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PubMed This is a summary of 16 peer-reviewed journal articles Updated
Gynecology · Uterine Leiomyoma

Uterus-Sparing Procedures and Surgeries for Fibroids

At a Glance

Uterus-sparing fibroid treatments include myomectomy, uterine artery embolization, radiofrequency ablation, and focused ultrasound. Myomectomy has the strongest fertility support, while other options may offer faster recovery but differ in pregnancy data and retreatment risk.

For many people, the goal of fibroid treatment is to find relief while keeping the uterus intact. These “uterus-sparing” options range from traditional surgeries to advanced procedures that use heat or sound waves to shrink the growths.

It is important to understand that while these treatments spare the uterus, they are not always “one and done.” Because the uterus remains, new fibroids can develop, or existing ones may not fully resolve [1]. Depending on the procedure you choose, the chance of needing a second treatment within five years can range from about 7% to over 50% [1][2].

Myomectomy: Surgical Removal

A myomectomy is a surgery to physically remove fibroids while repairing the uterine wall [3]. It is generally the preferred uterus-preserving intervention when a fibroid is clearly cavity-distorting or otherwise implicated in infertility, though not all fibroids require removal before conception [4][5].

The “route” or method of surgery depends on the location and size of your fibroids:

  • Hysteroscopic Myomectomy: Used for fibroids inside the uterine cavity (Types 0, 1, and 2). No external incisions are made; the surgeon enters through the vagina [6]. Recovery is very fast, often within a day [3].
  • Laparoscopic or Robotic Myomectomy: The surgeon uses small “keyhole” incisions and a camera to remove fibroids [3]. This offers a faster recovery (about 2-3 weeks) and less pain than open surgery [3].
  • Abdominal (Open) Myomectomy: A larger incision is made in the lower abdomen. This is typically reserved for very large fibroids, a high number of fibroids, or complex cases where the uterus needs significant reconstruction [3]. Recovery typically takes 4-6 weeks [3].

Risks: Surgery itself carries risks such as bleeding, pelvic adhesions (scar tissue), recurrence, and possible impact on future delivery options.

Uterine Artery Embolization (UAE)

UAE is a non-surgical procedure performed by an interventional radiologist [7]. A tiny catheter is used to inject small particles into the blood vessels supplying the uterus, cutting off blood flow to the fibroids and causing them to shrink over time [7].

  • Pros: It is highly effective at reducing heavy bleeding and avoids the risks of major surgery [7][8].
  • Cons: It carries a higher risk of reintervention over time than myomectomy in many estimates [7][8]. Common post-embolization symptoms include pain, nausea, fever, and vaginal discharge; less commonly, it can cause infection, non-target embolization, or ovarian dysfunction [9].
  • Fertility Warning: UAE is generally not recommended for patients actively seeking pregnancy [4]. It may reduce blood flow to the ovaries (ovarian reserve) and is linked to higher rates of miscarriage and pregnancy complications compared to myomectomy [10][5].

Thermal Ablation: RFA and MRgFUS

These newer, minimally invasive treatments use heat to destroy fibroid tissue without removing it. Both require specific patient selection and carry risks of thermal injury.

  • Radiofrequency Ablation (RFA): A needle-like device is inserted into the fibroid to deliver heat that kills the tissue [11]. RFA offers a very fast recovery and shows durable symptom relief for at least three years [12][13].
  • MR-Guided Focused Ultrasound (MRgFUS): This uses high-intensity ultrasound waves to treat the fibroid tissue while you are inside an MRI machine [10]. While it is the least invasive option, it has a high rate of fibroids returning or requiring further treatment and requires very specific fibroid characteristics to be effective [1][10].

Comparing the Options

The best choice depends on your symptoms, the “map” of your fibroids, and your future plans.

