Uterine artery embolization for symptomatic uterine fibroids

Uterine artery embolization (UAE) for uterine fibroids that cause symptoms such as heavy bleeding, pain, pressure symptoms and subfertility.The traditional treatment for fibroids (benign tumors) that cause symptoms such as heavy and prolonged bleeding, pain, pressure symptoms and subfertility, is surgery. The two main surgical approaches are myomectomy (hysteroscopic or abdominal approach) to remove the fibroids or hysterectomy where the uterus is removed: both are associated with complications. Uterine artery embolization (UAE) was originally devised to reduce pelvic bleeding due to postpartum haemorrhage and is now being used for reduction of fibroid bulk size and heavy menstrual bleeding. There are two randomized controlled trials (RCT) comparing UAE with hysterectomy and another comparing UAE with myomectomy. Two of these trials have a minimum of six months follow-up and the other is a peri- and postprocedural complications report for up to 6 weeks follow-up only. There is no evidence of benefit of UAE compared to surgery (hysterectomy / myomectomy) for satisfaction. There are more minor complications, more unscheduled visits and readmission rates after discharge in the UAE group compared to hysterectomy. However, there are no differences between major complication rates and UAE is associated with shorter hospital stay and return to work. Further research is awaited with long term follow up. Women with symptomatic fibroids may be offered UAE as a treatment option but more research with a longer follow up is needed.