The honest answer is that uterine fibroid embolization (UFE) itself is usually not very painful, but the first day or two afterward often are. During the procedure you receive sedation and a local anesthetic. Afterward, as the fibroids lose their blood supply, strong pelvic cramping is expected. RadiologyInfo, the patient site of the American College of Radiology and Radiological Society of North America, says the cramps are most severe during the first 24 hours. ACOG says abdominal pain and cramps may continue on and off for up to 2 weeks.
Cramping after UFE is normal and expected. The good news is that it is predictable and there are several proven ways to control it. This page explains what the pain is like at each stage and what published studies show about pain control.
Pain at each stage
| Stage | What is typical | How it is commonly managed in studies |
|---|---|---|
| During the procedure | Sting of the numbing shot; pressure at the puncture; brief warmth from contrast | Sedation and local anesthetic (ACOG) |
| First hours | Cramping begins and builds | IV pain medicine, often opioids, sometimes by a patient-controlled pump; anti-nausea medicine; nerve block in some centers |
| First 24 hours | Strongest cramping (RadiologyInfo) | Scheduled pain medicine; overnight stay for some women |
| Days 2 to 7 | Cramping eases; possible low fever, nausea and fatigue | Anti-inflammatory medicine, with or without opioid tablets |
| Up to 2 weeks | On-and-off cramps (ACOG) | Tapering pain medicine as needed |
During the procedure
ACOG says a sedative and local anesthesia are given. RadiologyInfo says that with sedation you should feel relaxed, sleepy and comfortable. You may feel a brief sting from the numbing medicine, pressure when the catheter goes into the artery, and warmth for a few moments when contrast dye is injected. Our page What happens during UFE walks through each step.
Why it hurts afterward
UFE works by cutting off the fibroids' blood supply. As that tissue is starved of oxygen, it causes cramping. The body's reaction to the fibroid tissue breaking down can also bring a low fever, nausea, loss of appetite and tiredness for a few days. This cluster of symptoms is called post-embolization syndrome.
Fibroid size does not seem to predict how much it will hurt. In a 2017 randomized trial of 60 women, the researchers found no link between fibroid volume and pain over the first 24 hours.
Questions about your treatment options? Dr. Fox can help.
Book a ConsultationThis article is part of our Fibroid Treatment Guide.
How UFE pain compares with other treatments
- Versus hysterectomy: In the Dutch EMMY trial, women had less pain in the first 24 hours after UFE than after hysterectomy.
- Versus focused ultrasound: In the FIRSTT trial (2017), immediate self-rated pain was a median of 5 out of 10 after UFE compared with 1 after MR-guided focused ultrasound. 75% of UFE patients used opioid pain pills at home, and 97% used anti-inflammatory medicines (NSAIDs).
Doctors have not fully solved UFE pain. A 2011 anesthesia study called pain control after UFE "a major problem," which is why so much research has gone into improving it.
Pain control options in the research
Different centers combine these approaches in different ways. These are findings from published studies, not a description of any one practice's routine.
Patient-controlled analgesia (PCA)
Many trials gave women an IV pump that lets them press a button for a small dose of opioid pain medicine during the first 24 hours. Several of the trials below used PCA as the starting point and tested what could be added to it.
Nerve blocks
A superior hypogastric nerve block numbs the nerves that carry pain from the uterus. It is placed during the procedure.
- In a 2018 randomized, double-blind, sham-controlled trial of 44 women, the block reduced opioid use in the recovery room (morphine-equivalent dose 5.1 mg vs 11.0 mg) and the need for anti-nausea medicine (23% vs 55%).
- In a 2020 study of 39 women, 97% did not need a PCA pump and the median stay was 2.2 hours.
- A 2023 systematic review of 15 studies found 98.8% same-day discharge with the block and major adverse events of 0.4%. The authors said more randomized trials are needed.
Anti-inflammatory and steroid medicines
NSAIDs such as ibuprofen are widely used; in FIRSTT, 97% of UFE patients took them. In a 2016 randomized placebo-controlled trial (59 women completed), one dose of the steroid dexamethasone before UFE lowered pain scores from 12 hours after the procedure and reduced severe nausea and vomiting.
Another 2013 randomized trial of 50 women found that adding an infusion of the sedative dexmedetomidine to a fentanyl PCA pump reduced fentanyl use over 24 hours by 28% and lowered nausea and vomiting.
Opioid tablets
Results are mixed. A 2014 randomized trial of 39 women found that a single dose of oral oxycodone before UFE did not lower early pain and caused more nausea and vomiting. A 2017 randomized trial of 60 women found that adding controlled-release oxycodone lowered pain at 24 hours and reduced the need for IV morphine.
