Some women pass pieces of fibroid tissue through the vagina after uterine fibroid embolization. This is called fibroid expulsion. It happens most often with submucosal fibroids, the ones that sit just under the lining of the uterus and bulge into the cavity. Often the tissue passes on its own, but sometimes a gynecologic procedure is needed to remove what is left. The CIRSE 2015 guideline reports that tissue passage occasionally needs surgery in about 5% of procedures.
For a full overview of UFE, see our main page on uterine fibroid embolization (UFE).
Why fibroid tissue can pass after UFE
UFE blocks the small arteries feeding the fibroids. Over the following months, the fibroid tissue dies, softens and shrinks. Where a fibroid sits makes a big difference to what happens next:
- Fibroids deep in the muscle wall (intramural) usually shrink in place and are slowly absorbed.
- Fibroids on the outer surface (subserosal) also shrink in place.
- Fibroids just under the lining (submucosal), especially those that bulge into the cavity, can detach from the wall. The uterus then contracts to push the softened tissue out through the cervix, much like a heavy period.
If you are not sure which kind you have, your MRI or ultrasound report will usually describe it, often using the FIGO system that numbers fibroids from type 0 (inside the cavity) to type 8. Our guide to types of fibroids explains these labels.
How often it happens
The numbers depend heavily on how many women in a study had submucosal fibroids and how "expulsion" is defined.
| Source | Who was studied | What was reported |
|---|---|---|
| RadiologyInfo (ACR/RSNA) | UFE patients in general | About 2% to 3% pass small pieces of fibroid tissue |
| CIRSE 2015 guideline | UFE procedures in published studies | Tissue passage occasionally needing surgery in about 5% |
| 2025 systematic review | Several minimally invasive fibroid treatments, including UFE | Expulsion in 14.4% overall; 1.4% needed extra care to remove leftover tissue |
| Radeleff 2010 (Germany) | 20 women whose main fibroid was submucosal | 10 of 20 (50%) fully expelled within the 1-year follow-up |
The 2025 review also found that the highest expulsion rate was after focused ultrasound treatment, not UFE.
Who is most likely to pass tissue
The Radeleff study is the most direct look at this question. Researchers measured each woman's main submucosal fibroid on MRI before UFE and repeated MRI every 3 months for a year. Half of the fibroids were completely expelled. Size mattered: fibroids of 66 mL or smaller were expelled 73% of the time, while larger fibroids were 78% likely to stay in place. The authors recommend that women with a submucosal fibroid under 66 mL be told in advance that expulsion is likely.
Expulsion is not necessarily a bad outcome. In the same study, all 20 women had significant symptom improvement and satisfaction was very high. In the large US FIBROID Registry, women with submucosal fibroids were among those who improved the most after UFE.
That said, submucosal fibroids can also be removed directly with hysteroscopic myomectomy, a procedure done through the cervix with no incision. If your main problem is a single submucosal fibroid, it is worth comparing both routes; see submucosal fibroids: hysteroscopy or UFE.
Questions about your treatment options? Dr. Fox can help.
Book a ConsultationThis article is part of our Fibroid Treatment Guide.
What it can feel like
Women who pass fibroid tissue may notice:
- Cramping that feels like strong period pain
- Vaginal discharge or bleeding
- Pieces of firm or rubbery tissue, which can range from small fragments to larger pieces
In the Radeleff study, expulsion was tracked over the full first year rather than only in the days after UFE, so it is not limited to the early recovery period. Do not assume that cramping weeks or months later is a sign of failure; tell your doctor so they can check what is happening.
What happens to fibroids that do not pass
Most fibroids never come out. They shrink in place as the dead tissue is slowly absorbed. In the EMMY trial, the dominant fibroid had shrunk by an average of 60.5% and the uterus by 48.2% at 2 years. In a 2021 series of 374 outpatient UFE procedures, the dominant fibroid had shrunk by 42.9% at 6 months. Shrinkage is gradual, which is why ACOG says it may take 2 to 3 months to notice a change in symptoms and that fibroids may keep shrinking for a year or more.
So passing tissue is one of two ways a treated fibroid can go away, and it mostly applies to fibroids that already touch the uterine cavity. If your fibroids are all within the wall or on the outer surface, expulsion is much less likely to be part of your recovery.
