We discuss the similarities and differences between three treatment options: UFE, myomectomy, and hysterectomy.
Each procedure has proven successful in treating fibroids. However, the treatment options differ from each other in critical ways that you will want to be aware of before deciding on a path.
Below you’ll find explanations of each option, as well as details on their efficacy, side effects, cost, and more to help you in the decision-making process.
What Is UFE?
Uterine fibroid embolization (UFE) is a method of treating fibroids by depriving them of nutrients by cutting off their blood supply. This is done in an outpatient procedure via a catheter inserted through a blood vessel guided by X-ray, where it releases embolizing agents to inhibit blood flow to the fibroids. The fibroids then begin to shrink over the ensuing weeks and months after the treatment.
The uterus’ blood supply is left unimpeded and the uterus itself is preserved.
Learn more about the UFE procedure.
What Is a Hysterectomy?
A hysterectomy is surgical removal of the uterus. Fibroids are a common reason for hysterectomy recommendations, although uterine prolapse, cancer, and chronic pelvic pain are other conditions doctors use hysterectomy as a treatment.
Hysterectomy for fibroids may be either partial (supracervical), in which just the upper part of the uterus is removed but the cervix is left in place, or total, in which both are fully removed. The fallopian tubes and ovaries are sometimes removed, as well.
What Is a Myomectomy?
Unlike hysterectomy, a myomectomy is a surgery specifically designed to treat fibroids. Its other key difference is that it addresses the fibroids while preserving the uterus.
There are three types of myomectomies:
Abdominal/“open” myomectomy: The most common and most invasive type. It involves making at least a horizontal incision on the “bikini line” to remove the fibroids from the wall of the uterus, then sewing the abdomen back together. For larger uteruses, a vertical incision may also be necessary. Open myomectomy is required for patients with large, numerous, and/or deeply embedded fibroids.
Laparoscopic myomectomy: If your fibroids are small enough, laparoscopic myomectomy may be used. Four small incisions are made in the naval, bikini line, and near each hip, into which long, thin metal tubes are inserted. Either directly or via computer-guided robotic arms, the doctor removes the fibroids using special tools inserted into the tubes, guided by a lighted telescope that’s also inserted through a tube. It concludes with sewing the abdomen and incisions back up.
Hysteroscopic myomectomy: The least invasive but least common method, as it’s only applicable for small, submucosal fibroids that aren’t buried deep in the uterine wall. This outpatient procedure involves no incisions, as the tool used to spot and remove fibroids is inserted through the vagina into the cervix.
| UFE | Hysterectomy | Myomectomy | |
|---|---|---|---|
| Lasting Symptom Relief | Success in up to 90% of cases | Potentially 100% success | Success in most cases, but relapse possible |
| Invasiveness | Least invasive | Most invasive | Moderately invasive |
| Recovery Time | Shortest (as little as 5 days) | 2-8 weeks | 2-6 weeks |
| Potential Side Effects |
|
|
|
| Scarring | Little to none | Multiple small scars or one 4-inch abdominal scar | 4-inch bikini line scar |
| Safety | Safest | Generally safe | Generally safe |
| Recurrence | New fibroids can develop over time | Only guaranteed zero-recurrence method | Significant recurrence rate |
| Fertility | Can become pregnant after | Cannot become pregnant after | Can become pregnant after |
Symptom Relief
UFE: Studies have shown that up to 90% of women who receive UFE receive significant symptom relief.
Hysterectomy: The most complete way to treat pelvic pressure, menstrual bleeding, frequent urination, and new fibroid growth.
Myomectomy: Most women experience relief from excessive menstrual bleeding and pelvic pain, unless/until fibroids return.
Invasiveness
UFE: A minimally invasive, non-surgical, outpatient procedure.
Hysterectomy: Although vaginal hysterectomy and laparoscopic hysterectomy are minimally invasive surgeries, abdominal hysterectomy–which still constitutes the majority of hysterectomy procedures–is major surgery.
Myomectomy: Laparoscopic procedures are minimally invasive but abdominal myomectomy is considered major surgery and requires potentially multiple days in the hospital.
Recovery Time
UFE: Offers the shortest recovery time of the three. Two weeks is often cited as a broad recovery window, although many women are back to their normal routines in five to seven days. Several days of cramps and tiredness after the procedure are normal, as are some bleeding or spotting for a month or so.
Hysterectomy: Vaginal hysterectomy can take two to four weeks to recover from, while an abdominal hysterectomy can take six to eight weeks. Doctors typically will recommend you refrain from sex or heavy lifting for six weeks after either type of surgery.
Myomectomy: As with hysterectomy, recovery times vary depending on the type of surgery. An open myomectomy takes the longest to recuperate from, at up to six weeks. Laparoscopic surgery may take between two and four weeks. With hysteroscopic surgery, you could be back to normal in under a week.
Side Effects
UFE: Pain, vaginal discharge, and post-embolization syndrome (flu-like symptoms) are relatively common side effects. Rare side effects include fibroid expulsion discharge, nontarget embolization, deep vein thrombosis (DVT), and septicemia.
Hysterectomy: Total curtailment of fertility is the most significant, but not the only side effect. Even partial hysterectomies can result in premature menopause, which increases the risk of osteoporosis, cardiovascular disease, and death, as well as emotional distress.
The surgery increases a woman’s risk of developing a pelvic floor disorder. Vaginal bleeding/discharge and bowel and bladder changes are also common afterward, as well.
Myomectomy: All three types of myomectomy share some potential side effects, such as uterine damage, excessive blood loss, reactions to general anesthesia, and infection.
Hysteroscopic myomectomies have been found to cause “frequent” venous gas embolisms, a dangerous complication.
Although the risk is low, laparoscopic and open myomectomies sometimes have to be converted to hysterectomies if there is excessive blood loss or uterine damage.
Scarring
UFE: Compared to the other options, UFE effectively causes no scarring from the small (2 mm) nick made in the skin.
Hysterectomy: The open method leaves a 4-inch scar in the lower abdomen, while laparoscopic hysterectomy and myomectomy create several 1 cm incisions across the abdomen totaling roughly 50 mm.
Myomectomy: Abdominal myomectomy also leaves a 4-inch scar near the bikini line.
Safety
UFE: Considered safe for any women with symptomatic fibroids by The American college of Obstetrics and Gynecology (ACOG). Compared to myomectomy, UFE results in shorter hospital stays, fewer and less severe adverse events, and similar success rates.
Hysterectomy: A fairly safe procedure, bearing in mind it is major surgery.
Myomectomy: Relatively safe with a low rate (about 5%) of infection.
Recurrence
UFE: Although it’s rare for fibroids to regrow after UFE treatment, new fibroids may develop over time.
Hysterectomy: The only proven treatment method for permanent fibroid cessation.
Myomectomy: Up to one-third of fibroids recur after myomectomy.
Future Fertility
UFE: A 2017 study found that UFE not only preserves fertility, it helped women who previously had not been able to conceive get pregnant.
Hysterectomy: You cannot get pregnant after a hysterectomy.
Myomectomy: You can still get pregnant, although your risk of C-section may be increased. But if you do become pregnant after surgery, you have a lower risk of developing new fibroids than women who don’t become pregnant.