Feature Myomectomy UAE RFA MRgFUS
Primary Goal Remove fibroids Shrink fibroids Shrink fibroids Shrink fibroids
Fertility Best supported [4] Generally discouraged [4] Limited data [14] Limited data [15]
Recovery Time 1–6 weeks [3] 1–2 weeks [16] < 1 week [12] < 1 week [16]
Reintervention Risk Lower (~12–19%) [1] Moderate (~24–35%) [2] Moderate (~11%) [13] Higher (up to 53%) [1]

Note: The percentages in this table are estimates drawn from heterogeneous meta-analyses of varying follow-up periods (such as 60-month estimates) and are not directly comparable personal probabilities. [1][2][13]

Common questions in this guide

What uterus-sparing treatment options are available for fibroids?
The main options are myomectomy, which removes fibroids, and procedures that shrink them, including uterine artery embolization, radiofrequency ablation, and MR-guided focused ultrasound. The best choice depends on your symptoms, fibroid size, number and location, recovery needs, and plans for pregnancy. Keeping the uterus does not guarantee that fibroids will not return.
Which uterus-sparing fibroid treatment is best if I want to become pregnant?
Myomectomy has the strongest support when a fibroid distorts the uterine cavity or is linked to infertility, although not every fibroid needs removal before conception. Uterine artery embolization is generally not recommended for people actively seeking pregnancy because it may reduce the remaining egg supply and has been linked with higher rates of miscarriage and pregnancy complications than myomectomy. Fertility information for radiofrequency ablation and MR-guided focused ultrasound remains limited.
How long does recovery take after fibroid surgery?
Recovery depends on the type of myomectomy. Hysteroscopic myomectomy often allows recovery within a day, laparoscopic or robotic surgery typically takes about two to three weeks, and open abdominal surgery usually takes four to six weeks. Your surgeon can give a more personalized timeline based on the size and number of fibroids and the reconstruction required.
What are the risks and side effects of uterine artery embolization?
Uterine artery embolization blocks blood flow to fibroids so they shrink over time. Pain, nausea, fever, and vaginal discharge can occur after the procedure. Less common risks include infection, particles reaching unintended blood vessels, and reduced ovarian function; UAE may also have a higher chance of requiring another treatment than myomectomy.
Can fibroids come back after a uterus-sparing treatment?
Yes. Because the uterus remains, new fibroids can develop and treated fibroids may not fully resolve, so additional treatment may be needed. Studies have reported a chance of a second treatment within five years ranging from about 7% to more than 50% across procedures, but these estimates are not directly comparable.
How are radiofrequency ablation and focused ultrasound different for fibroids?
Both treatments use heat to destroy fibroid tissue without removing it. Radiofrequency ablation places a needle-like device in the fibroid, while MR-guided focused ultrasound uses concentrated sound waves while you are inside an MRI scanner. Both may allow a fast recovery, but focused ultrasound requires specific fibroid characteristics and has a higher reported need for further treatment.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.Based on the size and FIGO type of my fibroids, am I a candidate for a minimally invasive myomectomy?
  2. 2.Why would you recommend myomectomy over UAE or RFA for my specific fertility goals?
  3. 3.If I choose UAE, what is the estimated risk to my ovarian reserve, and how might it affect my chances of a healthy pregnancy later?
  4. 4.How many myomectomies or UAE procedures do you perform annually, and what are your typical patient outcomes?
  5. 5.If we use RFA or HIFU, how will we monitor the shrinkage of the fibroids, and what is the likelihood they will require further treatment?

Questions For You

Tap a prompt to share your answer — we'll use it plus this page's context to start a tailored conversation.

References

References (16)
  1. 1

    Reintervention risk and quality of life outcomes after uterine-sparing interventions for fibroids: a systematic review and meta-analysis.

    Sandberg EM, Tummers FHMP, Cohen SL, et al.

    Fertility and sterility 2018; (109(4)):698-707.e1 doi:10.1016/j.fertnstert.2017.11.033.

    PMID: 29653718
  2. 2

    Uterine artery embolization vs hysterectomy in the treatment of symptomatic uterine fibroids: 10-year outcomes from the randomized EMMY trial.

    de Bruijn AM, Ankum WM, Reekers JA, et al.

    American journal of obstetrics and gynecology 2016; (215(6)):745.e1-745.e12 doi:10.1016/j.ajog.2016.06.051.

    PMID: 27393268
  3. 3

    Review of nonsurgical/minimally invasive treatments and open myomectomy for uterine fibroids.

