Uterine Fibroids and Their Treatment Uterine Artery Embolization or UFE

Uterine fibroids are benign tumors of uterus. They are seen in women around 30-40 years of age. Although fibroids are more common in African American women, women of all races are affected.
There may be a single large fibroid or multiple small to medium sized fibroids in uterus. Fibroids are most commonly located in the muscular wall of uterus which is sandwiched between inner and outer layers. However, some fibroids may be located on the inner lining of uterus causing more heavy periods and some on the outer layer causing more pressure on the surrounding structures of pelvis.
Fibroids may be completely asymptomatic and may be diagnosed on a routine examination of pelvis. When symptomatic, the symptoms depend upon their size and location. Common symptoms of fibroids include,

1. Changes in menstrual cycle
   • Longer and heavier periods
   • Menstrual pain and cramps
   • Vaginal bleeding between periods
   • Anemia, due to heavy bleeding
2. Pain
   • Dull aching pain in lower abdomen and pelvis
   • Painful intercourse
3. Pressure symptoms
   • Increased frequency of micturition
   • Inability to completely empty the bladder
   • Constipation due to pressure on rectum from a large fibroid
   • Abdominal cramps
4. Bulge in lower abdomen due to large fibroid
5. Miscarriage and infertility

Diagnosis of Uterine Fibroids

1. Ultrasound of pelvis
2. MRI scan
3. Hysteroscopy
4. Laparoscopy

Treatment of Fibroids

1. Uterine artery embolization also known as uterine fibroid embolization or UFE.
2. Myomectomy
3. Hysterectomy

At Premier vein and vascular center, we offer uterine artery embolization for the treatment of fibroids. In this procedure the blood vessels supplying fibroids are targeted using small sand like particles. These particles block the blood flow to fibroids leading to shrinking and death of fibroids. The patients are usually observed overnight after the procedure and sent home the next day.

How Uterine Fibroid Embolization Works

Fibroids are made of dense muscle and fibrous tissue, and they depend on a rich blood supply to grow. Almost all of that blood comes from the two uterine arteries, one on each side of the uterus. Fibroid tissue is especially sensitive to losing that supply, while the normal muscle of the uterus can draw blood from other small connecting vessels and recover.

Uterine fibroid embolization (UFE), also called uterine artery embolization (UAE), takes advantage of that difference. An interventional radiologist makes a tiny puncture in an artery at the wrist or the top of the thigh and, under live X-ray guidance, steers a thin catheter into each uterine artery in turn. Small particles are released until the flow into the fibroids slows. Starved of blood, the fibroids soften, shrink and stop producing symptoms, while the uterus itself stays in place.

Because every fibroid in the uterus is treated at the same time, UFE works for a single large fibroid as well as for many small and medium ones. There is no incision in the abdomen and no removal of tissue.

Why Fibroid Size and Location Matter for UFE

Where a fibroid sits shapes both the symptoms it causes and how well each treatment will work:

• Intramural fibroids, inside the muscular wall, are the most common type and usually respond well to embolization.
• Submucosal fibroids, bulging into the uterine cavity, are often behind very heavy bleeding. Many respond well to UFE; some small ones are better removed through a hysteroscope, and a fibroid that is mostly inside the cavity may be passed vaginally as it shrinks after UFE.
• Subserosal fibroids, on the outer surface, mainly cause pressure on the bladder or bowel and generally respond well.
• Pedunculated fibroids, attached by a narrow stalk, need careful assessment because the stalk itself can be affected by embolization.

A contrast-enhanced MRI shows each fibroid’s size, position and blood supply in detail, which is why it is our preferred test before recommending UFE.

UFE vs. Myomectomy vs. Hysterectomy

Each fibroid treatment has a role. The right choice depends on your symptoms, your fibroids, your health and whether you want a future pregnancy.

Who Is a Good Candidate for Uterine Fibroid Embolization?

UFE is a good option for many women with symptomatic fibroids who want to keep their uterus and avoid surgery. Typical candidates have heavy or prolonged periods, pelvic pain, or pressure symptoms such as frequent urination or bloating that interfere with daily life, and have fibroids confirmed on imaging.

UFE may not be suitable, or needs extra discussion, if you are pregnant, have an active pelvic infection, have a suspected cancer of the uterus or ovaries, or have severe kidney disease or a serious contrast allergy. Women who are actively planning a pregnancy are usually advised to discuss myomectomy first, although UFE can still be considered in selected cases.

Fibroid Effects That Are Easy to Overlook

Many women live with fibroid symptoms for years because heavy periods slowly become their normal. A few effects deserve attention even if the bleeding itself feels manageable:

• Iron deficiency. Ongoing heavy bleeding can drain iron stores, leading to tiredness, shortness of breath on stairs, headaches, brittle nails or cravings for ice. A simple blood test can check for anemia.
• Sleep and work disruption. Changing protection overnight, planning the day around bathrooms or missing work during periods are signs that symptoms are affecting quality of life.
• Bladder changes. A fibroid pressing on the bladder can cause frequent urination, getting up at night or a sense of incomplete emptying.
• Bowel and back symptoms. A large fibroid at the back of the uterus can contribute to constipation or a dull lower back ache.

These are all good reasons to have fibroids reassessed rather than simply waiting for menopause, especially since the years before menopause can still be long.

How We Evaluate Fibroids Before Recommending UFE

Fibroid care works best as a team effort between the interventional radiologist and your gynecologist. At Premier Vein & Vascular Center the consultation is designed to make sure UFE is the right fit before anything is scheduled.

