Pedunculated Fibroids and UFE: Safety, Stalk Width and Results

A pedunculated fibroid grows on a stalk, like a mushroom, rather than sitting inside the wall of the uterus. For years, many doctors avoided embolizing these fibroids, worried that the stalk might weaken and let the fibroid break off. Newer evidence is more reassuring. A 2022 review of 11 studies found adverse events in 1.7% of patients treated with uterine fibroid embolization (UFE) for fibroids on a stalk outside the uterus, and an average shrinkage of 38.6%. The evidence is still small, though, and the European CIRSE 2015 guideline still lists fibroids on a thin stalk as a relative contraindication, so each case needs careful review of the MRI.

What a pedunculated fibroid is

Doctors describe fibroids by where they sit, using a numbered system from FIGO (the International Federation of Gynecology and Obstetrics). Two types grow on a stalk:

• Type 7, pedunculated subserosal. The fibroid hangs off the outside surface of the uterus into the pelvis. This is the type this article is about.
• Type 0, pedunculated intracavitary. The fibroid hangs into the inside of the uterus on a stalk. These are usually removed through the cervix with a hysteroscope, which is a different discussion.

Our guide to types of fibroids explains the full system. Depending on their size and position, fibroids on the outside of the uterus can press on the bladder or bowel and cause a feeling of fullness, pressure or pain.

Why doctors were cautious

UFE works by cutting off the blood supply that feeds fibroids. With a fibroid on a stalk, the concern was that the stalk itself might lose blood supply and break down. In theory, that could let the fibroid detach into the abdomen, twist on its stalk, or become infected as it dies, possibly irritating nearby bowel.

The CIRSE 2015 guideline reflects this caution. It lists "pedunculated subserosal fibroids with thin stalks" as a relative contraindication, defining a thin stalk as one at least 50% narrower than the fibroid itself. It also labels this point "controversial (Level 3)", meaning the evidence behind it is limited. In other words, it is a reason for care, not a firm rule.

What the studies found

The review also described the problems that did occur across all the reports it found. One fibroid twisted on its stalk and was removed by laparoscopic surgery. One patient had persistent bleeding and needed a hysterectomy. One serious case involved a fibroid that died and caused a bowel blockage, which required bowel surgery and a hysterectomy. These events are rare, but they are the reason a doctor will look closely at your anatomy before recommending UFE.

This article is part of our Fibroid Treatment Guide.

Stalk width: what is known and what is not

Stalk width is the detail most people ask about, and the honest answer is that there is no proven safe cut-off. The CIRSE definition of a "thin" stalk compares the stalk with the fibroid rather than giving a number in centimeters. In Margau's study, stalks as narrow as 0.8 cm were treated without any fibroid breaking off, but 16 women are far too few to prove that narrow stalks are safe.

What a contrast MRI can show is how wide the stalk is, whether the fibroid and stalk have a good blood supply, and what else sits nearby, such as bowel. CIRSE names contrast MRI as the preferred imaging test before UFE. The decision then rests on the whole picture: how many fibroids you have, which ones cause your symptoms, and what the alternatives would involve.

What success looks like on follow-up imaging

After UFE, a follow-up MRI or ultrasound shows whether the fibroid has lost its blood supply and how much it has shrunk. In Margau's study, imaging about 6 months after treatment showed no pedunculated fibroid with continued blood flow, and the average fibroid was about 39% smaller. In the 2022 review, about 76% of pedunculated fibroids had fully lost their blood supply at roughly 4 months. Put the other way, about 1 in 4 still had some blood flow at that early check.

A fibroid that keeps part of its blood supply may shrink less, and symptoms may improve less. That does not always mean treatment failed, because symptoms are what matter most, but it is useful information if you and your doctor later discuss a repeat procedure or surgery. Shrinkage of about 39% in volume also means the fibroid gets smaller rather than disappearing, so a stalked fibroid that you can feel may still be there, only softer and smaller.

UFE or surgery for a fibroid on a stalk?

A pedunculated fibroid is often one of the easier fibroids to remove surgically, because it is attached by a stalk rather than buried in the muscle wall. That changes the comparison:

• A single stalked fibroid causing your symptoms may be a good target for laparoscopic myomectomy, which removes it completely in one operation and provides tissue to examine. See UFE vs myomectomy.
• Several fibroids, including one on a stalk, may favor UFE, because embolization treats all of them at once without an incision in the uterus.
• A higher surgical risk, such as several previous abdominal operations, may also tip the balance toward UFE.

Whichever way you lean, it helps to have the opinion of both a gynecologist and the specialist who would perform UFE. If you are still sorting out whether UFE fits you in general, see am I a candidate for UFE?

Warning signs after treatment

Cramping, a low fever and nausea in the first few days after UFE are common and expected. With a pedunculated fibroid, you and your doctor should also watch for signs that something is twisting or irritating the bowel. ACOG advises calling your doctor for pain that medication does not help, a fever above 101°F, or nausea and vomiting. Seek urgent care for severe or worsening abdominal pain, a swollen, hard belly, or being unable to pass gas or stool. The fuller picture of risks after UFE is in UFE risks with real numbers.

Questions to ask your doctor

• How wide is the stalk on my MRI, compared with the fibroid?
• Is the pedunculated fibroid actually the one causing my symptoms?
• Would laparoscopic removal be simpler for my anatomy?
• What would make you choose surgery over UFE for me?
• What symptoms after UFE should make me call you right away?

For an overview of the procedure, results and recovery, see our guide to uterine fibroid embolization (UFE). To compare UFE with every other option, see our fibroid treatment guide.

Frequently Asked Questions

Can a pedunculated fibroid fall off after UFE?

That was the original worry. In the small studies published so far, detachment into the abdomen has not been a reported pattern, but serious problems such as twisting of the fibroid and bowel blockage have been reported rarely.

What stalk width is safe for embolization?

No proven cut-off exists. The CIRSE 2015 guideline treats a stalk at least 50% narrower than the fibroid as a reason for caution, and one study treated stalks as narrow as 0.8 cm without detachment in 16 women.

How much does a pedunculated fibroid shrink after UFE?

In a 2022 meta-analysis of 11 studies, the dominant pedunculated fibroid shrank by an average of 38.6% in volume at about 4 months.

Is a fibroid hanging inside the uterus treated the same way?

No. A pedunculated fibroid inside the uterine cavity (FIGO type 0) is usually removed through the cervix with a hysteroscope, which is a different decision from the one discussed here.

Keep Reading

• Uterine Fibroid Embolization (UFE) in New York City
• Am I a Candidate for UFE? A Practical Checklist
• Types of Uterine Fibroids: Submucosal, Intramural, Subserosal and the FIGO System
• UFE vs Myomectomy: Results, Recovery and Fertility Compared
• UFE Risks and Complications: What the Numbers Show
• UFE for Large Fibroids: Realistic Shrinkage and Results
• Fibroid Treatment Guide: every option, compared

Sources

1. Koziarz et al., J Vasc Interv Radiol, 2022 — UAE for pedunculated subserosal fibroids: systematic review and meta-analysis (11 studies)
2. Margau et al., J Vasc Interv Radiol, 2008 — UAE for pedunculated subserosal leiomyomas (16 women)
3. van Overhagen & Reekers, Cardiovasc Intervent Radiol, 2015 — CIRSE Standards of Practice: uterine artery embolization for symptomatic leiomyomata
4. Munro et al., Int J Gynaecol Obstet, 2018 — FIGO systems for abnormal uterine bleeding, including leiomyoma classification
5. ACOG patient FAQ, Uterine Artery Embolization (last reviewed May 2026)

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.