Gynecologic Conditions
Fibroid Treatment Options: Myomectomy vs. UFE vs. Hysterectomy
The main fibroid treatments are medicines to control bleeding, myomectomy (surgery that removes fibroids but keeps the uterus), uterine fibroid embolization (UFE, which cuts off the fibroids' blood supply) and hysterectomy (removing the uterus). The right one depends on your symptoms, where your fibroids sit, and whether you want to get pregnant later.
There's rarely a single correct answer. A common frustration is hearing "hysterectomy" at the first visit and not much else. You're allowed to ask about every option on this page.
Start here: three questions that narrow it down
1. Are your fibroids actually bothering you? Fibroids that don't cause symptoms usually don't need treatment, and ACOG supports watchful waiting in that case. Treatment makes sense when they cause heavy bleeding, anemia, pain, pressure on your bladder or bowel, or fertility problems. New to all this? Read our overview of uterine fibroid symptoms and causes first.
2. Do you want a pregnancy in the future? If yes, myomectomy is usually the surgical option you'll be steered toward. If no, everything is on the table.
3. Where are the fibroids? Inside the cavity, in the wall, or on the outside of the uterus? Your ultrasound or MRI report will say (look for "submucosal," "intramural" or "subserosal"). Location decides which procedures are possible.
Medicines: often the first try
Medicines are commonly tried first, especially when heavy bleeding is the main issue.
- NSAIDs (such as ibuprofen) ease pain and modestly reduce bleeding.
- Tranexamic acid is a non-hormonal pill taken only during your period to cut bleeding.
- Birth control pills and progestins can help control bleeding.
- Levonorgestrel (hormonal) IUD can reduce heavy bleeding, though it may not work as well if fibroids distort the cavity.
- Oral GnRH antagonist combinations are daily pills approved for heavy bleeding from fibroids. They lower estrogen and include add-back hormones to reduce side effects like bone loss.
- GnRH agonists (injections) shrink fibroids temporarily and are sometimes used before surgery.
Medicines generally don't remove fibroids, and symptoms can come back when you stop. If you're anemic from heavy bleeding, ask about treating the anemia at the same time; many people feel better within weeks once iron levels improve.
Myomectomy: fibroids out, uterus stays
A myomectomy removes fibroids and leaves the uterus in place. It's usually the preferred surgery if you want to get pregnant later.
The three types
- Hysteroscopic myomectomy. A thin scope goes through the vagina and cervix to remove fibroids bulging into the cavity. No belly incisions, and most people go home the same day with cramping and some spotting.
- Laparoscopic or robotic myomectomy. Small incisions in the abdomen to remove fibroids in the wall or on the outside of the uterus.
- Abdominal myomectomy (laparotomy). A larger incision for very large or numerous fibroids.
What to know going in
- New fibroids can grow afterward.
- After some myomectomies, especially when the uterine wall is opened deeply, your surgeon may recommend a cesarean for future births. Ask about this before surgery so it's not a surprise at 36 weeks.
- Blood loss can be more significant than with some other procedures, depending on fibroid size and number.
Uterine fibroid embolization (UFE)
UFE (also called uterine artery embolization) is done by an interventional radiologist, not a gynecologist. A thin tube is threaded through an artery in the groin or wrist to the arteries feeding the uterus. Tiny particles block blood flow to the fibroids, and they shrink over the following months.
What it's like
- No abdominal incision. Many people go home the same day or after one night.
- Cramping and pain in the first day or two are common, and some people get flu-like symptoms (post-embolization syndrome) for several days. Plan on a quiet week at home.
- In most cases it treats all fibroids at once.
- It's generally not the first choice if you want a future pregnancy, because there's less data on pregnancy after UFE.
- Some people eventually need another procedure.
Because a different specialist does UFE, many people never hear about it unless they ask. You can request a consult with an interventional radiologist directly.
Other uterus-sparing procedures
- Radiofrequency ablation uses heat delivered through a probe (laparoscopically or through the cervix) to shrink fibroids.
