Fibroid specialist Dr. Michael Lalezarian compares myomectomy vs hysterectomy vs UFE for the treatment of fibroids and discusses which option is best for you. Compare each treatment's invasiveness, hospital stay time, recovery time, safety, pregnancy, risk of fibroid recurrence, and risk of reintervention in this detailed review.
In this Article
Overview of fibroid treatment options - hysterectomy, myomectomy, and uterine fibroid embolization (UFE)
What you should consider prior to undergoing a major surgery for fibroids
Detailed comparison of myomectomy vs hysterectomy vs UFE
How to decide which treatment is right for you
As we tend to say, there is no “silver bullet” treatment for fibroids. The three treatment options to compare are hysterectomy vs myomectomy vs UFE? Each treatment has distinct advantages and disadvantages, and in many ways, the question of one treatment versus another comes down to your specific situation and your preference. This means that understanding your treatment options is especially critical, so you can confidently choose the treatment that makes the most sense for you.
We put this review together to help you navigate your fibroid treatment options. Throughout this article, we draw from our own experience as Fibroid Specialists, as well as peer-reviewed medical literature to examine the most important factors that you should consider before deciding on a treatment path – factors like invasiveness, recovery time, side effects, and whether or not you can become pregnant after treatment. Read on to learn more.
Introduction to Fibroid Treatment Options
Hysterectomy - Hysterectomy is a major surgical procedure most commonly performed by a gynecologist or a general surgeon in a hospital setting. The goal of the procedure is to partially or completely remove the uterus. By removing the uterus, fibroids within the uterus are also removed. Visit our hysterectomy page or our pros and cons of a hysterectomy blog post to learn more.
Myomectomy - Myomectomy is another major surgical procedure, but instead of completely removing the uterus, a gynecologist or surgeon selectively cuts out the fibroids while preserving the rest of the uterus. Visit our myomectomy page or read about the different types of myomectomies to learn more.
Uterine Fibroid Embolization (UFE) - Uterine fibroid embolization (UFE) is a non-surgical, minimally invasive treatment. Rather than cutting into the uterus to remove the fibroids, micro-sized beads are injected into the arteries that feed the fibroids. When injected, the beads block blood flow to the fibroids, causing the fibroids to ‘starve’ and shrink. Uterine fibroid embolization is performed by an interventional radiologist (IR). An IR specialized in vascular anatomy and minimally-invasive image-guided procedures. Visit our UFE page to learn more.
Myomectomy vs Hysterectomy vs UFE – Everything You Should Consider
Clinical studies have repeatedly shown that hysterectomy, myomectomy, and UFE are equally effective treatment options when it comes to fibroid symptom relief.¹ That said, these treatments differ significantly when it comes to patient experience and longer-term health considerations. When we consult with patients about their options, we tend to focus on these 7 decision points (these are also good points to discuss with your gynecologist):
Invasiveness – how much trauma is involved in the procedure?
Hospital Stay – how many nights will I be hospitalized after the procedure?
Recovery Time – how many weeks until I can return to my daily activities?
Safety – how often do major side effects and complications occur?
Pregnancy – am I able to become pregnant afterwards?
Risk of Fibroid Recurrence – will the fibroids come back?
Risk of Reintervention – will I need another procedure for my fibroids in the future?
Throughout the rest of this article, we go through each of these decision points and provide more detail on how hysterectomy, myomectomy, and UFE compare. Because there’s a lot of information to consider, we also put together this infographic to help you navigate the details.
In the above infographic, we use green to highlight where a treatment provides an advantage over others, and red to show where a treatment provides some disadvantage compared to another treatment. It’s important to understand that individual patient experiences vary. The statements in this chart (and throughout the rest of this review) are based on the highest quality clinical data available but do not (and cannot) capture every individual experience.
1. Invasiveness of Fibroid Treatment
Generally, invasiveness describes the level of trauma that’s associated with a procedure. A procedure is more invasive when it involves larger incisions, more cutting to access the surgical target, or the insertion of larger medical instruments into the body. Generally, more invasive procedures have a greater risk of major complications than less invasive procedures and require a longer recovery period before patients can resume their normal activities.
Major surgery like hysterectomy is highly invasive as it requires incisions to access the uterus and extensive cutting to remove it. Myomectomy is equally invasive, even though the uterus is left intact. Up to 15% of patients that undergo hysterectomy² and nearly 5% of patients that undergo myomectomy³ require a blood transfusion to replenish blood that’s lost during the procedure, which is not ideal. UFE, on the other hand, is a non-surgical minimally invasive image-guided procedure. The procedure is performed through a single puncture in the leg with no major incisions and no cutting, making it the least invasive option available for fibroids.
