Uterine Artery Embolisation Versus Myomectomy for Fibroids
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Direct answer
Uterine artery embolisation is an image-guided procedure in which embolic particles are injected into both uterine arteries, usually by a femoral or radial route, to infarct symptomatic fibroids while preserving the uterus. It suits women with heavy menstrual bleeding or bulk symptoms who want to avoid surgery and do not plan pregnancy. Its drawbacks are post-procedure pain and a higher chance of later re-intervention than myomectomy.
What you must remember
- Route and technique: transfemoral or transradial angiography, bilateral uterine artery catheterisation and injection of embolic particles or microspheres.
- Indications: symptomatic fibroids causing heavy menstrual bleeding, bulk symptoms or pain in a woman who does not want surgery or pregnancy.
- Contraindications: pregnancy, active pelvic infection and suspected gynaecological malignancy, including sarcoma, with contrast allergy assessed beforehand.
- Post-procedure syndrome: pain, fever, nausea and fatigue for several days, managed with analgesia, anti-emetics and rest.
- Outcomes: most published series report symptom improvement, with a shorter hospital stay than surgery, but re-intervention, including hysterectomy, is more frequent than after myomectomy over the longer term.
- Fertility: the evidence is limited, and many guidelines advise myomectomy for women who wish to conceive, since some series report higher pregnancy loss after embolisation.
A comparison with myomectomy
A 42-year-old woman with heavy bleeding and bulk symptoms has declined hysterectomy and asks about a less invasive option. Both embolisation and myomectomy preserve the uterus, but they differ in recovery, fertility evidence and durability. The table compares the two approaches on the features that usually drive the choice.
| Feature | Uterine artery embolisation | Myomectomy |
|---|---|---|
| Uterus preserved | Yes | Yes |
| Recovery and stay | Usually shorter | Longer, with surgical recovery |
| Fertility evidence | Less well established | Better established |
| Re-intervention | Higher over time | Lower over time |
| Main early problem | Post-procedure pain | Blood loss and surgical risk |
The choice usually turns on whether pregnancy is still wanted, since myomectomy offers better-established fertility outcomes. For a woman who has finished childbearing and wants minimal surgery, embolisation is a reasonable option, provided she accepts a higher chance of further treatment.
Embolisation is also less suitable for a pedunculated subserosal fibroid, because the stalk can infarct and the fibroid may detach or necrose, so it is usually treated surgically. Patients should be counselled that symptoms can recur and that a second procedure or surgery may still be needed.
Where the exam tries to catch you
Examiners test whether you can match the procedure to the patient's fertility goals and recognise situations where embolisation is unsafe.
- Trap: Offer embolisation to a woman who may want a pregnancy in the next few years. Correct: Fertility after embolisation is less well established, so myomectomy is generally preferred when pregnancy is planned.
- Trap: Treat a large fibroid as an automatic contraindication. Correct: Size alone is not an absolute contraindication, but very large or pedunculated fibroids need careful selection by the interventional team.
- Trap: Overlook a rapidly growing post-menopausal fibroid before embolisation. Correct: Sarcoma cannot be excluded reliably by MRI, and embolisation could delay diagnosis, so suspicious growth needs assessment first.
- Trap: Assume post-procedure pain means a complication. Correct: Post-embolisation syndrome is expected for several days and is treated with analgesia, while fever or persistent pain needs review for infection.
Frequently asked questions
What are the main contraindications to uterine artery embolisation?
Pregnancy, active pelvic infection and suspected gynaecological malignancy, including sarcoma, are the main contraindications to uterine artery embolisation. Contrast allergy and other specific concerns are assessed by the interventional radiologist before the procedure.
What is post-embolisation syndrome?
Post-embolisation syndrome is the combination of pain, fever, nausea and fatigue that follows uterine artery embolisation over several days. It is managed with analgesia, anti-emetics and rest, and usually settles without intervention.
Does uterine artery embolisation preserve fertility?
Uterine artery embolisation preserves the uterus, but fertility after uterine artery embolisation is less well established than after myomectomy. Women who plan pregnancy are usually advised to choose myomectomy instead.
How does uterine artery embolisation compare with myomectomy for re-intervention?
Uterine artery embolisation is associated with a higher rate of re-intervention than myomectomy over the longer term, including repeat procedures or hysterectomy. Myomectomy has a lower re-intervention rate but carries surgical blood loss and a longer recovery.