Embolization treats abnormal, tangled blood vessels within the uterine wall that cause sudden, heavy bleeding — while preserving fertility.
A uterine arteriovenous malformation is an abnormal, tangled network of blood vessels within the wall of the uterus, in which arteries connect directly to veins without the normal capillary network in between. Because this direct connection carries blood at much higher pressure and flow than the vein is built to handle, it makes the affected area of the uterus prone to sudden, sometimes severe bleeding — which is usually what brings the condition to medical attention in the first place.
Uterine AVMs are rare and fall into two categories. True congenital AVMs, present from birth, are extremely uncommon. Far more frequently seen in clinical practice are acquired AVMs, which develop after some form of trauma or injury to the uterine wall — most often following a dilation and curettage (D&C), a miscarriage or abortion, a caesarean section, gestational trophoblastic disease (an abnormal pregnancy-related growth), or a uterine infection. Because of this, acquired uterine AVM is most often seen in women of reproductive age with a history of at least one pregnancy or uterine procedure.
In a woman with a relevant recent history, such as a D&C, miscarriage, or delivery.
Which directly shows the abnormal, high-flow tangle of vessels.
The established first-choice treatment for women wishing to preserve fertility.
A needle puncture is made at the groin or wrist artery.
Contrast dye maps the abnormal vessel tangle and confirms the diagnosis.
Embolic material closes off the AVM while preserving normal blood flow.
Most go home the same day or after a short stay.
The classic presentation is sudden, heavy vaginal bleeding — sometimes profuse, and occasionally significant enough to require emergency treatment — in a woman with a relevant recent history, such as a D&C, miscarriage, or delivery in the preceding weeks to months. Bleeding may be a single dramatic episode or may recur intermittently over time. Because this presentation can resemble other, far more common causes of abnormal uterine bleeding, uterine AVM is sometimes not considered or diagnosed until standard treatments for more typical causes have already been tried without success.
Pelvic ultrasound with colour Doppler is typically the first and most useful test, since it can directly show the abnormal, high-flow tangle of vessels characteristic of an AVM — a very different appearance from other causes of bleeding, such as retained products of conception. MRI or CT angiography may be used to further characterise the malformation's extent and its blood supply, particularly before planning treatment. In centres where embolization is being considered, catheter angiography is generally reserved for the time of treatment itself, since it offers the most detailed vascular map and directly confirms the diagnosis at the same time as treatment begins.
Because uterine AVM is so often diagnosed in women of reproductive age, and frequently in women who have already had — or hope to have — children, preserving fertility and the uterus itself is usually a primary goal of treatment, not a secondary consideration. This is precisely what makes embolization so significant here: it offers a way to definitively treat the bleeding without removing the uterus, unlike hysterectomy, which was historically the default treatment for severe or recurrent cases before embolization became widely available.
A growing body of case series following women after uterine AVM embolization has reported healthy pregnancies and live births afterward, and current evidence broadly suggests embolization doesn't compromise fertility or pregnancy outcomes for most women — reassuring data for a situation where the fear of losing the ability to have children can otherwise weigh heavily on a difficult decision made, not infrequently, in the middle of an acute bleeding episode.
Once a woman is stabilised — which, in the setting of heavy acute bleeding, may itself require resuscitation and blood transfusion before anything else — embolization can be considered. Some smaller, less symptomatic AVMs, particularly small acquired lesions, are known to be able to resolve on their own over time, so a period of watchful monitoring with ultrasound is sometimes appropriate for milder cases. For AVMs causing significant or recurrent bleeding, or where expectant monitoring hasn't resolved things, embolization is the established first-choice treatment for women wishing to preserve fertility.
Access: under local anaesthesia, a needle puncture is made in the groin or wrist artery.
Angiography: a catheter is guided to the uterine arteries — typically on both sides, since AVMs are often supplied from more than one direction — and contrast dye maps the abnormal vessel tangle and confirms the diagnosis.
Embolization: an embolic material is injected selectively into the vessels feeding the AVM, closing off the abnormal connection while preserving normal blood flow to the rest of the uterus.
Recovery: most patients are observed for a period after the procedure, with many going home the same day or after a short stay, depending on how they presented.
A meaningful proportion of patients — particularly with larger or more complex AVMs — need a second embolization session to fully resolve the abnormal vessels, which is why planned follow-up imaging, rather than a single treat-and-discharge approach, is a standard part of care.
Follow-up imaging, usually ultrasound with Doppler, is used to confirm the AVM has resolved and that normal uterine blood flow has been restored. Where future pregnancy is a goal, most published experience suggests waiting a period of time — commonly around several months — after confirmed resolution before trying to conceive, though this is individualised in discussion with the treating team. Women who go on to become pregnant after uterine AVM embolization are generally followed as a standard, though appropriately monitored, pregnancy, without evidence of a substantially different outcome from the wider obstetric population in the available literature.
Uterine AVM can present as a genuine emergency, and safe management depends on close coordination between the treating gynaecologist, who manages the acute bleeding and the patient's broader reproductive health, and the interventional radiology team performing embolization. Because fertility preservation is so often central to the decision-making here, treatment planning is a shared conversation between the patient and both specialties, rather than a decision made by either team in isolation.
Most cases are acquired, developing after a D&C, miscarriage, abortion, caesarean section, or uterine infection — a genuine congenital AVM present from birth is much rarer.
Current evidence, from a number of published case series following women after uterine AVM embolization, broadly suggests embolization doesn't compromise fertility or pregnancy outcomes for most women, and healthy pregnancies and live births have been reported afterward. This is discussed individually with your treating team.
Not usually — embolization has become the first-choice treatment for women who wish to preserve their uterus and fertility, and has largely reduced the need for hysterectomy in this condition. Hysterectomy remains an option in more difficult or recurrent cases.
Possibly — a meaningful proportion of patients, particularly with larger AVMs, need a second embolization session to fully resolve the abnormal vessels, which is why follow-up imaging is a planned part of treatment.
Not necessarily — smaller, less symptomatic AVMs, especially some acquired lesions, are known to sometimes resolve on their own with time, so a period of watchful monitoring can be appropriate. Significant or recurrent bleeding, however, generally warrants treatment.
Book a consultation with Dr. Giragani, or send your scans for a specialist second opinion.