BACKGROUND: Uterine fibroids are prevalent benign pelvic tumors, often causing debilitating symptoms that impair quality of life. Uterine fibroid embolization (UFE) is a consolidated minimally invasive treatment option. The purpose of this study is to report our experience with polyethylene glycol microspheres (HydroPearl) in UFE for symptomatic patients. METHODS: This single-center retrospective study evaluated 37 consecutive patients with symptomatic uterine fibroids referred to our institution since November 2016 to February 2020 for UFE with HydroPearl microspheres. All patients included completed a comprehensive pre-UFE clinical assessment and underwent a magnetic resonance imaging (MRI) pre- and post-procedure. Technical success, procedure-related complications, clinical outcomes, follow-up MRI findings, and patient satisfaction were evaluated. RESULTS: A technical success rate of 97% with complete bilateral uterine artery embolization was achieved. Significant improvements were observed in menorrhagia, bulk-type symptoms, abdominal pain, and urinary dysfunctions after UFE. Post-procedural MRI assessments demonstrated reductions in uterine and dominant fibroid volumes, indicating successful devascularization. No immediate procedural complications were reported. Symptoms interfering with everyday activities significantly improved after the procedure. Patient satisfaction was high, with 89% expressing satisfaction with the treatment and 84% indicating purpose to repeat the procedure if necessary. CONCLUSIONS: Uterine artery embolization with HydroPearl is a safe and effective treatment option for symptomatic uterine fibroids. A significant improvement in menorrhagia and bulk-type symptoms after the procedure was observed correlated by a reduction in diameters and volumes of both the uterus and the main fibroid in post-procedural MRI.