OBJECTIVE: To determine of the effectiveness of uterine arterial embolization as a primary therapy in the management of symptomatic leiomyomas. MATERIALS AND METHODS: Uterine arterial embolization was performed in 23 patients (age range, 27-50 years) who complaint menorrhagia, bulk-related symptoms(frequency of urination, sensation of pressure, sensation of mass), or both, with leiomyomas. The effectiveness of the therapy was evaluated in the view of symptomatic relief and the patients' acceptance with ultrasonography, 3 months later. RESULTS: Sixteen (89%) of 18 patients reported marked improvement in their abnormal bleeding. Ten (90%) of 11 patients with bulk-related symptoms reported marked improvement in these symptoms. Follow-up ultrasonographic examination showed a mean 21% reduction in uterine size and mean 39% reduction in leiomyoma size. CONCLUSION: Utrine arterial embolization is an effective therapy in the management of symptomatic leiomyomas and may prove to be a valuable alternative to myomectomy, hysterectomy, or other surgical procedures.