Uterine artery embolization (UAE) is a procedure used to stop vaginal bleeding. Bleeding can be caused by uterine fibroids, trauma, cancer, childbirth, and other conditions. UAE is a minimally invasive procedure that blocks blood flow to the uterus.
What is uterine artery embolization (UAE)?
Uterine artery embolization (UAE) is a minimally invasive procedure most commonly used to treat vaginal bleeding produced by uterine fibroids (benign tumors inside the uterus). In addition to fibroids, UAE can also help with heavy bleeding in emergency situations caused by trauma, malignant (cancerous) gynecological tumors, or postpartum hemorrhage.
The terms uterine artery embolization and uterine fibroid tumor embolization (UAE) are often used interchangeably. However, they are different. UAE is a special type of UAE designed to treat uterine fibroids. It treats uterine fibroids as well as other conditions that can cause vaginal bleeding.
Why is uterine artery embolization (UAE) treatment done?
The most common reason for uterine artery embolization is the treatment of uterine fibroids, which cause symptoms such as:
- Heavy menstrual bleeding.
- Bloating in the pelvic area.
- Pain during sexual intercourse
- Frequent urination.
- Your healthcare provider may recommend uterine artery embolization (UAE) for other conditions, such as heavy bleeding after childbirth, an injury, or cancer.
Uterine artery embolization (UAE) should not be performed if:
- Your uterine fibroids are asymptomatic.
- You are pregnant.
- You have a pelvic infection.
- You have a condition that affects the veins, arteries, and blood vessels.
- You have an allergic reaction to contrast agents (used in UAE).
How does uterine artery embolization (UAE) work?
In UAE, small particles (like grains of sand) are injected into the blood vessels leading to the uterus. These particles are injected into the uterine arteries through a thin, flexible tube (catheter) using fluoroscopy, a type of X-ray that produces affecting images.
If the blood vessels in the uterus are blocked by these particles:
- Your doctor may be able to stop extreme bleeding.
- Tumors or fibroids shrink because their blood supply is cut off.
- Treatment Details
What happens before uterine artery embolization (UAE)?
Your doctor will recommend UAE after a complete medical history and a thorough physical examination. Diagnostic tests will be performed to determine the source of your symptoms.
Before the procedure, the following may be performed:
- Your doctor will review your medical history, allergies, medications, and menstrual history. They will also discuss your pregnancy plans, as UAE may affect your ability to conceive.
- A magnetic resonance imaging (MRI), hysteroscopy, or uterine ultrasound will help your doctor determine the cause of your bleeding.
- A biopsy (tissue removal) of the uterine lining may be performed to control if cancer cells are present.
- Before UAE, your doctor will ask you to stop taking aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), and blood thinners.
- You should not eat or drink anything before the procedure. Your doctor will explain any specific fasting instructions.
What happens during uterine artery embolization (UAE)?
UAE is usually performed on an outpatient basis and does not require hospitalization. The entire procedure usually takes about 90 minutes.
UAE is generally performed as follows:
- The procedure is achieved by an interventional radiologist. Interventional radiologists perform minimally invasive procedures under medical imaging guidance.
- You will lie on a table and be connected to machines that display your vital signs, such as heart rate and blood pressure.
- An anesthetic (numbing medication) will be applied to the skin of your groin to numb it.
- You will be given intravenous fluids and sedatives. The sedatives will relax you and may cause drowsiness.
A small puncture is made in the skin of your groin (in the femoral artery), and a fine needle is inserted. X-rays (fluoroscopy) and a contrast agent are used to insert a tube into the uterine arteries.
- The contrast agent glows under the X-rays, showing the doctor the path of the arteries and blood flow in the uterus.
- Once inserted, the catheter releases particles called embolic agents (usually gelatin or plastic) that block blood flow from the arteries to the uterus.
- Once the procedure is complete, the catheter is removed. Bleeding at the puncture site is stopped, and a bandage is applied.
What happens after uterine artery embolization (UAE)?
Most patients can be cleared from the hospital within a few hours of uterine artery embolization (UAE). Below are other things you can expect after the procedure:
- You may be asked to remain lying down for a few hours after the procedure.
- Your doctor may prescribe pain relievers and antibiotics to take at home.
- You may have watery or mucousy discharge for a few weeks.
- Moderate to severe pelvic cramps are common during the first 24 hours after UAE.
- Most women can return to normal activities one to two weeks after the procedure.
Your period may not return for a few cycles. When it does return, the amount of blood may be less than normal. It will gradually increase in subsequent cycles to a level that indicates improvement from your pre-procedure level.
If you’re treating fibroids, symptoms should begin to subside in about two to three weeks. Some women remove the fibroid tissue vaginally. Most women experience complete relief within six months.
How painful is uterine artery embolization (UAE)?
You’ll feel relaxed and drowsy during the procedure and shouldn’t feel any pain. You may experience some discomfort when you go home and when the sedatives wear off. Your doctor may prescribe pain relievers or recommend over-the-counter pain relievers during your recovery.
Risks/Benefits
What are the benefits of uterine artery embolization (UAE)?
Nearly 90% of patients who undergo UAE to treat uterine fibroids experience partial or complete symptom relief. Other benefits of UAE include:
- It can be performed on an outpatient basis with local anesthesia.
- Fast recovery due to the absence of large incisions or stitches.
- Little blood loss or subsequent bleeding.
- Fewer complications than invasive surgeries.
- It avoids the side effects of hormone therapy, which is sometimes used to treat fibroids.
The procedure only requires a small puncture, making it less invasive than other treatments such as myomectomy (surgical removal of uterine fibroids) or hysterectomy (removal of the uterus).
What are the risks of uterine artery embolization (UAE)?
Most procedures carry certain risks. Risks associated with uterine artery embolization (UAE) include:
- Infection: Catheter placement can damage other blood vessels in the area or cause infection.
- Damage to healthy tissue: The embolic agent can enter the wrong blood vessel, disrupting the blood supply to healthy tissue.
- Allergic reaction: An allergic reaction to the contrast agent or sedatives may occur.
- Menstrual irregularities: Between 1% and 5% of patients will permanently stop menstruating after uterine artery embolization.
- Surgical failure: Symptoms may recur, and a second UAE or hysterectomy may be necessary.
- Infertility: You will lose the ability to conceive.
Is UAE safe?
Yes, uterine artery embolization is a safe procedure in most cases. Your healthcare provider will explain the risks of UAE to you based on your medical history.
It is not yet known for sure whether uterine artery embolization (UAE) affects future pregnancies. Some doctors prefer surgical removal of fibroids if a woman wishes to have more children. Pregnancies following UAE may be associated with an increased risk of miscarriage, cesarean section, and postpartum hemorrhage. If you are pregnant or wish to become pregnant, consult your healthcare provider about the risks of UAE.
Overview
Uterine artery embolization (UAE) is a minimally invasive procedure used to treat uterine fibroids, heavy postpartum bleeding, and other gynecological tumors. UAE is not appropriate for all women, so you should consult with your doctor about the risks and benefits of the procedure. If you are pregnant or planning to become pregnant, UAE may not be appropriate for you. Most women who undergo UAE experience resolution of symptoms within a few months. Serious complications from UAE are rare but possible. Be sure to discuss your concerns with your doctor so you feel comfortable with the procedure.