Uterine Artery Embolization (UAE): Candidates, Procedure, Recovery

Uterine artery embolization (UAE), also called uterine fibroid embolization (UFE), is an interventional radiology procedure. A thin tube is passed from an artery in the wrist or groin into the uterine arteries, which are then blocked. Fibroids that lose their blood supply gradually shrink, and heavy periods and pressure symptoms ease. It treats non-cancerous conditions (fibroids and adenomyosis) and is chosen by women who want to keep their uterus and avoid surgery.

The patient leaflet of the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) states that about 80% of women report a significant improvement in symptoms and quality of life one year after UAE. This article draws on that leaflet, UK NICE guidance, the UK randomised FEMME trial and a long-term Chinese adenomyosis study to explain who is suitable, what happens, recovery time and how side effects are managed.

What is uterine artery embolization?

Fibroids are growths in the muscle of the uterus and are almost always benign. Large fibroids can cause heavy bleeding and anaemia, or press on the bladder and bowel, causing frequent urination and a feeling of fullness. UAE uses tiny particles to block only the vessels feeding the fibroids. Normal uterine tissue also receives blood from other vessels and recovers, while the fibroids lose their supply and shrink.

There is no abdominal incision, only a small needle puncture, so scarring is minimal. Compared with removing the fibroids (myomectomy) or the uterus (hysterectomy):

Based on the CIRSE patient leaflet (2025) and the FEMME trial (NEJM 2020).

The principle is the same as TAE (transarterial embolization); an overview of the field is on our IVR (interventional radiology) page.

Who is it for?

• Symptomatic fibroids: heavy periods, anaemia, pelvic pain or frequent urination that affect daily life.
• Women who want to keep the uterus: those who do not want a hysterectomy, or for whom general anaesthesia and major surgery are a burden.
• Several fibroids: treating through the blood vessels reaches fibroids throughout the uterus at once.
• Adenomyosis: a condition in which lining tissue grows into the uterine muscle; UAE is used for painful and heavy periods.

NICE recommends that a gynaecologist and an interventional radiologist select patients together. Women planning a pregnancy should also talk with a fertility specialist first; CIRSE notes they may be advised to wait about six months after the procedure before trying to conceive.

Preparing for the procedure

• Tell the team about all your medicines; blood thinners may need to be reduced or paused.
• Blood tests and pelvic imaging (ultrasound or MRI) confirm the size and position of the fibroids.
• Let the team know if you have an intrauterine device (coil).
• You are often asked to fast on the day.

If you are being treated abroad, preparing recent scans and medical records in the local language or English speeds up the consultation. Our five questions before an RFA consultation are also a useful checklist.

The procedure step by step

According to CIRSE, the procedure takes about an hour. After a drip is placed and a sedative given, local anaesthetic numbs the groin or wrist and a thin tube is passed into the artery. Under X-ray guidance it is steered into both uterine arteries and embolic particles are injected slowly to stop the blood flow.

Strong cramping, like period pain, can occur as the vessels close and for several hours afterwards. Many hospitals therefore use a patient-controlled analgesia (PCA) pump that lets you give yourself pain relief at the press of a button; it is designed so you cannot take too much. The tube is then removed, the puncture site is pressed, and you lie flat for about four hours.

Recovery time and managing side effects

Summarised from the CIRSE patient leaflet (2025). Many Japanese hospitals use a stay of about five days.

Fever and pain in the first days are a natural response as the fibroids react, and they are controlled with medicine. If discharge smells unpleasant and you have a fever, contact your team promptly, as this may be infection. CIRSE says infection occurs in up to 2% of patients and most cases respond to antibiotics. Early menopause occurs in 2–4%, mainly in women over 45, so discuss your age and cycle at the consultation.

Results from international studies

The FEMME trial, run at 29 UK hospitals, randomly assigned 254 women with symptomatic fibroids to myomectomy or UAE and followed them for two years (NEJM, 2020). Quality of life improved substantially with both treatments.

Manyonda I, et al. N Engl J Med 2020;383:440-451. The authors note pregnancy numbers were too small for conclusions.

Myomectomy scored slightly higher, while UAE halved the hospital stay with a similar complication rate. If more treatment is needed, repeat embolization or surgery remains available. For women who value a quick recovery and a lighter physical burden, UAE is a good option.

Results in adenomyosis are also steady. Researchers at Nanfang Hospital, Southern Medical University, China, followed 252 women treated with UAE for five years (PLoS ONE, 2016).

Zhou J, et al. PLoS One 2016;11(11):e0165610. Results were better when lesions had a rich blood supply.

Around 70% of women still had improved symptoms after five years. The researchers suggest that assessing lesion blood supply on MRI before treatment helps predict the benefit.

Japan and other countries

Foreign patients are usually not covered by the local public insurance, so confirm costs and schedules directly with the hospital.

Most overseas university hospitals with a vascular intervention team offer UAE. The same embolization principle used for liver cancer is described in our TACE (transarterial chemoembolization) guide.

Questions for your doctor

• Given the size, position and number of my fibroids, is UAE suitable for me?
• Will you go in through the wrist or the groin, and how long is the hospital stay?
• How will pain be controlled during and after the procedure?
• What should I check first if I hope to become pregnant?
• When and how will the result be checked, and what are the options if symptoms return?

FAQ

How long is recovery after uterine artery embolization?

Under European guidance most women go home within 24 hours and rest at home for a few days. Mild fever and pain in the first one to three days are controlled with tablets. Many hospitals in Japan use a stay of about five days.

Can I get pregnant after UAE?

In the UK FEMME trial, nine women became pregnant within two years of UAE. Numbers are too small for a firm comparison with myomectomy. If you plan a pregnancy, talk with a fertility specialist first; you may be advised to wait about six months after treatment.

Does UAE help adenomyosis?

In a Chinese study following 252 women, improvement lasted at five years in 70.4% for painful periods and 68.8% for heavy periods. Results were better when lesions had more blood vessels.

Is the procedure painful?

Period-like cramps can occur as the vessels close and for a few hours afterwards. Sedation, local anaesthetic and a self-controlled pain pump manage this, and the pain settles within a few days.

This article summarises official overseas sources and studies as general information and is not medical advice. Discuss treatment choices with doctors who have examined you.