By Dr William Ormiston and Dr Matthew Clifford, Interventional Radiologists, Nedlands
Uterine fibroids and adenomyosis are among the most common benign conditions affecting women in their reproductive years. While many cases are asymptomatic, others can cause heavy menstrual bleeding, pelvic pain, and pressure symptoms, significantly impacting quality of life.
For decades, the primary treatment options were medical therapy or surgery, particularly hysterectomy or myomectomy. However, for women seeking a uterus-sparing, non-surgical alternative, uterine artery embolisation offers a compelling solution.
UAE is a minimally invasive procedure performed by an interventional radiologist. It involves the insertion of a thin catheter into the uterine arteries – typically via the wrist or groin – through which tiny particles are injected to block blood flow to the fibroids or areas of adenomyosis.
Deprived of blood supply, the abnormal tissue shrinks over time, resulting in symptom relief. The uterus, however, remains intact.
The procedure takes around 30-60 minutes and is usually performed with either twilight sedation or general anaesthesia. Most women experience pelvic cramping, fatigue, mild fever or nausea post procedure.
These symptoms peak at four to six hours, lasting about two days and are usually well-managed with analgesia and antiemetics. Most patients are discharged within 24 hours and return to normal activities within seven to 14 days.
The evidence
Multiple high-quality randomised trials (EMMY, FEMME, REST) have demonstrated that UAE is comparable to surgery in relieving symptoms and improving quality of life, with shorter recovery times and fewer perioperative complications.
Most women – up to 90% – report a significant reduction in heavy bleeding, and approximately 70% report improvement in pressure symptoms or pain. UAE is associated with a small reintervention rate (~20–30% over 5–10 years), but the majority of women avoid further procedures, including hysterectomy.
While UAE is widely recognised for treating uterine fibroids, it is also an effective option for selected patients with adenomyosis – a condition where endometrial tissue infiltrates the uterine muscle, causing painful and heavy periods. Evidence increasingly supports UAE as a safe and effective alternative to hysterectomy for women with symptomatic adenomyosis.
RELATED: Management of fibroids
UAE is most suitable for premenopausal women with symptomatic uterine fibroids or adenomyosis, especially those experiencing heavy menstrual bleeding or bulk-related symptoms who wish to avoid hysterectomy or myomectomy.
UAE has a favourable safety profile, but patients should be informed of potential risks, including post-procedural pain or fatigue (common but temporary), infection (<2.5%), fibroid expulsion – particularly with submucosal fibroids – and rare complications such as infection and need for emergency hysterectomy (<1%).
While pregnancy after UAE is possible, fertility outcomes are less predictable than with myomectomy, and UAE is generally not recommended for women actively trying to conceive.
Treatment in WA
UAE is increasingly accessible in Western Australia through the public and private sectors, with streamlined referral pathways.
Interventional radiologists provide outpatient assessment, procedural care and follow-up imaging. Collaborative decision-making with gynaecologists ensures that patients are fully informed about all treatment options.
Despite strong clinical evidence and endorsement from organisations like NICE, ACOG, CIRSE, RANZCOG and IRSA, the procedure remains underutilised in Australia. Bridging this gap starts with increased awareness among GPs, gynaecologists and patients.
UAE represents a significant advancement in the management of fibroids and adenomyosis. For appropriately selected women, it provides effective symptom relief, a short recovery and the opportunity to preserve the uterus without the need for major surgery.
It’s time for UAE to be considered a first-line option alongside surgical and medical therapies in everyday gynaecological care.
Key messages
- Uterine artery embolisation is a minimally invasive, uterus-sparing treatment for symptomatic uterine fibroids and adenomyosis
- It is safe and effective with comparable symptom relief to surgery, but fewer complications and faster recovery
- The procedure is still underutilised in Australia despite NHMRC level one data and international endorsement of the procedure.
Author competing interest – nil
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