Least Invasive Fibroid Treatment: UFE is the least invasive treatment option for fibroids. Hysterectomy and myomectomy are major surgeries and are therefore highly invasive. Learn what to expect before, during, and after a UFE procedure.
2. Hospital Stay
Most patients agree that it’s ideal to spend as little time in the hospital as possible, both for comfort and for financial reasons. The more invasive fibroid treatments, hysterectomy, and myomectomy, require at least 1 to 3 nights in the hospital to ensure a safe recovery, with the exact number of nights depending on the surgical technique used.
Because it’s a simple minimally invasive procedure, UFE does not require a hospital stay. That said, some doctors like to keep their UFE patients in the hospital for 1 night to observe recovery and ensure that patients are comfortable after the procedure.
Shortest Hospital Stay: UFE requires the shortest hospital stay, and in some cases, patients are able to return home on the day of the procedure.
3. Recovery Time
The recovery time of a procedure is a measure of how long it takes for patients to return to normal activities like work and exercise. For obvious reasons, minimal recovery time is ideal.
A more invasive procedure usually requires a longer recovery period. According to clinical studies, recovery time after hysterectomy or myomectomy can take anywhere from 2 to 6 weeks, with most patients requiring 3 to 5 weeks before they were able to resume normal activities. In the same clinical studies, UFE only required 1-2 weeks of recovery time in most cases.¹ This major disparity is directly related to the amount of healing that’s required with a major surgery versus a minimally invasive procedure.
Fastest Recovery: Patients that have a UFE procedure have a much shorter recovery time than patients that undergo hysterectomy or myomectomy surgery.
4. Safety – Side Effects & Complications
As important as it is to understand the benefits of treatment, it’s equally important to understand the ‘safety profile’ of it as well. For our purposes, we can think about safety in terms of side effects and complications. Side effects describe unintended negative interactions between the treatment and the body. Complications, on the other hand, describe things that can go wrong during a procedure that causes some degree of harm to the patient.
Side effects (and complications) can be divided into minor and major categories. Generally, minor side effects are those that are tolerated without additional medical intervention, whereas major side effects may require medical attention to resolve or result in significant patient morbidity. Data from clinical studies suggest that major side effects and complications are more common in patients that undergo major surgery (hysterectomy or myomectomy) than in patients that undergo UFE. When it comes to minor side effects and complications, the opposite appears to be true.¹
Safest Fibroid Treatment: Clinical studies have shown that UFE has higher rates of minor side effects and complications, but lower rates of major side effects and complications than surgical options.¹
5. Ability to Become Pregnant
Many women learn about their fibroids in the middle of their childbearing years and are concerned about the impact of fibroids and fibroid treatment on their ability to become pregnant. Hysterectomy removes the uterus (the womb) permanently, eliminating any possibility of pregnancy afterward. On the other hand, UFE and myomectomy are uterus-sparing procedures, meaning that women still have a chance of getting pregnant afterward.
While it has been studied to some degree,⁴ compelling evidence on which of the two treatments is more likely to result in full-term pregnancy is non-existent. The impact of UFE versus myomectomy on the health of the uterus has been hotly debated for the last two decades, especially as it pertains to bearing children.⁴ While fertility is by no means guaranteed after UFE or myomectomy, women should be optimistic about the fact that there have been several reports of healthy, full-term pregnancies after these procedures.²
Ability to Become Pregnant: There are several reports of healthy, successful pregnancies after UFE and myomectomy. Pregnancy is not possible after a hysterectomy.
6. Risk of Fibroid Recurrence
In medicine, the term “recurrence” describes the return of a symptom or a disease after previous treatment. Hysterectomy is the only treatment option that ‘cures’ fibroids and eliminates any chance of fibroid recurrence. If the uterus is not removed, as is the case with UFE or myomectomy, fibroids can regrow or entirely new fibroids can develop in new locations. One clinical study that followed women for multiple years after treatment observed that women have about a 10% chance of dealing with recurrent fibroids within 2 years of their first treatment.³
Lowest Recurrence Rate: Hysterectomy eliminates any chance of fibroid regrowth or new fibroid formation. Evidence suggests that women who receive UFE or myomectomy procedures have an equal chance of dealing with recurrent fibroids.
7. Risk of Reintervention
Ideally, a fibroid procedure is a ‘one-and-done’ thing. However, a small percentage of women that undergo fibroid treatment will later require a reintervention. A reintervention is a follow-up procedure to address recurrence or correct for a previously failed procedure. The follow-up procedure depends on the patient’s condition and preference.
