Treating Uterine Fibroids: Hysterectomy or Uterine Fibroid Embolization?

» Request a referral to a John C. Lincoln specialist who can help you explore your fibroid treatment options, including uterine fibroid embolization or hysterectomy.

Several treatments are available for uterine fibroids. Hysterectomy and uterine fibroid embolization (UFE) are among the most common.

Hysterectomy is a major surgery in which the uterus is surgically removed, typically through abdominal incision. Ovaries and fallopian tubes also may be removed.

UFE treatment represents an alternative to treating fibroids with hysterectomy. In UFE treatment, only a tiny incision in the groin is necessary. A highly trained interventional radiologist uses a catheter to release particles that "starve" the fibroid, by depriving it of blood supply. In time, uterine fibroids scar down and shrink.

Fibroids and Hysterectomy

Of the 600,000 hysterectomies performed in the U.S. each year, uterine fibroid tumors are indicated in 30 to 60 percent of these procedures. While it offers a 100 percent success rate against uterine fibroids, hysterectomy poses significant risk of side effects.

Potential surgical complications of uterine fibroid treatment with hysterectomy include infection, hemorrhage, injury to adjacent organs, adhesions and loss of childbearing potential.

Hysterectomy-Related ComplicationRisk of Complication
Hemorrhage 1 to 5%
Infection 4 to 25%
Fever 5 to 20%
Injury to adjacent organ 0.5 to 2%
Thromboembolic disease 0.4 to 2%
Paralytic Ileus 1 to 4%
Secondary major surgery 1.7 to 5%

Hysterectomy also can lead to long-term side effects: hormonal changes (if ovaries are removed), emotional changes and loss of sexual appetite.

A desire to avoid these adverse surgery-related events is among the reasons why women opt against hysterectomy. Other reasons are risk of pelvic support issues, bladder dysfunction, menopause and hormone replacement therapy. Naturally, saving the uterus is important — it is a source of fertility and feminine self-image.

Fibroids and UFE

More than 100,000 women have been treated with UFE since it was first performed in 1994. Unfortunately, most women are simply not aware that UFE is available, and they accept hysterectomy as a standard treatment.

Not only is UFE less invasive than hysterectomy, it also preserves the uterus and ovaries. UFE has a two-week recovery time, compared with as long as six weeks for hysterectomy.

A study of the U.S. Fibroid Registry, comprised of 3,160 enrolled patients who underwent UFE between 2000 and 2002, produced encouraging findings:

  • For bleeding, 90 percent of patients clinically demonstrated an improvement of uterine fibroid symptoms.
  • For bulk symptoms (a combination of urinary frequency or urgency, constipation, bloating and fullness), 85 percent of patients clinically demonstrated an improvement of symptoms.

Within six months of having a UFE, patients showed 40 to 70 percent shrinkage of fibroids and 40 to 60 percent shrinkage of the uterus.

Surveys also report high patient satisfaction following UFE. Most patients would repeat the procedure again, if needed.

UFE-Related Complication Risk of Complication
Treatment failure 4 to 15%
Infection Less than 1%
Amenorrhea (absence of menstrual period) 5%
Trancervical expulsion of fibroid (may require dilatation and curettage) 1 to 2%
Pain after 10 or more days following treatment 3 to 5%

If you are seeking to achieve pregnancy in the future, John C. Lincoln physicians will be happy to discuss whether UFE is right for you. Conservatively speaking, women who wish to maintain fertility may want to avoid UFE. However, a 2005 study of 555 women between ages 27 and 42 revealed that the majority of women actively trying to become pregnant were able to do so after UFE. Most resulted in term deliveries and newborns of typical size.