Uterine fibroid embolization is generally considered a safe procedure, but it is not risk-free. Most problems are minor and short-lived, such as cramping, nausea or a low fever in the first days. Serious complications are uncommon: the CIRSE 2015 guideline reports major complications in up to 5% of procedures during the first month. Deaths have been reported but are extremely rare. Below are the main risks, with the numbers published in guidelines and trials.
For a full overview of the procedure, see our main page on uterine fibroid embolization (UFE).
Expected side effects vs complications
It helps to separate what almost everyone feels from what counts as a complication.
- Expected effects: pelvic cramping, mild nausea, tiredness and a low-grade fever in the first few days. These come from the fibroid tissue losing its blood supply. ACOG notes that pelvic pain and a low fever are normal after the procedure, and that cramps can last up to 2 weeks.
- Minor complications: problems that need extra attention but usually resolve, such as a stronger-than-usual reaction, a bruise at the access site or a vaginal discharge.
- Major complications: problems that need hospital care, surgery or that cause lasting harm, such as serious infection or a blood clot.
When these expected symptoms are strong enough to need extra treatment, doctors call it post-embolization syndrome. Our article on post-embolization syndrome explains what is normal and when to call.
Complication rates at a glance
The table lists the rates reported in the European interventional radiology society's guideline, labelled with its year. These are pooled from published studies, so treat them as approximate.
| Complication | Reported rate (CIRSE 2015 guideline) |
|---|---|
| Any major complication, during or within the first month | Up to 5% |
| Vaginal discharge and fever | 4% |
| Technical failure (blood flow could not be fully blocked) | 4% |
| Post-embolization syndrome counted as a complication | 3% |
| Passage of fibroid tissue, occasionally needing surgery | About 5% |
| Major infection | 2.5% |
| Periods stopping (amenorrhea) | About 4%; lasting (not returning) in less than 2% |
| Deep vein thrombosis or pulmonary embolism | Less than 1% |
| Death | Extremely rare |
How UFE compares with surgery on safety
The Cochrane review pooled 7 randomized trials with 793 women comparing UFE with hysterectomy or myomectomy. Minor complications within the first year were more common after UFE. Major complications showed no clear difference between UFE and surgery, either at 1 year or at 5 years. Women who had UFE were much less likely to need a blood transfusion.
Individual trials tell a similar story:
- In the UK REST trial (157 women), major adverse events in the first year occurred in 12% after UFE and 20% after surgery, a difference that was not statistically significant. At 5 years, adverse events were 19% after UFE and 25% after surgery.
- In the UK FEMME trial (254 women), complications occurred in 24% after UFE and 29% after myomectomy.
The main trade-off is not safety but durability: more women need another procedure after UFE than after surgery. We cover that in detail in our article on the UFE success rate.
Questions about your treatment options? Dr. Fox can help.
Book a ConsultationThis article is part of our Fibroid Treatment Guide.
A closer look at specific risks
Infection
Once the fibroid tissue loses its blood supply, it can become infected. The CIRSE 2015 guideline reports major infection in 2.5% of procedures. Most infections are treated with antibiotics. In rare cases, a severe infection that does not respond can lead to surgery, sometimes including hysterectomy, which is why fever and worsening pain should never be ignored.
Passing fibroid tissue
Fibroids that sit just under the lining of the uterus can detach and pass through the cervix. This is often harmless but sometimes needs a procedure to remove tissue. See passing fibroid tissue after UFE for more.
Early menopause and ovarian function
Some of the particles can reduce blood flow to the ovaries. The CIRSE 2015 guideline says this can lead to premature menopause, especially in women older than 45, and that the risk seems overestimated in women under 40. In the EMMY trial, signs of reduced ovarian reserve appeared after both UFE and hysterectomy, with no clear difference between the groups at 2 years.
Blood clots
Deep vein thrombosis and pulmonary embolism are reported in less than 1% of procedures (CIRSE 2015 guideline).
Access-site problems
The catheter enters through an artery in the groin or wrist. In a 2021 randomized trial of 153 women, major complications occurred in 0% with wrist access and 2.7% with groin access, a difference that was not statistically significant. Minor complications were 11.5% and 17.3%, also not significantly different.
Large fibroids
Some doctors worry that very large fibroids raise the risk. In a 2003 study of 152 women, major complications were 6.4% in women with a fibroid of 10 cm or more and 1.9% in those with smaller fibroids. The difference was not statistically significant, and 4 of the 5 major complications were surgery for sloughing fibroid tissue.
