ENA woman who has been offered a hysterectomy almost always wants to know whether anything lies between putting up with it and major surgery. Uterine artery embolisation is one such option, and it usually raises more questions than it answers.
This page is about uterine artery embolisation in Germany: what the procedure is, who it suits, what the procedure day looks like in a German hospital and what to ask before consenting. No one can promise in advance that surgery will be avoided. For women’s health in general, see gynaecology in Germany.
What the procedure is and how it works
Uterine artery embolisation cuts off the blood supply to fibroids from inside the vessels. Through a puncture in an artery at the wrist or in the groin, a thin catheter is guided to the vessels feeding the fibroids, and tiny particles injected through it close them off. «Embolisation» means exactly this blocking of a vessel: the fibroid loses its blood supply and shrinks over time.
Unlike an operation, there is no incision and no organ is removed. It is performed not by a surgeon but by an interventional radiologist, who works through the blood vessels under X-ray guidance, and the woman receives local anaesthesia with sedation, a calming medicine given into a vein. The gynaecologist and the radiologist make the decision together.
What embolisation does not do: it does not replace the work-up, it yields no tissue for histology, and it is not the answer when the nature of the mass is unclear, since symptoms and scans cannot always tell a rare malignant tumour from a fibroid. Other ways of treating fibroids are covered on the page on fibroid treatment in Germany.
Who it suits and who it does not
Embolisation suits women whose fibroids cause real complaints, not merely women whose fibroids show up on a scan. It is typically discussed for heavy bleeding, anaemia, or pressure on the bladder or the rectum, provided the work-up confirms that the fibroids genuinely explain these complaints rather than another cause.
Pregnancy, acute pelvic infection and suspected malignancy rule embolisation out. With an unclear picture on ultrasound and MRI, or with certain fibroid positions, such as a single fibroid inside the womb cavity that can be removed through the cervix, or one on a thin stalk outside the womb, German teams usually choose another route; which of these applies, and what to do, is decided case by case.
In Germany, plans for pregnancy are discussed separately and in advance: there is less evidence on fertility after embolisation than after myomectomy, the surgical removal of fibroids that keeps the womb. The consensus of German gynaecologists and interventional radiologists from 2019 states that the role of embolisation for women who want children is not yet sufficiently defined; its next revision was planned for 2021. For help with conceiving, see fertility treatment in Germany.
The procedure day and the recovery
Embolisation is prepared in advance, performed under X-ray guidance and followed by observation on the ward. Beforehand come an MRI or ultrasound scan, blood tests and a pregnancy test, a conversation about pain relief and written consent.
On the day, the doctor punctures the artery and guides the catheter under X-ray control; the hospital states how long the procedure takes and what it involves. Afterwards the woman is observed on the ward and given pain relief: cramping pain in the first day is expected and is treated with medication prescribed in advance.
A check-up follows after some months, with ultrasound or MRI showing how the fibroids have changed. Bleeding and pressure usually ease gradually, and the fibroids shrink slowly, over months. In some women the symptoms return or do not fully go away, and another method, including surgery, is then discussed.
Money and the practical side
A foreign patient is almost always a self-payer: the hospital issues a written cost estimate before admission and usually asks for a deposit, and the doctor’s invoice and the hospital’s invoice are two separate documents. Any figure before the scans are reviewed would be unverified; see treatment prices in Germany.
For the trip you need the translated discharge summary, the MRI discs, the hospital’s written reply and its invitation letter for the medical visa; the page on the medical visa for Germany explains the steps.
Frequently asked questions
Does uterine artery embolisation hurt?
Yes, there can be strong cramping pain while the particles block the vessels and for some hours afterwards, but it is expected and treated in advance. The puncture site is numbed, a calming medicine is given into a vein, and strong painkillers are ready beforehand, in some hospitals as a pump the woman controls herself. The pain then eases, and tablets are usually enough.
Do I need to stay in hospital after embolisation?
Yes, German gynaecologists and radiologists recommend embolisation as an inpatient procedure, mainly because of the pain relief needed afterwards. You go home once you can eat, drink, walk on your own and control the pain with tablets; some women need to stay longer. Ask the hospital in advance how long the stay will be.
Can embolisation be used for several or large fibroids?
Yes, the number and size of fibroids do not rule it out by themselves: German gynaecologists and radiologists see embolisation as an alternative to surgery and medication regardless of fibroid size, number or previous operations. What matters more is what causes the complaints, where the fibroids lie and whether their nature is in any doubt.
When will I know whether embolisation has worked?
Not straight away: fibroids shrink gradually, so the result is judged at a check-up after some months, with ultrasound or MRI. The key measure is how far the complaints have eased, not only how much the fibroid has shrunk. If nothing improves or the fibroids grow, further tests follow and another method is discussed.
How AlenMed arranges the treatment
AlenMed sends the images and the discharge summary to a hospital that has both a gynaecology department and interventional radiology. The company works with 86 partner hospitals in 38 German cities and 345 doctors, and its office is in Munich.
It is worth asking in advance who exactly will perform the procedure, what happens if the work-up points to a different method, how long the stay will last and what the cost estimate covers.
This material is for reference only and is not an offer: the treatment plan is decided by a doctor in person.