastic particles. Each particle is smaller than a grain of sand. This starves the fibroids of the nutrients and oxygen they need to grow. As a result, the fibroids stop growing and become smaller and softer. Because there is almost no blood flow left to them, the fibroids also stop bleeding.
Risks and side effects
Many thousands of women in the United States and around the world have had UFE procedures. UFE is a very safe, minimally-invasive, non-surgical procedure with an extremely low risk of unexpected side-effects. After UFE, 1 in 4 women will have a collection of symptoms called "post-embolization syndrome". The post-embolization syndrome includes cramping, low fever, and nausea. It usually peaks at 24 hours and is gone by 3 days after the UFE procedure. Other complications are uncommon, including:
- Brownish vaginal discharge or passing pieces of tissue out the vagina (less than 5%)
- Early stop to regular periods (menopause, less than 4%). This almost never happens to women younger than age 40.
- Groin artery (femoral artery) injury (less than 3%)
- Infection (less than 3%, usually minor)
- Injury to the uterus requiring its removal by hysterectomy (less than 0.1%)
- All other extremely rare complications (less than 1%)
Will UFE cure my fibroids?
The only absolute cure for fibroids is a surgery to remove the uterus, though symptoms improve in 9 out of 10 women who have uterine fibroid embolization. All surgeries and procedures other than hysterectomy leave behind a uterus that may or may not form new fibroids in the future. If they do form, they may or may not cause you problems.
How will UFE affect my ability to become pregnant?
Women with fibroids have difficulty becoming pregnant. They also have an increased risk of miscarriage, bleeding and other problems during and after pregnancy. UFE works because it makes fibroids smaller, softer, and less "bloody". However, UFE usually does not make fibroids disappear, even if your fibroid symptoms do. These smaller, softer, and less "bloody" fibroids may still make it difficult to become pregnant and may cause problems during pregnancy. That is why we recommend surgical removal of fibroids (myomectomy) for women who know they want to become pregnant. In certain situations, women with problem fibroids who want to become pregnant may not be able to get a myomectomy. For these women, UFE is still an option.
How many times can I be treated with UFE?
There is no limit to the number of UFE procedures you can receive. Some women need more than one UFE. These women often have very large or very many fibroids. Overall, about 1 in 10 women will need more than one UFE procedure. This compares favorably to myomectomy, a surgical option, after which 2 in 10 women need more than one surgery.
Is UFE a good choice for me?
UFE may be a good option to treat your fibroids. Whether or not UFE is a good option for you will depend on:
- Your overall health
- How much of your uterus is replaced by fibroids
- The type and location of your fibroids
- Your preference and opinion
- Your expectations
- Your future plans for pregnancy
In general, UFE is a good option for women with problem fibroids who do not plan on becoming pregnant and want to avoid surgery. Please schedule an appointment with an interventional radiologist to discuss your options.
Do I need to see a gynecologist before having UFE?
Your interventional radiologist has a close, cooperative relationship with gynecologists. We strongly recommend you see a gynecologist before or after seeing your interventional radiologist. If you do not have a gynecologist, you may contact us for a referral to one.
What is an interventional radiologist?
Your interventional radiologist is a board-certified physician with at least 6 years of additional training after medical school. Interventional radiologists are experts in the use of imaging, like X-rays, sonograms and MRI, to treat and diagnose disease. They treat disease using "minimally-invasive," non-surgical techniques. Many surgeries have been completely or largely replaced by interventional radiology procedures. The benefit to patients has been great since interventional radiology procedures are usually faster, less risky, less expensive, require less time in the hospital and allow you to recover faster. Your interventional radiologist is involved in the diagnosis and treatment of many diseases and disorders, including:
- Uterine fibroids
- Pelvic pain
- Difficulty having children (infertility)
- Large veins in the legs (varicose veins)
- Leg pain and sores from clogged arteries
- Liver disease (“cirrhosis”)
- Feeding or swallowing problems
- Back pain
- Dialysis and kidney problems
Before your procedure
Prior to meeting your interventional radiologist, you will get an MRI scan of your uterus. These MRI images are important because they help your interventional radiologist figure out if UFE is an option for you, plan the UFE procedure, and follow your fibroids after UFE. You will also give a small amount of your blood for testing.
Your interventional radiologist will meet you in the outpatient clinic to go over your medical history and perform a physical examination. At this clinic visit, your interventional radiologist will help you decide if UFE is a good option for treating your fibroids. Your interventional radiologist will explain the UFE procedure in detail, including the procedure steps, risks, benefits, chance of success, and what to expect after the procedure.
Arriving for your procedure
On the day of your UFE procedure, a staff member will greet you in the interventional radiology waiting room. After registering, you will be led to a private area where you will take off your clothes and put on a gown. Your interventional radiologist will explain the procedure to you and any friends or family members with you. You will have the opportunity to have all your questions answered before agreeing to the procedure. An interventional radiology nurse will place an IV in your arm, ask you a few questions, and give you some medications. You will then be wheeled to the procedure room on a bed.
During your procedure
After arriving in the procedure room, you will be moved from your bed onto the procedure table. Most UFE procedures are performed with "twilight sedation" (also called "conscious sedation" or "moderate sedation"). With twilight sedation, you will be sleepy, calm, and pain-free. You will not have a breathing tube. You may or may not fall asleep during the procedure.
After you have been made comfortable, your interventional radiologist makes a tiny skin nick in the groin. A very thin, hollow, spaghetti-like tube called a "catheter" is passed through the skin nick and into a blood vessel ("artery") in the groin. The catheter tip is then placed in the artery feeding the uterus, called the "uterine artery". X-ray images are taken to guide the interventional radiologist during the procedure.
The interventional radiologist then injects millions of tiny particles, each smaller than a grain of sand, into the uterine artery. Since the fibroids have a rich supply of blood, most of the particles go to the fibroids instead of going to the normal uterus.
Most women have two uterine arteries feeding their fibroids. After moving the tip of the catheter into the second uterine artery, more particles are injected.
After your procedure
At the end of the procedure, pressure will be applied to your groin to prevent bleeding from the tiny catheter hole. After 10 to 15 minutes of holding pressure, a small bandage will be placed over the skin nick. You will then be moved from the procedure table to your bed. You will be wheeled on your bed to a recovery area. You will have to lay flat for 2 to 6 hours to give the catheter hole time to completely close. You will also be given medications to keep you comfortable and pain free.
Most women will stay in the hospital overnight for observation, pain control, and anti-nausea medication. However, if you do not need IV medications for pain or nausea, and if you are walking, eating, drinking, and using the bathroom without difficulty, you may be able to go home the day of the procedure.
When you return home
The day after the UFE procedure, most women have pain similar to menstrual cramps. This can last for 2-3 days and is very well controlled with medications you can take at home. You may also experience nausea and a low fever for 1-2 days. You will also be sent home the day after the procedure with a prescription for antibiotics to prevent an infection.
Before you go home, you will be given very detailed instructions describing what to expect and when to contact your interventional radiologist. You will be able to return to full activity in less than 1 week. You will visit with your interventional radiologist 1 week, 6 weeks, and 6 months after the UFE procedure. An MRI scan of the uterus will be performed at the 6 week and 6 month appointments to see how much the fibroids have decreased in size and how much their blood flow has decreased.