Medical encyclopedia · Cochin AP-HP

Fibroid embolization vs myomectomy vs hysterectomy: which option to choose?

Detailed comparison of uterine fibroid treatments: advantages, limitations, recovery, fertility et remboursement

Cochin Hospital AP-HP · Prof. Anthony Dohan · Updated April 2026

Criterion	Embolization (UFE)	Myomectomy	Hysterectomy
Anaesthesia	Local + sedation	General or spinal	General
Hospital stay	1 to 2 nights	2 to 5 days	3 to 5 days
Recovery	5 to 10 days	4 to 6 weeks	4 to 8 weeks
Incision	2 mm groin puncture	Laparotomy or laparoscopy	Laparotomy or laparoscopy
All fibroids	Yes (simultaneously)	No (targeted only)	Yes (complete removal)
Possible recurrence	Yes (5-15% at 5 years)	Yes (20-30%)	No (no uterus)
Uterus preserved	Yes	Yes	No
Pregnancy possible after	Yes	Yes	No
Reimbursement	100% (national insurance)	100% (national insurance)	100% (national insurance)

HAS and CNGOF recommendations
The French health authority (HAS) and the college of gynaecologists (CNGOF) recognise uterine artery embolization as a valid alternative to surgery for symptomatic fibroids, with an equivalent level of evidence. The choice should be discussed in a multidisciplinary consultation, taking any pregnancy plans into account.

Embolization: advantages and limitations

Advantages: minimally invasive treatment with no significant incision, short hospital stay (1-2 nights), quick return to activities (5-10 days), simultaneous treatment of all fibroids, preservation of the uterus and possibility of later pregnancy, effective on multi-fibroid uterus.

Limitations: post-embolization syndrome in the first 24-48h (expected, managed pain), not indicated for an isolated pedunculated submucosal fibroid (hysteroscopy preferred), risk of long-term recurrence (5-15% at 5 years requiring further treatment).

Myomectomy: advantages and limitations

Advantages: physical removal of the targeted fibroids, gold-standard treatment for submucosal fibroids via hysteroscopy, indicated when a diagnostic doubt requires pathological analysis.

Limitations: treats only the targeted fibroids (not the others), high 5-year recurrence rate (20-30%), possible surgical complications (haemorrhage, post-operative adhesions), long recovery (4-6 weeks).

Frequently asked questions

Is embolization as effective as surgery?

Randomised trials (including the EMMY study) show that embolization and hysterectomy have equivalent satisfaction rates at 2 and 5 years. Embolization offers advantages in recovery and uterine preservation, with a higher reintervention rate.

Can you become pregnant after fibroid embolization?

Pregnancies after embolization have been reported. Current data do not show an increased obstetric risk compared with myomectomy. The indication should be discussed if pregnancy is planned in the near future.

Can embolization fail and require surgery?

Yes, in about 5 to 15% of cases at 5 years, a reintervention (repeat embolization or surgery) may be needed. Even so, more than 85% of patients avoid surgery at 5 years thanks to embolization.

Which option if I want to preserve my chances of pregnancy?

Both embolization and myomectomy preserve the uterus and the possibility of pregnancy. The choice depends on the type and location of the fibroids. This question is systematically addressed during the consultation at Cochin.

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Embolisation des fibromes a Cochin AP-HP

Everything about the technique, procedure and results of fibroid embolization.

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