The fibroid treatment many women never hear about
By Dr. Hicham Abada, MD · A biweekly publication on minimally invasive medicine
Somewhere right now, a woman is planning her week around her period. She keeps a change of clothes at the office. She has turned down travel, canceled plans, and pushed through exhaustion that sleep doesn't fix. She has seen her doctor. She has been told what her options are. She still has no idea that another option exists.
Much of what modern medicine has learned to do, most patients never hear about. Not because anyone is hiding it, but because the information often gets lost in translation — between specialties that do not always know each other's tools, between research papers that never reach the people they could help, and between a fifteen-minute consultation and a decision that may shape the rest of someone's life.
This newsletter exists to close that gap. One condition at a time, in plain English, with no medical degree required.
That gap is especially wide in a specialty many patients have never heard of: interventional radiology, or IR. IR is a medical specialty in which physicians use real-time imaging to guide treatment through a single small puncture, often no larger than a pinhole — fibroids treated through the wrist, certain tumors through a tiny puncture in the leg. In place of a large operation, the result is sometimes a procedure done in a single afternoon, with the patient going home the same day or the next.
It is the specialty behind this newsletter's tagline: what can be done through a pinhole. It is also a specialty many patients discover only after a treatment decision is already moving forward.
We start with fibroids, because the information gap here is one of the widest in medicine, and the cost of that gap falls almost entirely on women. That burden is not distributed equally: fibroids disproportionately affect women of color, especially Black women, who are more likely to develop fibroids, develop them earlier, and experience more severe symptoms.
What fibroids are
Fibroids, also called leiomyomas, are non-cancerous growths that develop in or on the uterus. They are extremely common. The Society of Interventional Radiology notes that up to 77% of women will develop fibroids at some point in their lives, although that estimate varies with age and how fibroids are measured, and many women never need treatment.
When fibroids do cause symptoms, they can be life-altering. Heavy bleeding, pelvic pressure, pain, urinary symptoms, and fatigue from chronic blood loss can reshape work, sleep, travel, confidence, and daily life. What appears on paper as a gynecologic diagnosis can feel, in real life, like a life organized around limitation.
The awareness gap
In a 2024 survey commissioned by the Society of Interventional Radiology, 53% of women diagnosed with fibroids said they had been presented with hysterectomy, while fewer than one in five said they had been presented with less invasive options such as uterine fibroid embolization. In that same survey, 17% believed hysterectomy was their only treatment choice.
That is one of the central problems. Hysterectomy can be the right treatment for some patients, and sometimes it is the best treatment. But it should not be the only treatment a woman hears about when other evidence-based options exist.
How UFE works
Uterine fibroid embolization, or UFE, is a minimally invasive procedure performed by an interventional radiologist. Through a small puncture, usually at the wrist or groin, a catheter is guided into the arteries supplying the fibroids. Tiny particles are then released to block that blood flow, causing the fibroids to shrink while preserving the uterus.
UFE has been used to treat fibroids since the mid-1990s, and it is now supported by decades of clinical experience and follow-up data in appropriately selected patients. The Society of Interventional Radiology describes UFE as an established uterus-preserving treatment option for many women with symptomatic fibroids.
UFE and hysterectomy compared
Aspect | UFE | Hysterectomy |
|---|---|---|
Invasiveness | Minimally invasive, catheter-based | Major surgery |
What it does | Shrinks fibroids by blocking blood supply | Removes the uterus entirely |
Uterus preserved? | Yes, in most cases | No |
Recovery | Often home same day or next; many resume daily activities in about a week | Often several days in hospital; recovery may take weeks to months |
Definitive? | Symptoms improve in the large majority, but some women need further treatment | Yes — fibroids cannot recur without a uterus |
What the evidence says
Broader reviews and patient guidance support the same overall message: UFE is effective in reducing fibroid-related symptoms and offers a meaningful uterus-preserving alternative to surgery for many appropriately selected women.
The larger point is not that UFE replaces hysterectomy in every case. It is that the evidence is strong enough that eligible patients should know it exists before making an irreversible decision.