Women who have a UFE or a myomectomy procedure may have an additional UFE or myomectomy procedure to address fibroid recurrence, or undergo a hysterectomy sometime later. After myomectomy, women have about a 7% to 8% chance of undergoing a follow-up procedure within 2 years, and more recently, researchers have estimated that the risk of reintervention after myomectomy is 19% after 5 years. Reintervention rates after UFE are slightly higher – around 12% at 2 years and 24% at 5 years.
In the case of hysterectomy, patients may have a follow-up to the procedure to correct persistent abdominal pain, hernia, or prolapse. Clinical studies show that about 7% of hysterectomy patients will have a follow-up procedure within 2 years, with as many as 16% at 10 years.⁵⁻⁶
Lowest Risk of Reintervention: Overall, hysterectomy has lower reintervention rates than myomectomy and UFE.
Which Fibroid Treatment is Best For You?
Hopefully, this review has helped you evaluate your options and choose your fibroid treatment confidently. If you’re still unsure of which treatment is best for you, another way to look at all of these decision points is to ask three critical questions:
1. Do you aspire to get pregnant in the future? - If you’re planning to get pregnant in the future, hysterectomy is definitely not an option for you. You still have a chance of becoming pregnant after having a UFE or myomectomy.
2. How much time can you take off from your daily responsibilities? – The more invasive procedures, hysterectomy, and myomectomy, require a longer hospital stay and a much longer recovery period than the less invasive UFE procedure. Many women are busy with work, family, and other obligations, and cannot afford to take an extended leave from their responsibilities to heal from a major surgery. UFE might be the better option in these cases.
3. Are you comfortable with the long-term health implications of the treatment you choose? – While the majority of patients do not experience fibroid recurrence, reintervention, or procedural complications after fibroid treatment, there are slight differences in the longer-term health risks of each option. Though rare, fibroid recurrence is possible after UFE and myomectomy but not after hysterectomy. On the other hand, women who have a UFE are slightly more likely to require reintervention within the first 5 years of having their first procedure, but major surgery carries a slightly greater risk of major complications.
If you’ve evaluated your options and you feel that major surgery isn’t right for you, you can schedule a consultation with the Fibroid Specialists of University Vascular. Our physicians specialize in UFE and have helped countless women overcome fibroids without major surgery. However, they can also discuss the other treatment options, including myolysis and endometrial ablation.
About the Author
Dr. Michael Lalezarian is a practicing interventional radiologist with the Fibroid Specialists of University Vascular in Los Angeles, CA. In addition to patient care, Dr. Lalezarian teaches and supervises medical students, residents, and fellows as a full-time teaching Professor in the Department of Radiology at UCLA. He is regarded as an expert in uterine fibroid embolization. You can view Dr. Lalezarian's full bio here.
This blog post was written with research and editorial assistance from OnChart™.
References
[1] Gupta et al. (2014). Uterine artery embolization for symptomatic uterine fibroids (Review). Cochrane Library, (5).
[2] de Bruijn, A. M., Ankum, W. M., Reekers, J. A., Birnie, E., van der Kooij, S. M., Volkers, N. A., & Hehenkamp, W. J. K. (2016). Uterine artery embolization vs hysterectomy in the treatment of symptomatic uterine fibroids: 10-year outcomes from the randomized EMMY trial. American Journal of Obstetrics and Gynecology, 215(6), 745.e1-745.e12.
[3] Mara, M., Maskova, J., Fucikova, Z., Kuzel, D., Belsan, T., & Sosna, O. (2008). Midterm clinical and first reproductive results of a randomized controlled trial comparing uterine fibroid embolization and myomectomy. CardioVascular and Interventional Radiology, 31(1), 73–85.
[4] McLucas, B., Voorhees, W. D., & Elliott, S. (2016). Fertility after uterine artery embolization: A review. Minimally Invasive Therapy and Allied Technologies, 25(1), 1–7.
[5] de Bruijn, A. M., Ankum, W. M., Reekers, J. A., Birnie, E., van der Kooij, S. M., Volkers, N. A., & Hehenkamp, W. J. K. (2016). Uterine artery embolization vs hysterectomy in the treatment of symptomatic uterine fibroids: 10-year outcomes from the randomized EMMY trial. American Journal of Obstetrics and Gynecology, 215(6), 745.e1-745.e12.
[6] Davis, M. R., Soliman, A. M., Castelli-Haley, J., Snabes, M. C., & Surrey, E. S. (2018). Reintervention Rates After Myomectomy, Endometrial Ablation, and Uterine Artery Embolization for Patients with Uterine Fibroids. Journal of Women’s Health (2002), 27(10).
Medical Disclaimer
The Materials available on the FibroidSpecialists.org blog are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients.