Uterine Fibroid Embolization

Background and indications

Uterine fibroids (myomas) are the most common benign tumors in women, affecting 20-40% of women of reproductive age. They can cause menorrhagia (heavy periods) leading to anemia, pelvic pain, heaviness sensation, urinary symptoms from bladder compression, and sometimes fertility difficulties. Uterine artery embolization (UAE) is a recognized and validated alternative to surgical myomectomy and hysterectomy.

UAE is particularly indicated for symptomatic women wishing to preserve their uterus, in cases of multiple fibroids (where myomectomy would be complex), or in patients with high surgical risk. It is generally not recommended as first-line treatment for women with immediate pregnancy plans.

Pre-procedure assessment

Assessment includes pelvic MRI (key examination to characterize fibroid size, number and location, and exclude malignancy), pelvic ultrasound, blood tests (complete blood count, ferritin, hormonal panel), and up-to-date cervical smear. A prior gynecological consultation is essential.

Procedure

Under local anesthesia and sedation or epidural, a microcatheter is introduced through the right femoral artery or radial artery. Under fluoroscopic guidance, the interventional radiologist successively catheterizes both uterine arteries and injects calibrated microspheres (500-700 or 700-900 µm, most commonly tris-acryl gelatin) that occlude the fibroid blood supply. The bilateral procedure is performed in a single session and takes approximately 45 to 90 minutes.

Results and scientific evidence

The randomized EMMY trial (177 patients), with 10-year follow-up, showed a 78% satisfaction rate after embolization versus 87% after hysterectomy, with reintervention needed in 35% of cases at 10 years (de Bruijn et al., American Journal of Obstetrics and Gynecology, 2016; DOI: 10.1016/j.ajog.2016.06.051). The REST trial (NEJM, 2007) in 157 patients confirmed comparable quality of life improvement at 1 year between embolization and surgery.

Embolization achieves a 40-60% fibroid volume reduction at 6 months and improvement of menorrhagia in 85-90% of cases. Overall uterine volume reduction is 30-50%.

Risks and complications

Post-embolization syndrome (cramping pelvic pain, nausea, mild fever) is common in the first 24-72 hours and is managed with appropriate pain control (including patient-controlled analgesia if needed). Severe complications are rare: uterine infection (< 2%), submucosal fibroid expulsion (3-5%, potentially requiring curettage), permanent amenorrhea (< 3% before age 45, more frequent after 45). Non-target ovarian embolization is exceptional with current techniques.

Recovery

Hospitalization is typically 1-2 nights for pain management. Return to normal activities is possible after 1 to 2 weeks (versus 4-6 weeks after surgery). Follow-up is scheduled at 3, 6, and 12 months with control MRI to assess fibroid volume reduction.

Practical information

The procedure is performed as a short inpatient stay (1-2 nights) or outpatient depending on the case and pain tolerance. It is performed by an interventional radiologist, in coordination with the treating gynecologist.