When a procedure is needed
Most of the time, tissue passes on its own. A procedure may be needed when a piece of fibroid partly detaches and gets stuck in the cervix or cavity, keeps causing pain or bleeding, or becomes infected. RadiologyInfo notes that a dilation and curettage (D&C) may be needed in these cases. Hysteroscopy, in which a gynecologist uses a thin camera through the cervix to remove the tissue, is another option.
In a 2003 study of 152 women, 4 of the 5 major complications were surgery for sloughing fibroid tissue, which is why this is one of the main risks to discuss before UFE. For the full picture of risks, see UFE risks and complications.
Warning signs: when to call
Call your care team promptly if you have:
- A fever higher than 101 °F (ACOG's threshold for calling after UFE)
- Pain that medication does not control
- Heavy bleeding, or bleeding that is getting worse
- Discharge together with fever, which the CIRSE 2015 guideline lists among the more common complications (4%)
- A sensation that something is stuck, with ongoing cramping that is not easing
Infection of dying fibroid tissue is the main concern, and it is treatable when it is caught early. If you cannot reach your team and feel very unwell, go to an emergency department and tell them you recently had uterine artery embolization.
Early cramping and low fever in the first days after UFE are usually part of post-embolization syndrome rather than expulsion; see post-embolization syndrome for how to tell what is expected.
Questions to ask before UFE
- Do I have a submucosal fibroid, and how large is it?
- How likely is it that I will pass tissue, given my MRI?
- Would hysteroscopic removal be a better first step for that fibroid?
- If tissue gets stuck, who would remove it, and where?
- What should I do if I pass tissue: call, come in, or save it?
To see how UFE fits alongside every other treatment, read our fibroid treatment guide.
Frequently Asked Questions
Is it normal to pass fibroid tissue after UFE?
It can happen, especially if you had a submucosal fibroid. RadiologyInfo says about 2% to 3% of UFE patients pass small pieces of tissue, and in one study of women with a main submucosal fibroid, half were expelled within a year.
Does passing a fibroid mean UFE worked?
It means the fibroid lost its blood supply, which is the goal. In the 2010 Radeleff study, all women had significant symptom improvement and satisfaction was very high.
Will I need surgery if a fibroid comes out?
Usually not, but sometimes tissue gets stuck and needs removal with a D&C or hysteroscopy. The CIRSE 2015 guideline reports this in about 5% of procedures.
When can fibroid expulsion happen?
It is not limited to the first days. In the Radeleff study, women were followed with MRI every 3 months, and expulsions were counted across the full first year.
What symptoms mean I should call the doctor?
Call for fever over 101 °F, pain medication does not control, heavy or worsening bleeding, discharge with fever, or a feeling that tissue is stuck with cramping that is not easing.
Keep Reading
- Uterine Fibroid Embolization (UFE) in New York City
- Submucosal Fibroid Treatment: Hysteroscopic Myomectomy or UFE?
- Post-Embolization Syndrome After UFE: What Is Normal and When to Call
- UFE Risks and Complications: What the Numbers Show
- Types of Uterine Fibroids: Submucosal, Intramural, Subserosal and the FIGO System
- UFE Recovery Day by Day: What to Expect Week by Week
- Fibroid Treatment Guide: every option, compared
Sources
- Radeleff et al., Eur J Radiol, 2010 — expulsion of dominant submucosal fibroids after UAE (20 patients)
- van Overhagen and Reekers, Cardiovasc Intervent Radiol, 2015 — CIRSE standards of practice for uterine artery embolization
- Systematic review, Eur J Obstet Gynecol Reprod Biol, 2025 — fibroid expulsion after minimally invasive treatments
- RadiologyInfo.org (ACR/RSNA) — Uterine Fibroid Embolization
- Spies et al., Obstet Gynecol, 2005 — FIBROID Registry 1-year outcomes
- Katsumori et al., AJR, 2003 — UAE for fibroids 10 cm or larger (152 women)
- ACOG patient FAQ — Uterine Artery Embolization (last reviewed May 2026)
- Hehenkamp et al., Am J Obstet Gynecol, 2007 — EMMY trial 2-year results
- Transradial outpatient UFE series, AJR, 2021 — 374 procedures, observation time and 6-month volume reduction
Medically reviewed by David Fox, MD, FACS, RPVI. This article is general information, not a substitute for a medical evaluation.
Living with heavy periods, pelvic pressure or other fibroid symptoms? Schedule a consultation with Dr. David Fox at Fox Vein & Vascular in Manhattan to find out whether uterine fibroid embolization is right for you. Call (212) 362-3470 or request a UFE consultation online.
