If you want your fibroids treated but you want to keep your uterus, two main options are available: uterine fibroid embolization (UFE) and myomectomy. Both preserve the uterus. Both are effective. Both have robust clinical evidence behind them. But they work in fundamentally different ways, and the right choice depends on your specific clinical situation, your reproductive goals, and your personal priorities regarding recovery and approach.
Unfortunately, many women are presented with only one of these options, often whichever one falls within their referring physician’s specialty. A gynecologic surgeon is likely to recommend myomectomy. An interventional radiologist will discuss UFE. What you deserve is a comprehensive understanding of both, with an honest assessment of what each does best and where each has limitations.
At Surgical Associates, Dr. Albert Chun believes in informed, shared decision-making. Here’s the comparison, grounded in the published evidence.
How Each Procedure Works
UFE is a non-surgical, catheter-based procedure performed by an interventional radiologist. Through a small puncture in the wrist or groin, a microcatheter is guided to the uterine arteries. Tiny particles (microspheres) are injected to block blood flow to the fibroids. Deprived of their blood supply, the fibroids gradually shrink over the following weeks and months. UFE treats all fibroids simultaneously — including small ones that may not yet be visible on imaging.
Myomectomy is a surgical procedure performed by a gynecologic surgeon. Individual fibroids are physically located, dissected from the surrounding uterine muscle, and removed. The uterine wall is then repaired with sutures. Myomectomy can be performed through several approaches depending on fibroid size, number, and location: hysteroscopic (through the vagina and cervix, with no abdominal incision, for submucosal fibroids only), laparoscopic or robotic-assisted (small abdominal incisions, camera-guided), or open abdominal (larger incision, for very large or numerous fibroids).
The FEMME Trial: The Definitive Head-to-Head Comparison
The most important piece of direct comparative evidence is the FEMME trial, a randomized controlled trial of 254 women comparing UFE to myomectomy, published in the New England Journal of Medicine with follow-up data published in 2022 and 2023.
Quality of life: nearly identical. Both groups reported significant quality-of-life improvements after treatment. The difference between the two groups was only 8 points on the UFS-QoL scale, a difference that was not statistically significant. In plain language: women who had UFE and women who had myomectomy reported almost exactly the same improvement in their daily quality of life.
Patient satisfaction: comparable. The Gupta meta-analysis of UFE vs. all types of fibroid surgery (including 10 RCTs involving over 1,000 women) found no significant difference in patient satisfaction or major adverse events between UFE and any type of surgery.
These findings are important because they challenge the assumption that surgery is inherently “more effective” than embolization. When measured by what matters most to patients — symptom relief and quality of life — the two approaches deliver comparable results.
The Detailed Comparison
| Factor | UFE | Myomectomy |
|---|---|---|
| Approach | Non-surgical (catheter-based) | Surgical (hysteroscopic, laparoscopic, or open) |
| Anesthesia | Conscious sedation | General anesthesia |
| Hospital stay | Outpatient — same-day discharge | 1–3 days (laparoscopic) or 2–4 days (open) |
| Recovery to normal activities | 1–2 weeks | 2–4 weeks (laparoscopic) or 4–6 weeks (open) |
| Fibroids treated | All fibroids simultaneously (including small ones) | Individual fibroids removed; small ones may be missed |
| Uterine incision | None | Yes, myometrial incision(s) required |
| Blood loss | Minimal (no tissue is cut) | Variable; can be significant for large fibroids |
| Symptom improvement | ~90% significant improvement in bleeding; >90% satisfaction | ~80–90% depending on completeness of removal |
| QoL improvement | Significant (FEMME trial) | Significant (FEMME trial) — only 8-point difference (NS) |
| Fibroid recurrence | Re-intervention rates ~15–30% over 5 years | New fibroid growth in up to 60% over 5 years |
| Fertility data | Pregnancies documented; 40–69% pregnancy rates in recent reviews; data less established | More established historical fertility data; traditionally first-line for fertility |
| Adenomyosis | Can treat concurrent adenomyosis | Does not address adenomyosis |
| Insurance coverage | Covered by virtually all plans | Covered by most plans |
| Best for | Symptom relief, multiple fibroids, fast recovery, surgical risk factors, adenomyosis co-treatment | Fertility-focused patients, single or few fibroids, submucosal fibroids accessible hysteroscopically |
The Fertility Question: Where Nuance Matters Most
The fertility comparison between UFE and myomectomy is the most debated aspect of this decision and the one where intellectual honesty is most important.
The historical position. Myomectomy has been the traditional recommendation for women whose primary goal is future pregnancy. This position is based on longer historical experience with myomectomy in the fertility population and a 2020 systematic review that found higher live birth rates after myomectomy (75.6%) compared to UAE (60.6%) with lower miscarriage rates.
The emerging challenge to that position. More recent data has complicated this picture. The Gupta meta-analysis (Cochrane-affiliated) evaluated the evidence that myomectomy provides a fertility benefit over UFE and deemed it “low-quality evidence” that “should be regarded with extreme caution.” Another systematic review of RCTs and non-RCTs concluded that there is currently “insufficient evidence that myomectomy improves fertility compared to UFE.” Two 2024 systematic reviews reported that 40–69% of women desiring pregnancy achieved it after UAE, with one study (Peng et al.) finding no difference in live birth or miscarriage rates between UAE and myomectomy. A 2025 PMC study of 46 women after UAE found comparable fertility outcomes with no significant adverse effects on ovarian reserve markers.
