What you can expect

To see your uterus and blood vessels, the radiologist uses a fluoroscope. This device is a pulsed X-ray beam that produces moving images of internal structures and displays them on a computer monitor.

Before the procedure

In the radiology procedure room, you'll have an intravenous (IV) line placed in one of your veins to give you fluids, anesthetics, antibiotics and pain medications.

During the procedure

The procedure includes:

• Anesthesia. Typically you'll receive a type of anesthesia that reduces pain and helps you relax, but leaves you awake (conscious sedation).
• Blood vessel access. The doctor makes a small incision in the skin over your femoral artery, a large blood vessel that passes lengthwise through your groin. Then your doctor inserts a catheter into the artery and guides the catheter to one of the two uterine arteries. Generally, the doctor can access both uterine arteries through one incision.

• Blood vessel mapping and injection. An injected contrast fluid, usually containing iodine, flows into the uterine artery and its branches and makes them visible on the fluoroscope's monitor. The fibroids "light up" more brightly than other uterine tissue.

  The radiologist identifies the right area of the uterine artery and then injects the blood vessel with tiny particles made of plastic or gelatin. The particles are carried by the blood flow to block the fibroid vessels.

  After injecting more contrast into the uterine artery, the doctor checks additional images to make sure that blood is no longer reaching the fibroids. The same steps are then repeated in the second uterine artery.

After the procedure

In the recovery room, your care team monitors your condition and gives you medication to control any nausea and pain. When the effects of the anesthesia fade, they take you to your hospital room for overnight observation.

• Position. You must lie flat for several hours to prevent pooling of the blood (hematoma) at the femoral artery site.
• Pain. The primary side effect of uterine artery embolization is pain, which may be a reaction to stopping blood flow to the fibroids and a temporary drop in blood flow to normal uterine tissue. Pain usually peaks during the first 24 hours. To manage the pain, you receive pain medication.

• Observation. Post-embolization syndrome — characterized by low-grade fever, pain, fatigue, nausea and vomiting — is frequent after uterine artery embolization.

  Post-embolization syndrome symptoms peak about 48 hours after the procedure and usually resolve on their own within a week. Ongoing symptoms that don't gradually improve should be evaluated for more-serious conditions, such as an infection.

  By the next day, your urinary catheter is removed, and you're encouraged to walk around. Recovery is generally rapid, and complications are rare.

Recovery

Most women return home the day after the procedure with a prescription for oral pain medication. Pain usually ends within a day or two, but in some women it may last up to a few weeks.

Monitor your recovery for:

• Vaginal discharge. You might have a watery or mucus-like vaginal discharge for a few weeks to a month after uterine artery embolization. The discharge should stop without treatment. In a few women, remnants of fibroids are passed through the vagina.
• Infection. Return to your obstetrician-gynecologist or primary care doctor for a follow-up exam within four weeks of the procedure to make sure there's no infection. Signs and symptoms of infection include fever, chills and pain. Delayed infections and vaginal discharge are rarely reported weeks to months after the procedure.

Follow-up

You may have a magnetic resonance imaging (MRI) exam over the next year to monitor shrinkage or other changes in the fibroids or your uterus. Doctors usually schedule the first exam three months after the procedure.