- MRI-guided focused ultrasound uses focused sound waves to destroy fibroid tissue without incisions. It's available at a limited number of centers and doesn't suit every fibroid.
- Endometrial ablation destroys the uterine lining to reduce bleeding. It may help with small fibroids but not larger ones, and it's only for people done having children. See our guide to endometrial ablation.
Hysterectomy
Hysterectomy removes the uterus and is the only treatment that gets rid of fibroids for good. It ends periods and the ability to carry a pregnancy. In many cases the ovaries can stay, so surgery won't put you into menopause.
It can often be done vaginally, laparoscopically or robotically, which usually means less pain and a faster recovery than open surgery. Very large fibroids may need an abdominal approach. Our guide to hysterectomy types has the details.
A note on morcellation
Morcellation means cutting tissue into smaller pieces to remove it through small incisions. The FDA has warned about power morcellation because, in rare cases, what looks like a fibroid is an undiagnosed cancer that could be spread. Ask your surgeon how tissue will be removed and how they reduce that risk.
Side-by-side comparison
| Myomectomy | UFE | Hysterectomy | |
|---|---|---|---|
| Keeps the uterus | Yes | Yes | No |
| If you want future pregnancy | Usually preferred | Generally not first choice | Not possible |
| Who does it | Gynecologic surgeon | Interventional radiologist | Gynecologic surgeon |
| Fibroids can return | Yes | Possible | No |
| Typical hospital stay | Same day to a few days, by approach | Same day or overnight | Same day to a few days, by approach |
| Recovery | Days (hysteroscopic) to several weeks (abdominal) | Often about one to two weeks | Often a few weeks to six weeks, by approach |
Recovery varies by person and procedure. If you commute by subway or train, ask specifically when you can manage stairs and standing for 30-plus minutes; that's often the real limit for going back to work in the city.
Questions to ask your doctor
- Where exactly are my fibroids, and how big are they?
- Which treatments would protect my fertility?
- Can this be done minimally invasively?
- How likely am I to need another treatment later?
- How long is recovery, and when can I go back to work?
- Should I see an interventional radiologist about UFE?
- How many of these procedures do you do in a typical year?
When to see a doctor
Talk with a gynecologist about treatment if fibroid symptoms are affecting your life:
- Heavy or long periods
- Fatigue or other signs of anemia
- Pelvic pain or pressure
- Needing to pee constantly, or constipation from pressure
- Trouble getting pregnant
After any fibroid procedure, call your provider right away for fever, heavy bleeding, severe pain your prescribed medicine doesn't control, foul-smelling discharge or trouble breathing.
Getting a second opinion in New York
Fibroid treatment involves real trade-offs, so getting more than one opinion is reasonable, ideally from both a gynecologic surgeon and an interventional radiologist. Search gynecologists in New York by borough or county, or start with gynecologists in the Bronx or Westchester.
Frequently asked questions
What is the best treatment for fibroids if I want to get pregnant?
Myomectomy, which removes fibroids and keeps the uterus, is generally the preferred procedure if you want a future pregnancy. The type of myomectomy depends on where the fibroids are.
Can I get pregnant after uterine fibroid embolization?
Pregnancy after UFE is possible, but there's less information about its safety than after myomectomy. People who want a future pregnancy are usually counseled toward myomectomy first.
Can fibroids come back after a myomectomy?
Yes. New fibroids can grow after a myomectomy, and some people need another treatment later. After a hysterectomy, fibroids can't come back because the uterus is gone.
Is UFE surgery?
No. UFE is a minimally invasive procedure done by an interventional radiologist through a small puncture in the wrist or groin, without a surgical incision on the belly.
Sources
- ACOG — Uterine Fibroids (Patient FAQ)
- ACOG — Management of Symptomatic Uterine Leiomyomas (Practice Bulletin 228)
- ACOG — Hysterectomy (Patient FAQ)
- NIH, NICHD — Uterine Fibroids: Treatment
- FDA — Laparoscopic Power Morcellation safety communications
This article is for general education and is not medical advice. It does not replace an evaluation by a licensed clinician who knows your history. If you think you have a medical emergency, call 911.