Uterine Artery Embolisation (UAE)

1) Understanding the conditions

Fibroids are non-cancerous growths of the muscle of the uterus. They can be single or multiple, tiny or large. Depending on size and location, they can cause heavy or prolonged periods, pelvic pressure or pain, bloating or constipation, frequent urination, and sometimes fertility or pregnancy issues.

Adenomyosis is different. The lining of the uterus (endometrium) grows down into the muscle wall (myometrium). The uterus can become thicker and tender. Many patients experience very heavy, painful periods and a deep, dragging pelvic ache that is exhausting.

Fibroids and adenomyosis commonly occur together. Neither condition is life-threatening, but both can seriously affect quality of life. The aim is to tailor treatment to your symptoms and goals.

2) Treatment options

There isn’t one “best” treatment for everyone. Many patients use a combination of therapies over time.

You may try pain relief, anti-inflammatories, iron if you’re anaemic, and tracking your cycles. Medications like tranexamic acid or hormonal therapies (including the Mirena® IUD) can reduce bleeding and pain. Short courses of hormone injections (GnRH analogues/antagonists) sometimes shrink the uterus temporarily. These options are provided by your GP or Gynaecologist.

Surgical options include myomectomy (removing fibroids while keeping the uterus), endometrial ablation (treats bleeding only – not suitable if you want future pregnancy), and hysterectomy (removes the uterus completely and is definitive).

Uterine Artery Embolisation (UAE) sits between medical treatment and surgery. It’s a minimally invasive, image-guided procedure that reduces the blood supply to fibroids or adenomyosis tissue so they gradually shrink and soften. Recovery is usually faster compared to major surgery.

3) Planning and imaging

Most patients have already had a pelvic ultrasound which discovered the fibroids or adenomyosis. To plan precisely, a pelvic MRI will be organised to map the size, number and position of fibroids or the extent of adenomyosis. A CT angiogram will be arranged to provide a “road map” of the arteries that feed the uterus. This helps identify any variant supply (for example from the ovarian arteries) so Dr Hillhouse can treat all relevant vessels. Missing a significant feeder vessel can lead to technical failure.

You may be referred to a gynaecologist for endometrial biopsy prior to the UAE procedure to ensure there is no endometrial cancer. This is required for patients who are 45 years or older who have abnormal uterine bleeding, or if the planning pelvic ultrasound or MRI happens to show an abnormality. If you are being referred by a gynaecologist, they will usually discuss this with you beforehand. Otherwise, Dr Hillhouse or your GP can help with this referral to a gynaecologist.

A repeat MRI at about six months after UAE is performed to confirm that the treated tissue has fully lost its blood supply (infarcted) and to document shrinkage.

4) The Embolisation procedure

UAE is performed in an angiography suite, a sterile room with specialised x-ray equipment. In the public hospital setting, you’ll be provided medical sedation and local anaesthetic at the access site. Anaesthetic support is provided in the private hospital setting and anaesthetic options can be individualised in discussion with the anaesthetist.

A left radial artery (wrist) approach is almost always used. This tiny puncture (about 2–3 mm) usually means less discomfort and earlier mobilisation. If the wrist artery isn’t suitable, a femoral artery (groin) approach is used. All vascular procedures carry a small risk of bruising, bleeding, vessel spasm or injury/thrombosis at the puncture site; these events are uncommon and usually resolve with compression or a closure device.¹

Through this puncture, a very fine catheter is guided into the arteries that supply the uterus. Using x-ray and contrast dye, microspheres are injected (tiny medical-grade beads) that lodge in small vessels and block blood flow to the targeted tissue. The healthy uterus continues to receive blood from other tiny vessels.

You’ll have a urinary catheter placed at the start of the procedure to keep the bladder empty and improve comfort. The procedure typically takes 45–90 minutes. You’ll stay overnight and have patient-controlled analgesia (PCA) so you can top up pain relief safely as needed. The urinary catheter is removed later that day or the next morning.

What you’ll feel: crampy pelvic pain is common for the first 6–24 hours and is managed proactively. Some patients feel nauseated or feverish and tired for a few days. This is expected and short-lived.

5) Preparing for Your Procedure

On the day of your procedure you need to arrive fasted (no food or drink). The hospital will provide specific instructions.

Blood tests may be done before the procedure to check your kidney function and blood clotting.

If you take blood thinners (anticoagulants), these may need temporary adjustment. Please confirm this with the Hospital and Doctor’s secretary before your admission.

The procedure can be performed at any stage of your menstrual cycle.

6) Recovery (the first days to weeks)

The first 12–24 hours are the most uncomfortable; then the pain settles quickly. Expect to feel washed-out for a few days, then steadily better over the first week. Light vaginal spotting or discharge is common for a couple of weeks. Most patients are up and about the next day, driving in a few days, and back to work in 3–7 days depending on the job. Avoid heavy lifting for about 1 week after wrist access or 1–2 weeks after groin access.

