Am I a Candidate for UFE? A Practical Checklist

You may be a good candidate for uterine fibroid embolization (UFE) if fibroids confirmed on imaging are causing heavy bleeding, pain, pressure or urinary symptoms, you are not pregnant, there is no sign of cancer or active infection, and you would like to keep your uterus or avoid surgery. A few situations, such as hoping to get pregnant later, being close to menopause, or having a fibroid on a thin stalk, need a more careful conversation. The final answer comes after a gynecologic evaluation and imaging, usually an MRI.

This page is a practical checklist. It is meant to help you prepare for a consultation, not to replace one. For a full overview of the procedure itself, see our guide to uterine fibroid embolization (UFE).

A quick self-check before your visit

If you can answer "yes" to most of the first five questions, UFE is worth discussing with a specialist.

• Do your fibroids cause symptoms? Heavy or long periods, pelvic pain or pressure, frequent urination, or pain during sex.
• Have the symptoms been confirmed as coming from fibroids? Usually by ultrasound, and ideally by MRI before UFE.
• Do you want to keep your uterus, or would you rather avoid an operation and a longer recovery?
• Are you not pregnant right now?
• Have cancer and active infection been ruled out by your gynecologist?
• Is pregnancy in your future plans? If yes, this needs a separate discussion.
• Are you over 45 or close to menopause? If yes, the effect on your periods and ovaries deserves extra attention.

Symptoms that make UFE worth considering

The European interventional radiology society's practice standards (CIRSE 2015 guideline) list two main reasons to treat fibroids with embolization: heavy menstrual bleeding, and what it calls mechanical complaints, "such as pain, pressure, dyspareunia, urinary urgency and frequency." Insurers tend to use a similar list. Aetna's current fibroid policy, for example, describes UFE as an alternative to hysterectomy or myomectomy when symptoms caused by fibroids persist, including heavy bleeding, pelvic pain or pressure from bulk, urinary symptoms and painful intercourse.

Notice what is missing: fibroid size alone. Many women have fibroids that cause no trouble and never need treatment. The UK's NICE guideline on heavy bleeding makes the same point from another angle. It asks doctors to aim treatment at improving quality of life, not just at the amount of blood lost. If your fibroids are found by chance and you feel fine, watching them is usually reasonable.

Who should not have UFE

CIRSE separates reasons not to do UFE into absolute contraindications (UFE should not be done) and relative contraindications (UFE may still be possible after careful review).

One more warning sign is important. Aetna's policy background notes that fibroid growth after menopause, or rapid growth at any age, can raise concern for a rare cancer called sarcoma, and lists it as a reason not to proceed. Embolization does not remove tissue for testing, so anything unusual on imaging should be worked up first.

This article is part of our Fibroid Treatment Guide.

Situations that need a closer look

These do not automatically rule you out, but the decision depends on details.

• You hope to get pregnant later. Pregnancies after UFE are well documented, but the evidence is limited, and myomectomy is usually discussed first. Read more in pregnancy after UFE.
• You are over 45. The chance that periods stop for good after UFE is higher in this age group. See will UFE cause early menopause?
• Your fibroids are very large. Size alone is not a reason to say no, but shrinkage is partial. See UFE for large fibroids.
• You have a fibroid on a stalk. Small studies are reassuring, but a thin stalk is still a recognized caution. See pedunculated fibroids and UFE.
• Your main fibroid sits inside the uterine cavity. These submucosal fibroids often respond well, but they are also the type most likely to pass out through the vagina afterward, and some can be removed through the cervix instead.

The evaluation: gynecologist visit and imaging

Before UFE, two things need to happen. First, a gynecologist confirms that fibroids are the likely cause of your symptoms and checks for other problems. Depending on your age and bleeding pattern, that can include an up-to-date cervical screening test and a sample of the uterine lining. Second, the person performing UFE needs a clear picture of your fibroids.

CIRSE states that contrast-enhanced MRI is the preferred imaging test before UFE. NICE recommends an ultrasound first and an MRI when more detail is needed about the position, size, number and blood supply of the fibroids. An MRI shows which fibroids are present, where they sit, whether they have a good blood supply, and whether another condition, such as adenomyosis, could explain your symptoms.

