A 38-year-old woman with heavy menstrual bleeding and a 7 cm intramural fibroid (FIGO Type 3) on MRI is being counselled about uterine artery embolisation (UAE). Which of the following correctly describes the mechanism of action and a key clinical consideration for UAE in this setting?

• A UAE selectively embolises the feeding vessels of the fibroid alone without affecting normal uterine perfusion
• B UAE is contraindicated in women with intramural fibroids >5 cm due to risk of uterine wall necrosis
• C UAE occludes both uterine arteries with PVA particles, causing fibroid infarction and shrinkage of 40–60%; future pregnancy is not contraindicated but carries increased risk of placenta praevia and suboptimal uterine contractility ✓
• D UAE permanently eliminates fertility potential and is only recommended in postmenopausal women

Explanation

UAE involves bilateral catheterisation of the uterine arteries (via femoral artery) with injection of polyvinyl alcohol (PVA) or tris-acryl gelatin microspheres to occlude uterine blood flow. Fibroids shrink 40–70% in volume due to ischaemic infarction; symptom improvement (menorrhagia relief) occurs in 85–90%. Both uterine arteries are embolised — not selective to fibroids alone. For women who wish future pregnancy, UAE is not absolutely contraindicated but carries risks: impaired endometrial vascularity, uterine contractility defects, placenta praevia/accreta, premature ovarian failure (6% risk from ovarian artery collateral embolisation), and premature labour — hence myomectomy is preferred for fertility preservation.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.