7) Results you can expect

For fibroids, periods usually become lighter and pressure symptoms ease within 1-3 cycles. Fibroids shrink gradually – on average by 40-60% over 6-12 months.²

For adenomyosis, pain relief often appears earlier, and bleeding improves over subsequent cycles. Using a Mirena® alongside UAE can further improve bleeding control for some patients and this can be discussed with your GP/Gynaecologist. UAE can still be performed even if you already have a Mirena®.^{3 4}

Most patients report better sleep, energy and daily comfort. The goal is symptom control and quality-of-life improvement, not a perfect-looking scan.

Fertility & pregnancy: UAE is not contraception. Pregnancy can occur afterward, but fertility depends on age, ovarian reserve and the underlying condition. If pregnancy is a priority, we’ll discuss all options before you decide.¹

8) What the studies show

In short: multiple audits and quality-care guidelines show that UAE provides durable symptom relief for both fibroids and adenomyosis, with low complication rates and high uterus-preservation over long-term follow-up.^{1 4 5}

9) Risks and side-effects

Common and short-term: pelvic cramps, tiredness, mild fever, temporary cycle changes, and light discharge.
Occasional: infection (~1–3%), non-target embolisation (rare with modern technique), ovarian impact with earlier menopause (mainly in patients >45 years), and bruising or bleeding at the access site.

Seek help urgently for heavy bleeding, foul discharge, high fever, or worsening pain.

10) Follow-up and imaging

We’ll speak by phone or telehealth within 1–2 weeks. You’ll have a clinic review and a follow-up MRI at ~6 months to confirm full infarction and assess shrinkage. Further review is tailored to your symptoms and goals.

11) Key differences: fibroids vs adenomyosis

12) Involvement of your GP and Gynaecologist

If you have a gynaecologist, they remain an important part of your care. Many patients are referred by their gynaecologist; others come after discussion with their GP. Dr Hillhouse maintains close communication with your gynaecologist (and GP) to ensure co-ordinated care before and after your procedure.

13) Summary of practical details for your procedure

• • • Performed personally by Dr James Hillhouse.
    • Access: radial/wrist preferred; femoral/groin used only if radial isn’t appropriate.
    • Anaesthesia: sedation + local anaesthetic in the public hospital setting. Anaesthetic support is available in the private hospital setting.
    • Urinary catheter: placed at the start of the procedure; removed later that day or the next morning.
    • Admission: overnight with PCA; next-day discharge when comfortable.
    • Imaging: ultrasound (usually already done). Pre-procedure MRI + CT angiogram for planning. Post-procedure MRI at around 6 months for response.

Do the beads stay in my body?
Yes. They sit in the tiny vessels that fed the target tissue and are designed for this purpose.

Does it matter if I have my period on the day of the procedure?
No. The procedure can be performed at any stage of your menstrual cycle.

Does UAE cause menopause?
Rarely in patients younger than 45. The risk is higher over age 45 and likely related to the fact that this group is closer to menopause naturally.

Can I get pregnant after UAE?
Some patients do; fertility depends on age and the underlying condition. Please discuss if this is a goal.

Will my symptoms come back?
Sometimes over the years; if needed, we can discuss medicines, repeat UAE, or surgery.

How soon will I feel better?
Many notice improvement after 1–3 cycles; most benefit builds over 6–12 months.

Do I need an endometrial biopsy prior to UAE?
An endometrial biopsy is performed by a gynaecologist prior to UAE if you are 45 years or older with abnormal uterine bleeding, or if your workup pelvic ultrasound or MRI showed an abnormality. This screening ensures that malignant conditions are not mistakenly treated with UAE.

15) References

1. Clements W et al. Quality-care guidelines for uterine artery embolisation in women with symptomatic fibroids. J Med Imaging Radiat Oncol 2022.
2. Liang E et al. Uterine artery embolisation for leiomyomata: clinical audit. Aust N Z J Obstet Gynaecol 2012.
3. Liang E et al. Adenomyosis: audit of outcomes after UAE. Aust N Z J Obstet Gynaecol 2018.
4. Kröncke T. An update on uterine artery embolisation for leiomyomata and adenomyosis. Br J Radiol 2022.
5. de Bruijn A et al. Uterine artery embolisation for symptomatic adenomyosis: 7-year follow-up. Cardiovasc Intervent Radiol 2017.
6. IRSA. Uterine Artery Embolisation – Patient Information Leaflet. 2022.

Prepared for patients of Dr James Hillhouse, Interventional Radiologist.

This information is general and should be discussed with your treating clinicians.