Comparison
Uterine fibroid embolization (UFE) vs hysterectomy: keeping the uterus or ending fibroid symptoms for good
UFE keeps the uterus and has a shorter recovery, but in the main trial about 1 in 3 women had a hysterectomy within 10 years. Hysterectomy is major surgery with a longer recovery, and fibroids cannot grow back after it. This page lists what the trials and guidelines say so you can talk it over with your doctor.
What the studies and guidelines say
| Uterine fibroid embolization (UFE) | Hysterectomy | Sources | |
|---|---|---|---|
| What it is | A thin tube is passed through an artery at the top of the leg to the arteries that feed the uterus. Tiny particles block blood flow to the fibroids so they shrink. | Surgery that removes the uterus. The ovaries may or may not be removed. | [13] [14] [16] |
| Anesthesia and setting | Sedation and local numbing medicine. ACOG says it can be an outpatient procedure in most cases. | General anesthesia, or regional anesthesia that numbs the lower body, in an operating room. | [13] [14] [16] |
| Hospital stay | EMMY trial (Netherlands, 2002 to 2004): 2.5 days on average. REST trial (UK): 1 day (median). | EMMY trial: 5.1 days on average. REST trial: 5 days (median). | [1] [9] |
| Recovery | EMMY trial: back to paid work after 28 days on average. | EMMY trial: back to paid work after 63 days on average. The NHS says full recovery takes about 6 to 8 weeks. | [2] [16] |
| Symptom relief | Quality of life improved and matched hysterectomy at 2, 5 and 10 years in the EMMY trial. At 10 years, 78% were satisfied or very satisfied. | Quality of life improved by the same amount. Patients were more satisfied than UFE patients at 2 years, and 87% were satisfied or very satisfied at 10 years. | [3] [4] [5] [6] |
| Another procedure later | In the EMMY trial, 23.5% had a hysterectomy within 2 years and 35% within 10 years. A Cochrane review found 15% to 32% need more surgery within 2 years, and in the REST trial 32% needed another treatment within 5 years. | The uterus is removed, so fibroids cannot grow back. ACOG calls it a definitive treatment. | [3] [6] [10] [11] [12] |
| Main risks | EMMY trial: major complications in 4.9%, minor complications after going home in 58.0%, and 11.1% readmitted to hospital. | EMMY trial: major complications in 2.7%, minor complications in 40.0%, none readmitted. The NHS lists heavy bleeding, infection and damage to the bladder or bowel. | [1] [16] |
| Uterus and fertility | The uterus is kept. ACOG says the effect on future pregnancy is not clear, and NICE says it is uncertain. Hormone tests in the EMMY trial showed both treatments can lower ovarian reserve. | The uterus is removed, so pregnancy is no longer possible. If the ovaries are also removed, menopause starts right away. | [8] [13] [14] [16] |
| Sexual function | No different from hysterectomy at 2 years in the EMMY trial. | No different from UFE at 2 years in the EMMY trial. | [7] |
| What guidelines say | NICE (2010): it relieves symptoms for a large share of patients in the short and medium term, but symptoms may return and more procedures may be needed. NICE (2018) lists it as an option for fibroids 3 cm or larger. | ACOG (2021): a definitive and effective treatment for fibroids. NICE (2018) lists it as an option for fibroids 3 cm or larger. | [12] [14] [15] |
| Who was studied | The EMMY trial enrolled women before menopause with heavy periods from fibroids who did not plan a pregnancy. | The same women; all were candidates for hysterectomy. ACOG says hysterectomy is done when other treatments have not worked or are not possible, or the fibroids are very large. | [3] [13] |
Sources, checked November 11, 2026. Numbers in the last column point to this list.
- Hehenkamp et al. EMMY trial: results around the procedure. Am J Obstet Gynecol 2005
- Hehenkamp et al. EMMY trial: pain and return to daily activities. Cardiovasc Intervent Radiol 2006
- Volkers et al. EMMY trial: 2-year outcome. Am J Obstet Gynecol 2007
- Hehenkamp et al. EMMY trial: results. Radiology 2008
- van der Kooij et al. EMMY trial: 5-year outcome. Am J Obstet Gynecol 2010
- de Bruijn et al. EMMY trial: 10-year outcomes. Am J Obstet Gynecol 2016
- Hehenkamp et al. EMMY trial: sexuality and body image. Cardiovasc Intervent Radiol 2007
- Hehenkamp et al. EMMY trial: ovarian reserve. Hum Reprod 2007
- Edwards et al. REST trial: uterine-artery embolization versus surgery. N Engl J Med 2007
- Moss et al. REST trial: 5-year results. BJOG 2011
- Gupta et al. Uterine artery embolization for symptomatic uterine fibroids. Cochrane Database Syst Rev 2014
- ACOG Practice Bulletin 228: Management of Symptomatic Uterine Leiomyomas (2021)
- ACOG patient FAQ: Uterine Fibroids
- NICE HTG240: Uterine artery embolisation for fibroids (2010)
- NICE NG88: Heavy menstrual bleeding (2018)
- NHS: Hysterectomy
Why people choose one or the other
Why some people choose UFE
- They want to keep the uterus.
- A shorter recovery matters to them.
- They accept that symptoms can return and that another procedure may be needed.
Why some people choose hysterectomy
- They want fibroid symptoms to end for good.
- Other treatments have not worked or are not possible, or the fibroids are very large.
- They are sure they do not want a future pregnancy.
What this evidence can and cannot tell you
The main trial, EMMY, was run in the Netherlands from 2002 to 2004, and the REST trial in the United Kingdom. Hospital stays and surgical methods there and then may differ from care near you today.
Trial results describe groups of patients. They cannot say which treatment is right for one person. Your own doctors, ideally a gynecologist and an interventional radiologist together, can tell you which options fit your fibroids and your plans.
Common questions
Will I need a hysterectomy later if I choose UFE?
In the EMMY trial, 23.5% of women had a hysterectomy within 2 years of UFE and 35% within 10 years. The authors summed this up as about two thirds of women avoiding hysterectomy over 10 years.
How long is recovery after UFE compared with hysterectomy?
In the EMMY trial, women returned to paid work after an average of 28 days with UFE and 63 days with hysterectomy. The NHS says full recovery from hysterectomy takes about 6 to 8 weeks.
Does UFE work as well as hysterectomy?
In the EMMY trial, quality of life improved by the same amount in both groups and stayed that way for 10 years. Hysterectomy patients were more satisfied at 2 years, and fibroids cannot grow back after hysterectomy because the uterus is removed.
Can I get pregnant after UFE?
ACOG says the effect of UFE on future pregnancy is not clear, and NICE says the effects on fertility and pregnancy are uncertain. Pregnancy is not possible after hysterectomy.
What are the risks of UFE?
In the EMMY trial, major complications were uncommon with both treatments (4.9% with UFE and 2.7% with hysterectomy, not a significant difference). Minor complications after going home were more common with UFE, and 11.1% of UFE patients were readmitted to hospital.
How much does UFE cost compared with hysterectomy?
Prices vary by hospital and insurance plan. LA Vascular lists typical prices for both procedures on its cost pages, which are linked below.
See prices and anatomy
UFE: typical price Hysterectomy: typical price How UFE is done Pelvic artery anatomy
More comparisons: Procedure cost tools · FDA device databases · Vascular anatomy resources · GAE vs knee replacement · PAE vs TURP · Vein ablation vs vein stripping · All comparisons
For education only, not medical advice. This page summarizes published studies and guidelines and does not recommend a treatment. Trial results come from specific groups of patients and may not match your situation. Talk with your own doctor.