Short answer
After uterine artery embolization, most patients improve durably, but about one in five needs a second procedure within ten years. Myomectomy carries fewer reinterventions but remains surgery, and hysterectomy removes the risk of recurrence at the price of removing the uterus. A pelvic MRI is needed to decide on the best treatment for your situation.
What long-term studies show
According to PubMed, a 2026 series of 199 patients with MRI-confirmed fibroids, embolized between 2013 and 2018 (follow-up of at least 5 years for 92.5% of them), reports:
- 75.4% of respondents (132 of 175) with significant symptom improvement at least 2 years after the procedure;
- additional treatment in 33.2% of patients (medical 17.4%, procedural 18.5%);
- hysterectomy in 15.8%;
- a 10-year cumulative incidence of a second procedure of 19.4%, higher when embolization was done at a younger age.
This is a retrospective single-centre study: it cannot predict your individual course.
Embolization, myomectomy, hysterectomy: what do the trials say?
A 2026 network meta-analysis including 23 randomised trials (2,055 women) compares embolization with hysterectomy, myomectomy, MRI-guided focused ultrasound, microwave ablation and laparoscopic uterine artery occlusion. Technical success and major complications do not differ significantly between strategies; myomectomy needs fewer reinterventions than embolization (OR 0.21). The data do not allow any embolic agent to be declared superior to another.
The FEMME randomised trial (254 women) had already compared embolization and myomectomy: quality of life at 2 years was slightly better after myomectomy, with no significant difference at 4 years. When a pregnancy is planned, myomectomy is generally preferred.
Why the MRI decides the treatment
A pelvic MRI with contrast shows the number, size, position and blood supply of the fibroids, looks for associated adenomyosis and rules out a suspicious lesion. It allows a choice between embolization, myomectomy, hysterectomy or medical treatment. When treatment appears to fail, cross-sectional imaging helps look for residual extra-uterine blood supply.
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Frequently asked questions
Is fibroid embolization durable?
In a series of 199 patients followed for 5 to 13 years, 75% of respondents reported significant symptom improvement at least 2 years after embolization. About one patient in five nevertheless needed a second procedure within 10 years (cumulative incidence 19.4%).
What is the risk of hysterectomy after embolization?
In the same series, 15.8% of patients had a hysterectomy during follow-up. The risk of reintervention is higher in patients who were younger at the time of embolization.
Embolization or myomectomy: which lasts longer?
A 2026 network meta-analysis (23 randomised trials, 2,055 women) found no significant difference in technical success or major complications, but fewer reinterventions after myomectomy. Embolization, on the other hand, avoids surgery and keeps the uterus.
Why is an MRI needed before embolization?
A pelvic MRI with contrast shows the number, size, position and blood supply of the fibroids, detects adenomyosis and allows a choice between embolization, myomectomy and other options. Without an MRI, no treatment is proposed.
References (PubMed)
- Medema AM et al. Long-term outcomes and reinterventions following uterine artery embolization for the treatment of uterine leiomyomata. Curr Probl Diagn Radiol 2026. PubMed · DOI
- Coutinho ML et al. Comparative Effectiveness and Safety of Treatments and Embolic Agents for Symptomatic Uterine Fibroids: A Bayesian Network Meta-analysis. J Vasc Interv Radiol 2026. PubMed · DOI
- Daniels J et al. Uterine artery embolisation versus myomectomy for premenopausal women with uterine fibroids wishing to avoid hysterectomy: the FEMME RCT. Health Technol Assess 2022;26(22):1-74. PubMed · DOI