Uterine artery embolisation for symptomatic fibroids

Traditional operative treatments for symptomatic fibroids — hysterectomy and myomectomy — involve considerable morbidity. Although morbidity is reduced with endoscopic surgery, this technique is not widely available, and has limitations. Embolisation of the pelvic vasculature is not a new procedure, having been used to treat postpartum and postsurgical bleeding for 20 years. It has only recently been used to treat symptomatic fibroids. Uterine artery embolisation can produce a mean reduction of 29%‐51% in uterine volume at the time of the three‐month review, with longer follow‐up showing continued shrinkage and no regrowth. The range of shrinkage is highly variable, which needs to be explained to all potential candidates. Symptomatic relief is a more certain outcome, with relief of pelvic pressure symptoms in 91%‐96% of women. There is a small risk of complications requiring hysterectomy, and the long‐term effect on ovarian function is unknown.