Bring copies of past ultrasound or MRI reports and images, a list of medicines, and notes on your periods if you keep them. That makes the first visit far more useful.

How UFE compares, so you can decide

Being a candidate does not mean UFE is automatically the right choice. ACOG's 2021 practice bulletin recommends uterine artery embolization for patients who want to keep the uterus and who are counseled about the limited data on pregnancy afterward. CIRSE goes further and says every woman with symptomatic fibroids should be offered UFE as an alternative to surgery.

The trade-off is re-treatment. A 2014 Cochrane review of 7 randomized trials (793 women) found satisfaction at 2 years was similar after UFE and surgery, but more women needed another procedure after UFE: if 7% need further surgery within 2 years of hysterectomy or myomectomy, an estimated 15% to 32% would after UFE. In exchange, UFE involves no abdominal incision and a shorter hospital stay. Our fibroid treatment guide compares every option side by side.

When to get help right away

Do not wait for a scheduled visit if you have very heavy bleeding with dizziness or fainting, chest pain or shortness of breath, or sudden severe pelvic pain with fever. Go to an emergency department or call 911.

Questions to bring to your consultation

• Do my imaging results show anything that makes UFE less suitable for me?
• Which of my fibroids is most likely causing my symptoms, and how much might it shrink?
• How does my age affect the chance of my periods stopping?
• If I might want children, what would you recommend instead, and why?
• What happens if my symptoms come back?

Frequently Asked Questions

Do I need an MRI before UFE?

The CIRSE 2015 guideline calls contrast-enhanced MRI the preferred imaging test before UFE. It shows the size, location and blood supply of each fibroid and can reveal other conditions that would change the plan.

Can I have UFE if I have an IUD?

An IUD in place is listed as a relative contraindication in the CIRSE 2015 guideline, which means it needs to be discussed. Ask your doctor whether it should be removed before treatment.

Is there a fibroid size that is too big for UFE?

No single size cut-off is agreed. Studies of women with fibroids larger than 10 cm found complication rates similar to smaller fibroids, but the fibroids shrank only partly, so expectations matter.

Can I have UFE if I am close to menopause?

Yes, it is often considered, but the chance that periods stop permanently is higher after age 45. Because fibroids usually shrink after menopause, some women in their late 40s also weigh waiting.

Do I need a referral from my gynecologist?

A gynecologic evaluation is part of a safe workup because other causes of bleeding must be ruled out. Whether your insurance plan requires a formal referral depends on the plan.

Keep Reading

• Uterine Fibroid Embolization (UFE) in New York City
• UFE for Large Fibroids: Realistic Shrinkage and Results
• Pregnancy After UFE: Honest Numbers and What They Mean
• Will UFE Cause Early Menopause? Ovarian Function and Age
• Pedunculated Fibroids and UFE: Safety, Stalk Width and Results
• UFE vs Myomectomy: Results, Recovery and Fertility Compared
• Fibroid Treatment Guide: every option, compared

Sources

1. van Overhagen & Reekers, Cardiovasc Intervent Radiol, 2015 — CIRSE Standards of Practice: uterine artery embolization for symptomatic leiomyomata
2. ACOG Practice Bulletin No. 228, Obstet Gynecol, 2021 — Management of symptomatic uterine leiomyomas
3. Gupta et al., Cochrane Database Syst Rev, 2014 — uterine artery embolization for symptomatic fibroids (7 trials, 793 women)
4. NICE guideline NG88, Heavy menstrual bleeding: assessment and management (updated July 2026)
5. Aetna Clinical Policy Bulletin 0304, Fibroid Treatment (reviewed April 2026)
6. Spies et al., Obstet Gynecol, 2005 — FIBROID Registry 1-year outcomes (2,112 patients)
7. Katsumori et al., AJR, 2003 — is a large fibroid a high-risk factor for UAE? (152 women)
8. ACOG patient FAQ, Uterine Fibroids (last reviewed December 2025)

Medically reviewed by David Fox, MD, FACS, RPVI. This article is general information, not a substitute for a medical evaluation.

Living with heavy periods, pelvic pressure or other fibroid symptoms? Schedule a consultation with Dr. David Fox at Fox Vein & Vascular in Manhattan to find out whether uterine fibroid embolization is right for you. Call (212) 362-3470 or request a UFE consultation online.