If uterine fibroids are causing heavy periods, pelvic pressure, pain, or other disruptive symptoms, you may reach a point where medication and watchful waiting are no longer enough. If medication and monitoring are no longer enough, the next question is often whether to choose a surgical or minimally invasive treatment.
Two uterus-preserving options are uterine fibroid embolization (UFE) and myomectomy. Both are used to treat symptomatic fibroids, but they work in very different ways. Myomectomy surgically removes individual fibroids. UFE treats them from inside the blood vessels, reducing their blood supply so they gradually shrink.
The best uterine fibroids treatment depends on your symptoms, the size and location of your fibroids, your plans for future pregnancy, previous treatments, and how you feel about surgery.
What Is the Difference Between UFE and Myomectomy?
The biggest difference is what happens to the fibroids themselves.
During a myomectomy, a surgeon removes one or more fibroids while leaving the uterus in place. Depending on the number, size, and location of the fibroids, surgery may be performed hysteroscopically through the cervix, laparoscopically through several small abdominal incisions, or through a larger abdominal incision.
A UFE procedure, also called uterine artery embolization or fibroid embolization, does not surgically remove the fibroids. An interventional radiologist guides a small catheter through an artery to the blood vessels supplying the uterus. Tiny particles are then delivered to selected uterine arteries, reducing blood flow to the fibroids. Without the same blood supply, the fibroids shrink over time.
Both approaches preserve the uterus, but only myomectomy physically removes fibroid tissue.
Which Procedure Is Less Invasive?
UFE is generally less invasive than laparoscopic or open myomectomy because it does not require abdominal surgery or surgical removal of fibroid tissue.
The procedure is performed through a small arterial access point, typically using local anesthesia and sedation. At ECCO Medical, UFE is performed as an outpatient treatment, allowing patients to return home the same day.
Recovery after myomectomy varies considerably because there are several ways to perform the surgery. Recovery after a hysteroscopic procedure may be relatively short, while laparoscopic or open abdominal myomectomy can require substantially more recovery time.
The American College of Obstetricians & Gynecologists (ACOG) notes that, compared with hysterectomy or myomectomy, uterine artery embolization typically involves a shorter hospital stay and allows patients to return to work and other activities sooner.
Does UFE Treat Multiple Fibroids at Once?
This is one of the practical differences between the two treatments.
Because UFE treats the uterine arteries supplying fibroid tissue, multiple fibroids can often be treated during the same procedure. That can be particularly useful for patients who have numerous fibroids scattered throughout the uterus.
Myomectomy requires the surgeon to identify and remove individual fibroids. The surgical approach therefore depends partly on how many fibroids are present, where they are located, and how deeply they extend into the uterine wall.
Neither approach prevents new fibroids from developing later. With myomectomy, the fibroids that are removed do not grow back, but new ones can form. With UFE, treated fibroids typically shrink rather than being removed.
Is UFE or Myomectomy Better for Heavy Periods?
Both UFE and myomectomy can improve heavy menstrual bleeding caused by fibroids.
With UFE, symptoms often improve as treated fibroids shrink over time. Myomectomy can also reduce bleeding by physically removing the fibroids contributing to symptoms. The best option often depends on where the fibroids are located and how they are affecting the uterus.
For example, fibroids that project into the uterine cavity may be especially likely to contribute to abnormal bleeding and may sometimes be removed hysteroscopically. This is why imaging is so important. Two patients can have similar symptoms but very different fibroid patterns, which may lead to different treatment recommendations.
Which Has a Shorter Recovery: UFE or Myomectomy?
For many patients, UFE offers a shorter recovery.
After the UFE procedure, cramping, pelvic discomfort, fatigue, and flu-like symptoms can occur during the first several days as the fibroids lose their blood supply. Most recovery happens at home, and patients generally return to normal activities sooner than they would after abdominal surgery.
Myomectomy recovery depends heavily on the surgical technique. Hysteroscopic myomectomy may involve a relatively quick recovery. Laparoscopic surgery usually requires more time, while an open abdominal myomectomy may involve several weeks of healing.
