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Bilateral uterine artery embolisation was performed to treat eight women with symptomatic large fibroids requiring treatment. Uterine volume was quantitatively assessed by magnetic resonance imaging. Both uterine arteries were occluded effectively in all women, and the procedure was well tolerated, with a 24-36 hour admission for pain relief. The level of pain experienced was variable, but well controlled. Some women experienced intermittent vaginal discharge and pain following the procedure. Improvement of symptoms occurred in six of the seven women and the eighth woman conceived. There were no significant complications. At three months four women had a uterine volume of < 350 cm3. Embolisation appears to be a good alternative to surgery, but longer follow up is required to evaluate the long term effects and to determine those patients for whom the procedure is suitable.Treatment of large uterine fibroids, which are particularly prevalent in the Afro-Caribbean population', is a difficult and controversial problem2. Many women are unwilling to undergo a hysterectomy, even if their childbearing is complete, and myomectomy is associated with significant morbidity. Management of symptomatic fibroids is particularly difficult in women who have had a previous myomectomy, in those whose religious faith does not permit blood transfusion and in women who do not want a hysterectomy. Arterial embolisation was first reported as a pre-operative technique to devascularise uterine myomata before surgery3; only later was it used as a definitive treatment for symptomatic uterine myomata4s5. These studies have focused on women with smaller fibroids, and the assessment of treatment response was based on ultrasound findings which gives only a semiquantitative result. We report a pilot study of eight women with large symptomatic fibroids where magnetic resonance imaging was used to obtain precise measurements of pre-and post-treatment fibroid volume. MethodsWomen were referred for consideration for embolisation by local gynaecologists and general practitioners; some referred themselves having heard about the technique in the community. They were considered suitable for embolisation if they had a large fibroid uterus with symptoms warranting surgical treatment, wished to retain their uterus, and were younger than 50 years of age. Exclusion criteria were a history of coagulation disorder and those whose fibroids were asymptomatic. Local ethics committee approval was obtained before starting the study.Details of the embolisation procedure were discussed with all the women and informed consent obtained. Most of the women wished to retain their potential for future pregnancies, but the unknown effect of this technique regarding fertility and pregnancy was discussed fully. Women were advised to use contraception in the cycle before the procedure. The date of the most recent period was confirmed on the day of the procedure and urine pregnancy test performed if there was any uncertainty with the dates.Following embolisation, the women were...

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