RESEARCHBackground. Symptomatic uterine fibroids have a significant impact on women's health. Surgical intervention (myomectomy and hysterectomy) has been the mainstay of treatment. Women living with symptomatic uterine fibroids contribute significantly to a growing waiting list for surgery in South African public hospitals. Uterine artery embolisation (UAE) is a newer treatment option and has shown to be a minimally invasive, safe and effective alternative to surgery for such women. Objective. To evaluate the efficacy of UAE in women with symptomatic fibroid uterus. Methods. A prospective, observational, single-centre study of 51 women with symptomatic fibroid uterus who underwent UAE at Steve Biko Academic Hospital from February 2007 to November 2012. Results. A total of 51 women underwent UAE, 3 of whom were lost to follow-up. The remaining 48 women were followed for a mean duration of 43.6 months. There was a statistically significant reduction in the mean uterine and dominant myoma volumes, as well as improvement in the haemoglobin levels (p=0.001). The mean uterine and dominant fibroid volume reductions were 38% and 58%, respectively. Minor complications were reported in 19% of the women (fever, post-embolisation syndrome and vaginal fibroid passage were frequently reported complications). Reintervention (hysterectomy and gonadotropin-releasing hormone analogue use) was required in 35% of women. Conclusion. UAE has a good clinical effect on fibroid volume reduction. It is a treatment option that can be considered prior to major surgery in a select group of women with symptomatic fibroid uterus. The impact of uterine artery embolisation on fibroid volume at 43.6 months in women with symptomatic fibroids at a tertiary-level hospital Uterine fibroids, also known as leiomyomas, are the most commonly occurring benign tumours of the uterus.[1] Symptomatic fibroid tumours have a major negative impact on the woman's quality of life and reproductive potential.[2] Great health disparities exist worldwide, with African black women experiencing earlier debilitating symptoms and more varied responses to treatment compared with their white counterparts. [3,4] The economic burden of treating symptomatic women is substantial. A recent total cost estimate (direct and indirect) by Soliman et al.[5] in a 2015 systematic review, ranges from USD11 717 -USD25 023 per patient per year after diagnosis or surgery. The true economic impact on South African (SA) public health systems is likely to be higher than the average estimates owing to high disease burden, limited access to treatment, longer waiting times for surgery, low hysterectomy uptake and the presence of severe symptoms among African black women. [4] Surgical management (hysterectomy or myomectomy) has traditionally been the mainstay of treatment (Fig. 1). Recently, umbilical artery embolisation (UAE) and magnetic resonanceguided high-intensity focused ultrasound (MR-g HIFU) has emerged as both an attractive and effective treatment.[6] UAE has proven to be safe and an e...