    Chittawar PB, Kamath MS

    Current opinion in obstetrics & gynecology 2015; (27(6)):391-7 doi:10.1097/GCO.0000000000000223.

    PMID: 26536205
  4. 4

    The management of uterine fibroids in women with otherwise unexplained infertility.

    Carranza-Mamane B, Havelock J, Hemmings R, et al.

    Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC 2015; (37(3)):277-285 doi:10.1016/S1701-2163(15)30318-2.

    PMID: 26001875
  5. 5

    Fibroids and Fertility: A Comparison of Myomectomy and Uterine Artery Embolization on Fertility and Reproductive Outcomes.

    Zanolli NC, Bishop KC, Kuller JA, et al.

    Obstetrical & gynecological survey 2022; (77(8)):485-494 doi:10.1097/OGX.0000000000001052.

    PMID: 35932289
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    Short-term quality of life after myomectomy for uterine fibroids from the COMPARE-UF Fibroid Registry.

    Laughlin-Tommaso SK, Lu D, Thomas L, et al.

    American journal of obstetrics and gynecology 2020; (222(4)):345.e1-345.e22 doi:10.1016/j.ajog.2019.09.052.

    PMID: 31678093
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    Uterine-Artery Embolization or Myomectomy for Uterine Fibroids.

    Manyonda I, Belli AM, Lumsden MA, et al.

    The New England journal of medicine 2020; (383(5)):440-451 doi:10.1056/NEJMoa1914735.

    PMID: 32726530
  8. 8

    Uterine artery embolization or myomectomy for women with uterine fibroids: Four-year follow-up of a randomised controlled trial.

    Daniels J, Middleton LJ, Cheed V, et al.

    European journal of obstetrics & gynecology and reproductive biology: X 2022; (13()):100139 doi:10.1016/j.eurox.2021.100139.

    PMID: 34877531
  9. 9

    Uncommon Complication of Uterine Artery Embolization: Expulsion of Infarcted Myoma and Uterine Sepsis.

    Martins JG, Gaudenti D, Crespo F, et al.

    Case reports in obstetrics and gynecology 2016; (2016()):8695318 doi:10.1155/2016/8695318.

    PMID: 27073705
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    FIRSTT study: randomized controlled trial of uterine artery embolization vs focused ultrasound surgery.

    Laughlin-Tommaso S, Barnard EP, AbdElmagied AM, et al.

    American journal of obstetrics and gynecology 2019; (220(2)):174.e1-174.e13 doi:10.1016/j.ajog.2018.10.032.

    PMID: 30696556
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    Recovery After Transcervical Fibroid Ablation Versus Minimally Invasive Myomectomy for Symptomatic Uterine Fibroids: A Randomised Controlled Trial.

    Neis F, Kraemer B, Bauer A, et al.

    BJOG : an international journal of obstetrics and gynaecology 2026; (133(4)):618-625 doi:10.1111/1471-0528.70081.

    PMID: 41208417
  12. 12

    Clinical outcomes and health care utilization pre- and post-laparoscopic radiofrequency ablation of symptomatic fibroids and laparoscopic myomectomy: a randomized trial of uterine-sparing techniques (TRUST) in Canada.

    Rattray DD, Weins L, Regush LC, et al.

    ClinicoEconomics and outcomes research : CEOR 2018; (10()):201-212 doi:10.2147/CEOR.S155038.

    PMID: 29670382
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    Clinical Performance of Radiofrequency Ablation for Treatment of Uterine Fibroids: Systematic Review and Meta-Analysis of Prospective Studies.

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  14. 14

    Radiofrequency Ablation of Uterine Myomas and Pregnancy Outcomes: An Updated Review of the Literature.

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    Reproductive outcomes of high-intensity focused ultrasound ablation and myomectomy for uterine fibroids: a systematic review and meta-analysis.

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    Periprocedural outcomes comparing fibroid embolization and focused ultrasound: a randomized controlled trial and comprehensive cohort analysis.

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This page is for informational purposes only and does not constitute medical advice about choosing a uterus-sparing fibroid treatment. A gynecologist and, when appropriate, an interventional radiologist can help you weigh symptoms, fibroid characteristics, recovery, and pregnancy plans.

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