“Large studies following women for several years show that uterine fibroid embolization provides lasting relief from heavy periods, pain, and pressure symptoms, with most patients avoiding major surgery afterward.” 1–3
“Quality-of-life research confirms that women generally feel better and stay better in the years after embolization, with improvements in energy, mood, sexual function, and social life.” 4
“Expert reviews of all published data conclude that embolization is a well-established, effective option for treating fibroids in appropriately selected women.” 5–7
Voices from the field
We are fortunate to have hundreds of studies over the past 30 years which support the ability of UFE to ease patient’s symptoms, reduce the size of a patient’s fibroids, and improve their quality of life.
Generally, patients have a very positive experience with UFE. While the immediate recovery after the procedure can be difficult for some patients, the Interventional Radiology experience with UFE allows women to be counseled and prepared for the expected symptoms. Within a few days, most patients can get back to their normal lives without limitation and then it’s just a matter of time before they notice a significant improvement in their symptoms. Ultimately, most patients are very happy with their choice to undergo UFE to treat their fibroids.
What UFE is not
UFE is not the right choice for every patient, and this is why the conversation has to be initiated with the patient.
It does not work for everyone. Society of Interventional Radiology guidance notes that about nine out of ten women who undergo UFE experience significant improvement or complete resolution of symptoms, which also means some do not get the relief they hoped for and some will still need additional treatment.
Recovery, while usually shorter than surgery, is not nothing. Many women experience what is called post-embolization syndrome in the first few days after the procedure — cramping, nausea, low-grade fever, and fatigue as the fibroids die off. It usually settles within about a week, but it is real.
For women hoping to become pregnant in the future, the picture is more complicated. Evidence on UFE and future fertility is mixed, and for women actively trying to conceive, myomectomy is often preferred. That is a real conversation to have with both a gynecologist and an interventional radiologist before deciding.
UFE is an option. It is not always the best option for every patient. The point is that it should be on the table, discussed openly, before any irreversible decision is made.
What to ask your doctor
If you or someone close to you has been diagnosed with symptomatic fibroids, four questions worth asking:
Am I a candidate for uterine fibroid embolization?
Can I speak with an interventional radiologist before deciding on surgery?
Given my age, symptoms, fibroid pattern, and fertility plans, what are the trade-offs between my options?
What are the downsides and long-term effects of hysterectomy itself?
A good decision is not just the one that treats the condition. It is the one made with a full understanding of what modern medicine can actually offer.
Evidence at a glance
Fibroid prevalence
up to 77% of women develop fibroids during their lifetime, although many never need treatment.
Awareness gap
in a 2024 SIR-commissioned poll, 53% of women diagnosed with fibroids said they were presented with hysterectomy, while fewer than one in five said they were presented with less invasive options such as UFE.
Long-term outcomes
about two-thirds of women treated with embolization avoided hysterectomy over 10 years, with quality of life comparable to hysterectomy.
Symptom improvement
SIR patient guidance states that approximately nine out of ten women who undergo UFE experience significant improvement or complete symptom resolution.
This newsletter is for educational purposes only and is not medical advice. Always consult a qualified physician about your specific situation.
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Next issue: Why fibroids do not affect all women equally — and why Black women often carry the heaviest burden.
References and further reading
1. Spies JB, Allison S, Flick P, et al. Uterine artery embolization for treatment of leiomyomata: long-term outcomes from the FIBROID Registry. Obstet Gynecol. 2008;111(1):22-33.
2. Kitamura K, et al. Long-term results of symptomatic fibroids treated with uterine artery embolization: in conjunction with MR evaluation. Eur J Radiol. 2010;73(2):339-344.
3. Kroencke TJ, et al. Long-term outcome and pre-interventional predictors for late intervention after uterine fibroid embolization. Eur J Obstet Gynecol Reprod Biol. 2020;247:149-155.
4. Hehenkamp WJK, Volkers NA, Donderwinkel PFJ, et al. Uterine artery embolization for symptomatic fibroids: long-term changes in health-related quality of life. Hum Reprod. 2011;26(8):2036-2044.
5. Goodwin SC, Spies JB, Worthington-Kirsch R, et al. Current evidence on uterine embolization for fibroids. J Vasc Interv Radiol. 2008;19(1):91-104.
6. Bratby MJ, et al. An update on uterine artery embolization for the treatment of symptomatic uterine fibroids and adenomyosis. Clin Radiol. 2022;77(11):e849-e858.
7. Manyonda IT, et al. Uterine artery embolization for symptomatic uterine fibroids: a review of the evidence. BJOG. 2012;119(4):366-376.
Source: Society of Interventional Radiology — Uterine fibroids and UFE treatment.