Uterine Artery Embolisation (UAE) Non-Surgical Treatment for Fibroids

What are Uterine Fibroids?

Uterine fibroids (leiomyomata) are benign (non-cancerous) tumours of smooth muscle that develop in the wall of the uterus. They are the most common pelvic tumour in women, affecting up to 70–80% of women by the age of 50. While many fibroids are asymptomatic, symptomatic fibroids cause a significant burden heavy menstrual bleeding (menorrhagia) leading to anaemia, pelvic pain and pressure, urinary frequency, bowel symptoms, painful intercourse, and in some cases, fertility challenges. The traditional treatment — hysterectomy is the second most common surgical procedure in women, but it permanently removes the uterus and is associated with surgical risks and a prolonged recovery.

• Affect 70–80% of women by age 50
• Can cause heavy bleeding, pain, pressure, and urinary symptoms
• Leading cause of hysterectomy worldwide
• UAE offers effective treatment while preserving the uterus
• Suitable for most women with symptomatic fibroids

How Does UAE Work?

Uterine fibroids are highly dependent on their blood supply for growth and survival they receive their blood predominantly from the uterine arteries. UAE exploits this dependency: using fluoroscopic guidance, a thin catheter is inserted via the femoral artery (groin) and selectively positioned in the uterine artery. Small microspheres (embolic particles) are injected into the uterine arteries, blocking blood flow to the fibroids. Starved of their blood supply, the fibroids undergo infarction and necrosis they shrink over the following weeks to months. Both uterine arteries are typically treated in the same session.

• Catheter inserted via a small puncture in the groin
• No general anaesthesia sedation and local anaesthesia
• Both uterine arteries treated in one session
• Fibroids shrink by 40–60% over 3–6 months
• Symptoms improve significantly in 85–90% of patients
• Uterus is preserved

Who is Suitable for UAE?

UAE is suitable for most pre-menopausal women with symptomatic uterine fibroids who wish to preserve their uterus or avoid surgery. Ideal candidates include women with multiple fibroids, heavy menstrual bleeding, pelvic pain or pressure, urinary symptoms, or those who have declined or are unfit for surgery. UAE is generally not recommended for post-menopausal women (as fibroids typically regress with menopause), women with active pelvic infection, suspected uterine malignancy, or those with very specific types of fibroid (pedunculated submucosal fibroids with a thin stalk). A detailed MRI of the pelvis is performed before UAE to characterise fibroid number, size, position, and vascularity.

The UAE Procedure Step by Step

UAE is performed in the interventional radiology suite. The patient is given intravenous sedation and analgesia for comfort, and local anaesthesia at the groin. A small puncture is made in the femoral artery, and a catheter (2mm diameter) is advanced under X-ray guidance into the uterine artery. Angiography is performed to visualise the fibroid blood supply. Embolic microspheres (typically 500–700 microns in size) are then injected slowly until flow in the uterine artery is significantly reduced. The procedure is then repeated on the opposite uterine artery through the same groin puncture. The total procedure time is approximately 60–90 minutes.

Fertility Preservation and Uterine Conservation

Uterine artery embolisation (UAE) is an effective minimally invasive treatment option for women who wish to preserve their uterus while managing symptomatic fibroids. Unlike hysterectomy, UAE avoids removal of the uterus and allows many women to maintain their reproductive potential. Current evidence suggests that most women can safely undergo UAE with only a mild risk of reduced fertility, subfertility, or complications such as premature delivery in future pregnancies. Because the procedure targets the blood supply to fibroids while preserving the surrounding uterine tissue, many patients experience significant symptom relief without major disruption to normal uterine function. However, fertility outcomes can vary depending on factors such as age, ovarian reserve, fibroid size and location, and prior reproductive history. Therefore, treatment decisions should be individualised after detailed discussion with both the interventional radiologist and gynaecologist, especially in women actively planning pregnancy.