So when comparing recovery, it is important to know what type of myomectomy is actually being proposed rather than comparing UFE with “myomectomy” as a single procedure.
Is UFE or Myomectomy Better if I Want to Get Pregnant?
This is one of the most important questions to discuss before choosing a uterine fibroids treatment.
Myomectomy has a longer and more established history for patients who want to become pregnant in the future. Because it removes fibroids while preserving the uterus, it is often considered when fibroids may be interfering with fertility or pregnancy.
Pregnancy after UFE is possible, but the effects of uterine artery embolization on future fertility and pregnancy are less certain.
That does not mean every patient who may want children must automatically rule out UFE. It does mean reproductive goals should be part of the conversation from the beginning.
If becoming pregnant is an important future priority, your gynecologist and interventional radiologist can help you compare the benefits and limitations of each approach based on your age, fibroid anatomy, fertility history, and overall health.
Who May Be a Good Candidate for UFE?
UFE may be worth considering if your fibroids are causing heavy menstrual bleeding, pelvic pressure, pain, urinary symptoms, abdominal fullness, or other symptoms that are interfering with daily life.
It may be especially appealing if you want to preserve your uterus but would prefer to avoid traditional surgery, have multiple fibroids, or want a treatment with a shorter recovery.
Before treatment, imaging such as ultrasound or MRI can help determine the size, number, and location of the fibroids and whether fibroid embolization is appropriate.
You can learn more about how ECCO Medical approaches non-surgical fibroid care in Tired of Heavy Periods? This Non-Surgical Fibroid Treatment Could Be Your Answer.
Which Treatment Is More Likely to Need Another Procedure Later?
Both UFE and myomectomy can provide lasting symptom relief, but neither guarantees that fibroids will never require treatment again.
Research suggests that patients who undergo UFE are somewhat more likely to need another fibroid-related procedure later than those who have a myomectomy, according to the four-year FEMME trial follow-up.
That does not mean UFE is less effective. It reflects a tradeoff between treatments. UFE avoids surgical removal of fibroids and generally offers a shorter recovery, while myomectomy may have a lower chance of requiring another procedure for some patients. New fibroids can also develop after myomectomy, so long-term follow-up may still be needed.
When comparing the two, it is helpful to consider not only recovery and fertility goals, but also how comfortable you are with the possibility of needing additional treatment in the future.
UFE vs. Myomectomy: Which Is Better?
There is no single treatment that is best for every patient with fibroids.
UFE may be a good option if you want to avoid surgery, treat multiple fibroids during the same procedure, preserve your uterus, and have a shorter recovery. Myomectomy may be more appropriate when the goal is to physically remove a particular fibroid, especially if it is affecting the uterine cavity or if future pregnancy is a major priority.
Fibroid size, number, location, symptoms, reproductive plans, and overall health can all influence the recommendation. Some fibroids are simply better suited to surgery, while others may be good candidates for fibroid embolization.
The most useful question is not whether UFE is better than myomectomy overall, but which treatment best matches your fibroid pattern, symptoms, and long-term goals.
How Do I Decide Which Fibroid Treatment Is Right for Me?
Start by confirming exactly what is causing your symptoms.
Fibroid size alone does not tell the whole story. The number of fibroids, their location within the uterus, how they affect surrounding structures, your bleeding pattern, your age, and your reproductive plans all matter.
ECCO Medical provides uterine fibroid embolization for patients seeking a minimally invasive option in Colorado. The team evaluates patients at its Lone Tree location serving the Denver metro area and its Pueblo West location serving Pueblo and Southern Colorado.
If myomectomy has been recommended, it may still be worth asking whether UFE is appropriate for your fibroid pattern and treatment goals. A consultation with an interventional radiologist can help you understand whether UFE may be appropriate and how it compares with myomectomy for your specific situation.
Schedule a consultation with ECCO Medical to learn whether uterine fibroid embolization could be part of your treatment plan.