The particles used
In a 2021 randomized trial of 54 women, pain scores were similar with PVA particles and microspheres, though more women needed rescue pain medicine with PVA (33% vs 11%).
Questions to ask about pain before your procedure
Because pain control differs so much between centers, it is worth asking about it at your consultation:
- What medicines will I get during and right after the procedure?
- Do you use a nerve block or a patient-controlled pump?
- Will I go home the same day, and what decides that?
- What will I take at home, and can the prescriptions be filled in advance?
- Who do I call at night or on a weekend if the pain is not controlled?
Tips for the first few days at home
- Take your pain medicine on the schedule your doctor gives you rather than waiting for pain to peak.
- Rest, drink fluids and eat light meals while nausea settles.
- Ask your doctor whether a heating pad, stool softener or anti-nausea medicine is appropriate for you, since opioids can cause constipation.
- Plan for cramping to come and go for up to 2 weeks. See our UFE recovery timeline for the full picture.
When pain is not normal
ACOG says pelvic pain and a low fever are normal after UFE. Call your doctor if you have pain so severe that medicine does not help, a fever higher than 101°F, nausea or vomiting, bleeding or pain where the catheter was inserted, or a change in the color or temperature of either leg. Pain that gets worse after the first week, rather than better, also deserves a call. Infection and passing fibroid tissue are uncommon causes of later pain; the CIRSE 2015 guideline lists major infection in about 2.5% of cases. For an overview of all fibroid options and their recovery, see our fibroid treatment guide.
Frequently Asked Questions
Does UFE hurt during the procedure?
Usually not much. You receive sedation and a local anesthetic. RadiologyInfo says you may feel pressure when the catheter goes in and brief warmth when contrast dye is injected.
How long does the pain last after UFE?
The worst cramping is usually in the first 24 hours, according to RadiologyInfo. ACOG says abdominal pain and cramps may continue on and off for up to 2 weeks.
Is UFE more painful than a hysterectomy?
Early pain was lower after UFE in the EMMY trial, which found less pain in the first 24 hours than after hysterectomy. UFE causes more early pain than focused ultrasound, according to the FIRSTT trial.
What pain medicine is used after UFE?
In published studies, common approaches include anti-inflammatory medicines, opioids (sometimes through a patient-controlled pump in the first day), anti-nausea medicine and, in some centers, a nerve block. Your doctor will explain their own plan.
When is pain after UFE not normal?
Call your doctor if pain is so severe that medicine does not help, if you have a fever over 101°F, nausea or vomiting, or bleeding or pain where the catheter went in, as ACOG advises.
Keep Reading
- Uterine Fibroid Embolization (UFE) in New York City
- Post-Embolization Syndrome After UFE: What Is Normal and When to Call
- UFE Recovery Day by Day: What to Expect Week by Week
- What Happens During UFE: A Step-by-Step Walk-Through
- UFE vs Hysterectomy: What 10 Years of Trial Data Show
- Fibroid Treatment Guide: every option, compared
Sources
- RadiologyInfo.org (ACR/RSNA) — Uterine Fibroid Embolization
- American College of Obstetricians and Gynecologists, FAQ522 — Uterine Artery Embolization (last reviewed May 2026)
- Volkers et al., Cardiovasc Intervent Radiol, 2006 — EMMY trial: pain and return to work after UAE vs hysterectomy
- Barnard et al., Am J Obstet Gynecol, 2017 — FIRSTT trial: UAE vs focused ultrasound, periprocedural outcomes
- Yoon et al., Radiology, 2018 — superior hypogastric nerve block for pain after UAE, randomized sham-controlled trial (44 women)
- Pereira et al., J Vasc Interv Radiol, 2020 — superior hypogastric nerve block and same-day discharge after UFE (39 women)
- Musa et al., J Vasc Interv Radiol, 2023 — systematic review of superior hypogastric nerve block for UAE (15 studies)
- Kim et al., BJOG, 2016 — single-dose dexamethasone and pain after UAE, randomized placebo-controlled trial
- Kim et al., J Vasc Interv Radiol, 2013 — dexmedetomidine plus fentanyl PCA after UAE, randomized trial (50 women)
- Konstantatos et al., Cardiovasc Intervent Radiol, 2014 — pre-procedure oral oxycodone with morphine PCA after UAE, randomized trial (39 women)
- Freire et al., Clin Radiol, 2017 — controlled-release oxycodone for pain after UFE, randomized (60 women)
- Han et al., Radiology, 2021 — randomized trial of PVA particles vs microspheres and pain after UAE (54 women)
- Lipszyc et al., Br J Anaesth, 2011 — remifentanil vs morphine PCA for acute pain after UAE
- van Overhagen & Reekers, Cardiovasc Intervent Radiol, 2015 — CIRSE standards of practice for uterine artery embolization
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.