1. Focused history. We ask about your periods, bleeding between cycles, pain, bladder and bowel symptoms, any history of anemia or transfusion, previous fibroid treatments and your plans for future pregnancy.
2. Review of gynecologic care. We confirm that you have had an up-to-date gynecologic exam and Pap test, and that abnormal bleeding has been checked with an endometrial evaluation when your gynecologist recommends it, so that other causes of bleeding are not missed.
3. Pelvic MRI. A contrast-enhanced MRI maps every fibroid, measures its size and blood supply and checks for other conditions, such as adenomyosis, that can mimic or accompany fibroids. Ultrasound is useful too, but MRI gives the most complete picture for planning embolization.
4. A clear plan. We walk you through what the imaging shows, how much improvement is realistic, how UFE compares with surgery in your situation and what recovery will look like, so you can make an informed decision.

What to Expect on the Day of UFE and Afterward

On the day of treatment, you receive IV medicine for relaxation and pain control, and the access site is numbed. The procedure itself usually takes about an hour to an hour and a half. You are awake but drowsy and most patients feel little beyond pressure at the access site.

The most important part of recovery is managing the cramping that follows as the fibroids lose their blood supply. It is usually strongest during the first several hours, which is one reason patients are observed overnight and given pain medicine through the IV or a pump before going home the next day. Over the following days, many women have what is called post-embolization syndrome: pelvic cramping, tiredness, mild nausea, poor appetite and sometimes a low-grade fever. This is an expected reaction to the treated fibroids and usually settles within a few days to a week with oral pain relievers and anti-inflammatory medicine.

Most women return to desk work and light activities within about one to two weeks. Some notice a light vaginal discharge for a few weeks, and occasionally a small fibroid lining the cavity is passed during a period.

Results After Uterine Fibroid Embolization

Heavy bleeding often improves within the first few menstrual cycles after UFE. Pressure symptoms such as frequent urination, bloating and pelvic fullness ease more gradually as the fibroids shrink, with continued change over several months. The fibroids do not usually disappear completely, but they become smaller and softer, and it is the reduced blood supply rather than the final size that relieves most symptoms.

Fibroids that have been successfully embolized rarely grow back. New fibroids can still develop in the years before menopause, and a small number of women need a further procedure. As with any treatment, results vary, and we review your progress with a follow-up visit and, when helpful, a repeat MRI.

Risks to discuss

UFE is considered a safe procedure, but no treatment is risk-free. Possible issues include bruising at the access site, infection of the uterus, prolonged discharge, a fibroid that needs to be removed as it passes, reaction to contrast dye and, in women closer to menopause, an earlier onset of menopause. We explain how each applies to you before treatment.

Fibroids, Fertility and Pregnancy

Fibroids that distort the inside of the uterus can make it harder to conceive or carry a pregnancy, while many fibroids in the wall or on the surface have little effect. If you hope to become pregnant, it is important to say so early. Myomectomy is usually the first option to consider in that situation, but some women who are poor surgical candidates, or whose fibroids are not suitable for surgery, still choose UFE after a detailed discussion with both their gynecologist and the interventional radiologist. We will not recommend a treatment without talking through how it may affect your family plans.

Uterine Fibroid Embolization in Houston

If fibroids are causing heavy periods, anemia, pain or pressure, and you have been told hysterectomy is your only option, it is worth getting a second opinion on non-surgical treatment. Dr. Syed Raza is a fellowship-trained interventional radiologist, board certified in diagnostic and interventional radiology by the American Board of Radiology and a Fellow of the Royal College of Radiologists (UK), and a former Chief of Interventional Radiology at UTMB Galveston and Memorial Hermann Memorial City. He works with patients and their gynecologists across Houston and Katy to decide whether UFE is a good fit.

If you are looking for an interventional radiology and vein clinic in Houston to discuss fibroid embolization, you can read more on our fibroid treatment page, browse answers on our fibroid treatment FAQs, learn about Dr. Syed Raza or request a consultation. Same-week appointments are usually available and most insurance plans, including Medicare, are accepted.

Frequently Asked Questions

Is uterine fibroid embolization painful?

The procedure itself is done under local anesthesia and sedation, so most women feel little more than pressure. Cramping afterward is common and is strongest in the first day, which is why pain medicine and overnight observation are provided. Discomfort usually settles to a manageable level within a few days.

How much do fibroids shrink after UFE?

Fibroids usually shrink gradually over several months after embolization, though they rarely disappear completely. Symptom relief depends mostly on cutting off the fibroids’ blood supply, so many women feel much better even when some fibroid tissue remains.

Can fibroids come back after embolization?

Fibroids that have been successfully embolized rarely regrow. New fibroids can still form in the years before menopause, and a minority of women need further treatment later. Follow-up imaging helps track any changes.

Will UFE cause early menopause?

For most women, periods return to their usual pattern after UFE. The chance of earlier menopause is higher in women already in their mid-to-late forties, whose ovaries are nearing the end of their function. This is something we discuss individually before treatment.

Is UFE covered by insurance?

Uterine fibroid embolization is a recognized treatment for symptomatic fibroids and is covered by most insurance plans, including Medicare, when it is medically necessary. Our office can help confirm your coverage before your procedure.

What is the difference between uterine artery embolization and uterine fibroid embolization?

They refer to the same procedure. Uterine artery embolization describes what is blocked, and uterine fibroid embolization describes the condition being treated. Both names are used by doctors and insurance plans.

How soon can I go back to work after UFE?

Most women return to desk-based work and light daily activities within about one to two weeks. Jobs involving heavy lifting or long shifts on your feet may need a little longer, depending on how quickly the post-procedure cramping and fatigue settle.

Trusted Health Resources

1. Uterine Fibroids, Office on Women’s Health (HHS)
2. Uterine Fibroids, MedlinePlus (NIH)