Surgical vs
Non-Surgical Treatment For Fibroids

Surgical & Non-Surgical Fibroid Treatments Explained

Surgical 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.

Surgical 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.

Non-Surgical Uterine Fibroid Embolization (UFE)

Uterine fibroid embolization (UFE) is a non-surgical, minimally invasive fibroid 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 usually performed by a Vascular and Interventional Radiologist (IR) that specializes in vascular anatomy and minimally-invasive, image-guided procedures.

Scar from invasive surgical hysterectomy.

Invasiveness

A 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 hysterectomy [2] and nearly 5% of patients that undergo myomectomy [3] require a blood transfusion to replenish blood that’s lost during the procedure, which is not ideal, and speaks to the level of trauma involved.

In stark contrast to its surgical counterparts, UFE, 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.

Hospital Stay

Non-surgical uterine fibroid embolization, on the other hand, does not require a hospital stay and many UFE patients are able to return home just a few hours after their procedure. Some doctors do like to keep their UFE patients in the hospital for one night to observe recovery and ensure that patients are comfortable after the procedure.

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. Recovery time varies widely from patient to patient, but we can get a general idea of the typical recovery period by looking at clinical studies.

Recovery time after surgical hysterectomy or myomectomy can take anywhere from 2 to 6 weeks, with most patients requiring 3 to 5 weeks before they’re able to resume normal activities. According to the same clinical studies, non-surgical UFE requires 1 to 2 weeks of recovery time in most cases [1]. This difference is significant, and is directly related to the amount of healing that’s required with a major surgery versus a non-surgical, minimally invasive fibroid treatment procedure.

Side Effects & Complications

Side effects and complications can be divided into minor and major categories. Generally, minor side effects are those that are tolerated well enough without additional medical intervention, whereas major side effects may require medical attention to resolve or result in significant patient morbidity. Data from clinical studies suggests that major side effects and complications are more common in patients that undergo surgical hysterectomy or myomectomy than patients that undergo non-surgical UFE. On the other hand, minor side effects and complications are more common with UFE [1].

Pregnancy

While it has been studied to some degree [4], it’s unknown which of the two treatments (UFE or myomectomy) is more likely to result in full-term pregnancy. 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 either of these procedures [2].

Fibroid Recurrence

If the uterus is not removed, as is the case with UFE or myomectomy, new fibroids can develop or existing fibroids can grow back again. Evidence suggests that women who receive UFE or myomectomy procedures have an equal chance of dealing with recurrent fibroids. One clinical study that followed women for multiple years after treatment observed that women who undergo myomectomy or UFE have roughly a 10% chance of dealing with recurrent fibroids within 2 years of their first treatment [3].

Reintervention

After surgical 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 non-surgical UFE are only slightly higher: around 12% at 2 years and 24% at 5 years [5,6].

Even with the finality of hysterectomy, patients may have a follow-up to 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].