What is uterine fibroid embolization?

Uterine fibroid embolization (UFE) — also called uterine artery embolization (UAE) — is a non-surgical, image-guided treatment for symptomatic uterine fibroids and adenomyosis. First described by Ravina and colleagues (Lancet, 1995), UFE is now recommended in major society guidelines as a uterus-preserving alternative to hysterectomy and myomectomy. Through a 2-millimeter puncture in the wrist or groin, an interventional radiologist guides a thin catheter to both uterine arteries and releases microscopic particles that block the abnormal blood flow feeding the fibroids. Without their blood supply, fibroids gradually shrink — and the symptoms go down with them. Technical success exceeds 95%, and the uterus is preserved because its collateral blood supply keeps healthy tissue alive.

Symptoms UFE is designed to treat

UFE specifically targets the symptoms driven by abnormal blood flow and uterine bulk:

• Heavy menstrual bleeding (menorrhagia) — the most common driver of fibroid-related anemia
• Abnormal or dysfunctional uterine bleeding (AUB / DUB) — prolonged periods or breakthrough bleeding
• Pelvic pressure, bloating, and bulk symptoms from fibroids pressing on neighboring organs
• Urinary frequency or urgency from bladder pressure — improves in roughly 85% of UFE patients
• Pelvic pain and dysmenorrhea — improves in 79–84% of UFE patients (Walker & Pelage, BJOG, 2002)
• Symptoms of adenomyosis — heavy bleeding and severe cramping from endometrial tissue in the uterine wall

How the procedure works

UFE is performed in an outpatient procedure suite under moderate sedation — not general anesthesia. After the access site is numbed, a catheter about the width of a strand of spaghetti is threaded through the radial or femoral artery and navigated, under live X-ray, to both uterine arteries. Calibrated embolic particles — typically tris-acryl gelatin microspheres or polyvinyl alcohol — are then released. They are sized to lodge in the abnormal vessels feeding the fibroids while sparing the larger vessels supplying healthy uterine tissue. Most procedures take 60–90 minutes.

What to expect

UFE is a same-day outpatient procedure with a much shorter recovery than hysterectomy or open myomectomy.

UFE outcomes: what the data show

UFE is one of the most extensively studied minimally invasive procedures in women’s health. The strongest evidence comes from large prospective registries and randomized trials — most notably the EMMY trial (UFE vs hysterectomy, 10-year follow-up; van der Kooij et al., Am J Obstet Gynecol, 2017) and the UK FEMME trial (UFE vs myomectomy; Manyonda et al., N Engl J Med, 2020).

• Technical success: over 95% for bilateral uterine artery embolization
• Heavy menstrual bleeding improves in 83–92% of patients
• ~90% of patients see meaningful improvement in bulk symptoms (Society of Interventional Radiology guidelines)
• EMMY 10-year follow-up:no significant difference in pain control, bulk symptom relief, or overall satisfaction between UFE and hysterectomy. About 33% of UFE patients eventually elected hysterectomy for recurrent symptoms — meaning roughly two-thirds avoided major surgery permanently
• Complications: serious complications are rare; fewer than 1% of patients require a hysterectomy for an embolization complication

Who is a good candidate for UFE?

UFE works for the majority of women with symptomatic uterine fibroids and for selected patients with adenomyosis. You may be a candidate if:

• You have one or more fibroids causing heavy menstrual bleeding, pelvic pressure, pain, or urinary symptoms
• Your symptoms haven’t responded to medical management — oral contraceptives, hormonal IUDs, GnRH antagonists, tranexamic acid, or NSAIDs
• You’d prefer to avoid hysterectomy or open/laparoscopic myomectomy
• You’d like to preserve your uterus, whether or not future pregnancy is on the table
• You have adenomyosis with heavy bleeding and want a uterus-sparing option

UFE is generally not recommended in active pelvic infection, suspected uterine malignancy, current pregnancy, or for an isolated pedunculated subserosal fibroid on a thin stalk. Black women are diagnosed with fibroids 2–3× more often than white women and are 2.4× more likely to undergo hysterectomy (Eltoukhi et al., Am J Obstet Gynecol, 2014) — UFE is an effective, uterus-sparing option regardless of fibroid number or size in most cases.

Why an interventional radiologist?

UFE should be performed by an interventional radiologist. Interventional radiology is the specialty built around image-guided, minimally invasive treatment. Every procedure performed at Florida Interventional Specialists is done under direct imaging — meaning catheter placement is verified in real time rather than estimated by feel. UFE depends entirely on the operator’s ability to selectively catheterize sub-millimeter arteries, identify variant anatomy, and embolize precisely. That visibility, precision, and fellowship-trained expertise is what separates a routine 95% success rate from a complication. View our Interventional Radiologists here. 

Common questions

Is UFE painful?

The procedure itself isn’t painful — you have local anesthesia plus moderate sedation. The most common discomfort is cramping in the first 24 hours, controlled with anti-inflammatories.

Will I still have periods after UFE?

Yes — most premenopausal women keep menstruating, but periods are typically much lighter and shorter. Permanent loss of periods is uncommon (about 7% in large series) and almost always occurs in women over 45.

Can I get pregnant after UFE?

Healthy pregnancies after UFE are well documented. For women with completed family planning, UFE is an excellent first-line option. If you’re actively trying to conceive in the near term, the choice between UFE and myomectomy is discussed at consultation.

How is UFE different from endometrial ablation?

Endometrial ablation destroys the uterine lining and works best for heavy bleeding without large fibroids. UFE treats every fibroid in the uterus at once by cutting off blood supply — and is more durable for women with multiple or larger fibroids.

Is UFE covered by insurance?

Yes — UFE is covered by Medicare and most commercial insurance plans for symptomatic fibroids. The office verifies your benefits before scheduling.