Our approach at SACMD. We present both sets of data transparently. For women whose primary and urgent goal is maximizing fertility — particularly those under 35 with a limited number of fibroids accessible via hysteroscopy or laparoscopy — myomectomy may still represent the most conservative choice, supported by the longer track record. For women whose primary goal is symptom relief with fertility as a secondary consideration, or women with multiple fibroids where complete surgical removal would be technically challenging, UFE may offer the best balance of effectiveness, recovery, and uterine preservation.
This is a decision that should be made collaboratively, ideally with input from both a gynecologic surgeon and an interventional radiologist who can each assess your anatomy and discuss the realistic expectations for their respective procedures.
Advantages of UFE That Often Go Undiscussed
Several UFE advantages are frequently overlooked in the gynecologic referral pathway:
UFE treats all fibroids at once. Because embolization blocks the blood supply to the entire fibroid vascular bed, it treats every fibroid simultaneously, including small fibroids that may not yet be visible on imaging. Myomectomy can only remove the fibroids the surgeon can see and access, and small intramural fibroids left behind can grow and cause recurrent symptoms.
UFE treats concurrent adenomyosis. Up to 35–55% of women with fibroids also have adenomyosis. Myomectomy does not address adenomyosis. If adenomyosis is contributing to your symptoms, particularly heavy bleeding and severe cramping, it will persist after myomectomy. UFE can treat both conditions in a single procedure.
No uterine incision means no uterine scar. Myomectomy requires cutting into the uterine wall to remove fibroids, then suturing the wall closed. This creates a uterine scar that can affect future pregnancy management — many obstetricians recommend cesarean delivery after myomectomy due to the risk of uterine rupture at the scar site during labor. UFE creates no uterine incision.
Lower risk of adhesion formation. Abdominal myomectomy, in particular, can cause pelvic adhesions (scar tissue between organs) that may contribute to pain and, paradoxically, to fertility problems. UFE involves no abdominal entry and no pelvic manipulation.
Advantages of Myomectomy That Should Be Acknowledged
Tissue diagnosis. Removed fibroids can be sent to pathology for definitive tissue analysis. While the vast majority of uterine masses are benign leiomyomas, myomectomy provides histological confirmation. UFE does not provide tissue for analysis.
Targeted removal of specific fibroids. Hysteroscopic myomectomy is uniquely effective for submucosal fibroids that distort the uterine cavity. If a single submucosal fibroid is the primary cause of bleeding or infertility, hysteroscopic removal may be the most targeted and effective intervention.
Longer fertility track record. Despite the evolving data, myomectomy has a larger volume of published fertility outcome data collected over a longer period.
How to Decide
We recommend the following framework for decision-making:
Consider UFE when you have multiple fibroids (making surgical removal technically challenging or incomplete), symptom relief is your primary goal, you want the shortest possible recovery, you have adenomyosis alongside fibroids, you have medical conditions that increase surgical risk, or your fibroids are intramural and symptom-driving but not easily accessible surgically.
Consider myomectomy when fertility is your primary and immediate goal and you have a limited number of fibroids, you have a submucosal fibroid accessible hysteroscopically, tissue diagnosis is clinically important, or your individual anatomy favors surgical access.
Consider getting both evaluations. See a gynecologic surgeon for a myomectomy assessment AND an interventional radiologist for a UFE evaluation. Compare the assessments. Ask each specialist to explain not only why their procedure is appropriate but also in what scenarios the alternative might be preferable. This is informed, shared decision-making.
Frequently Asked Questions
The Bottom Line
UFE and myomectomy are both effective, evidence-based, uterus-preserving treatments for symptomatic fibroids. The FEMME trial demonstrated nearly identical quality-of-life improvements between the two approaches. The fertility question is more nuanced than many women are told, and the evidence increasingly suggests the gap between the two is narrower than historically assumed.
No woman should undergo hysterectomy without knowing that uterus-preserving options exist. And no woman should choose between UFE and myomectomy without understanding both.
Schedule a UFE consultation: Call (240) 427-1630 or visit www.sacmd.com
Disclaimer: This article is for informational purposes only and does not constitute medical advice. Individual treatment decisions should be made in consultation with qualified physicians based on your specific clinical situation.
References:
- Manyonda I, et al. Uterine-Artery Embolization or Myomectomy for Uterine Fibroids (FEMME Trial). NEJM. 2020. With 4-year follow-up data, 2022 and 2023.
- Gupta JK, et al. UFE vs Surgery — Cochrane-Affiliated Meta-Analysis. 2014.
- NIH/StatPearls. Uterine Fibroid Embolization. PubMed Bookshelf. 2025.
- Peng YX, et al. 2024 Systematic Review: Pregnancy Outcomes after UAE.
- Tzanis AA, et al. Fertility outcomes after UAE for symptomatic leiomyomas. PMC. 2025.
- Systematic review of pregnancy outcomes after fertility-preserving treatment of uterine fibroids. European J Obstet Gynecol. 2020.
- ACOG. Management of Uterine Fibroids. Practice Bulletin.
- SIR. UFE — Patient Information and Fertility Guidance.