Pregnancy
Evidence on pregnancy after UFE is limited and of low quality. ACOG's 2021 practice bulletin supports UFE for women who want to keep the uterus when they are counseled about the limited data on pregnancy afterward. If you hope to become pregnant, discuss this carefully before choosing UFE.
Who should not have UFE
The CIRSE 2015 guideline lists these as absolute contraindications:
- Pregnancy
- Cancer of the uterus or ovaries (except in special situations)
- Active infection of the uterus
It lists several relative contraindications that call for a careful discussion: a wish for future pregnancy, pedunculated fibroids on a very thin stalk, an IUD in place, contrast dye allergy, impaired kidney function and bleeding disorders. Rapid fibroid growth, or any growth after menopause, needs evaluation before treatment.
When to seek urgent care
ACOG advises calling your doctor after UFE if you have:
- Pain so severe that medication does not help
- A fever higher than 101 °F
- Nausea or vomiting
- Bleeding or pain where the catheter was inserted
- A change in color or temperature of either leg
Also call promptly for shortness of breath, chest pain or a swollen, painful leg, which can be signs of a blood clot. If you cannot reach your care team, go to an emergency department and tell them you recently had uterine artery embolization.
Lowering your risk
Much of the safety of UFE comes from careful selection before the procedure. The CIRSE 2015 guideline names contrast-enhanced MRI as the preferred imaging test before UFE, because it shows the size and position of the fibroids and can point to other conditions. Many programs also check the lining of the uterus beforehand. Ask your doctor what imaging and tests they recommend, and how they will reach you in the days after the procedure. To compare UFE with every other option, including medication and surgery, see our fibroid treatment guide.
Frequently Asked Questions
Is uterine fibroid embolization safe?
It is generally considered safe. Major complications are reported in up to 5% of procedures in the first month (CIRSE 2015 guideline), and a Cochrane review found no clear difference in major complications between UFE and surgery.
What is the most common complication of UFE?
Short-term symptoms such as pain, nausea and low fever are the most common. Among complications, the CIRSE 2015 guideline lists discharge with fever (4%), technical failure (4%) and post-embolization syndrome needing extra care (3%).
Can UFE cause early menopause?
It can, mainly in women over 45. The CIRSE 2015 guideline reports periods stopping in about 4% of women, and not returning in less than 2%, and says the risk seems overestimated in women under 40.
Can anyone die from UFE?
Deaths have been reported, but they are extremely rare. Your doctor can explain how the risks of UFE compare with the risks of surgery for your situation.
When should I call the doctor after UFE?
ACOG advises calling for pain medication does not control, a fever over 101 °F, nausea or vomiting, bleeding or pain at the catheter site, or a change in color or temperature of a leg.
Keep Reading
- Uterine Fibroid Embolization (UFE) in New York City
- Post-Embolization Syndrome After UFE: What Is Normal and When to Call
- Passing Fibroid Tissue After UFE: Why It Happens and When to Call
- UFE Success Rate: What 1, 2, 5 and 10-Year Studies Show
- Will UFE Cause Early Menopause? Ovarian Function and Age
- Am I a Candidate for UFE? A Practical Checklist
- Fibroid Treatment Guide: every option, compared
Sources
- van Overhagen and Reekers, Cardiovasc Intervent Radiol, 2015 — CIRSE standards of practice for uterine artery embolization
- Gupta et al., Cochrane Database Syst Rev, 2014 — uterine artery embolization for symptomatic fibroids (7 trials, 793 women)
- Edwards et al., N Engl J Med, 2007 — REST trial, UAE vs surgery at 1 year (157 women)
- Moss et al., BJOG, 2011 — REST trial 5-year results
- Manyonda et al., N Engl J Med, 2020 — FEMME trial, UAE vs myomectomy (254 women)
- ACOG patient FAQ — Uterine Artery Embolization (last reviewed May 2026)
- ACOG Practice Bulletin No. 228, Obstet Gynecol, 2021 — management of symptomatic uterine leiomyomas
- Hehenkamp et al., Hum Reprod, 2007 — ovarian reserve after UAE vs hysterectomy (EMMY)
- Khayrutdinov et al., Diagn Interv Radiol, 2021 — randomized trial of wrist vs groin access for UAE (153 women)
- Katsumori et al., AJR, 2003 — UAE for fibroids 10 cm or larger (152 women)
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.
