Uterine fibroid embolization (UFE) and hysterectomy lead to similar quality of life over the long run. In the Dutch EMMY trial, women in both groups reported similar quality of life at 2, 5 and 10 years. The difference is in what you trade. UFE keeps your uterus, means a much shorter hospital stay and a faster return to work, but about a third of women in EMMY eventually had a hysterectomy anyway. Hysterectomy ends fibroid bleeding for good, at the cost of major surgery and a longer recovery.
If you have been told a hysterectomy is your only option, it helps to know what the long-term trials actually found.
Two different approaches
Hysterectomy removes the uterus, so fibroids and fibroid bleeding cannot return, and periods stop. It can be done through the abdomen, laparoscopically, robotically or vaginally. ACOG's 2021 practice bulletin recommends it as a definitive option for women who do not want future pregnancy or do not wish to keep the uterus, after counseling about long-term health risks.
UFE keeps the uterus. Through a small puncture in an artery at the wrist or groin, a doctor blocks the blood vessels feeding the fibroids, which then shrink over the following months. ACOG recommends UFE for patients who want to keep the uterus and are counseled about the limited data on pregnancy afterward. Learn more on our main page about uterine fibroid embolization (UFE).
UFE vs hysterectomy side by side
| Factor | UFE | Hysterectomy |
|---|---|---|
| Uterus kept | Yes | No |
| Incision | Small artery puncture | Abdominal, laparoscopic, robotic or vaginal surgery |
| Median hospital stay (REST trial) | 1 day | 5 days |
| Return to paid work (EMMY trial) | 28.1 days on average | 63.4 days on average |
| Quality of life at 10 years (EMMY) | No difference between groups | No difference between groups |
| Very satisfied or satisfied at 10 years (EMMY) | 78% | 87% |
| Further procedure at 5 years (REST, treatment failure or complications) | 32% | 4% |
| Chance fibroid bleeding returns | Possible | None (uterus removed) |
The figures above come from different trials and populations, so read each row on its own rather than combining them.
The EMMY trial: 2, 5 and 10 years
EMMY randomly assigned 177 women with heavy bleeding from fibroids who were eligible for hysterectomy, at 28 Dutch hospitals between 2002 and 2004, to UFE or hysterectomy. It is the longest randomized comparison available.
- At 2 years, 23.5% of the UFE group had gone on to hysterectomy. In those who kept the uterus, the uterus shrank by about 48% and the dominant fibroid by about 61%.
- At 5 years, 28.4% (23 of 81) had had a hysterectomy. Quality of life did not differ between the groups.
- At 10 years, 35% (28 of 81) had had a hysterectomy, or 31% after a technically successful UFE. Quality of life was stable "without differences between both groups." Satisfaction was 78% after UFE and 87% after hysterectomy.
The authors' bottom line: in about two-thirds of women treated with UFE, a hysterectomy can be avoided. They also wrote, at 2 years, that for women who want certainty that bleeding will stop, hysterectomy remains the treatment of choice. Both statements are true at the same time, and which one matters more depends on you.
Questions about your treatment options? Dr. Fox can help.
Book a ConsultationThis article is part of our Fibroid Treatment Guide.
The REST trial: hospital stay and repeat treatment
The UK REST trial randomized 157 women at 27 centres, two to one, to UFE (106) or surgery (51, of whom 43 had a hysterectomy and 8 a myomectomy).
- Median hospital stay was 1 day after UFE vs 5 days after surgery, and UFE patients returned to work sooner.
- At 1 year, symptom scores were somewhat better after surgery, while general quality of life was the same.
- Major adverse events in the first year were 12% after UFE vs 20% after surgery, a difference that was not statistically significant.
- At 5 years, 32% of the UFE group had needed another intervention for treatment failure or complications, compared with 4% after surgery. Satisfaction was very high in both groups, and costs evened out.
The REST authors summed it up well: the less invasive nature of UFE "needs to be balanced against the need for re-intervention in almost a third of patients. The choice should lie with the informed patient."
Recovery, pain and your hormones
In EMMY, women had less pain in the first 24 hours after UFE than after hysterectomy, and returned to paid work after an average of 28.1 days compared with 63.4 days. A 2014 Cochrane review of 7 randomized trials also found a shorter hospital stay and faster return to usual activities after UFE, and a lower chance of needing a blood transfusion. Minor complications were more common after UFE, while major complications showed no clear difference. Death after UFE is extremely rare. For a day-by-day picture, see our UFE recovery timeline.
Many women ask whether either option brings on menopause early. EMMY measured hormone markers for 2 years. FSH rose in both groups with no significant difference between them, and the authors concluded that both UFE and hysterectomy can affect ovarian reserve, which may lead older women to reach menopause after either treatment. Our article on UFE and early menopause covers age-related risk in more detail.
When hysterectomy may be the better choice
- You want certainty that fibroid bleeding will not return and are done having children
- You have adenomyosis as well as fibroids and pain is a major symptom. In a 2025 Dutch study of 101 women with adenomyosis, hysterectomy improved pain more and satisfaction was 95% vs 73% after UFE
- A fibroid grows quickly, or grows after menopause, or imaging raises concern for cancer, because hysterectomy provides tissue for diagnosis
- You have other uterine or cervical conditions that also call for surgery
- You would rather accept one larger recovery than risk a second procedure
When UFE may be the better choice
- You want to keep your uterus, for any reason
- You want to avoid major surgery and general anesthesia, or have health problems that raise surgical risk
- A shorter hospital stay and quicker return to work matter for your job or family
- You accept a meaningful chance of needing further treatment later
UFE is not appropriate during pregnancy, with an active pelvic infection or with suspected cancer of the uterus or ovaries.
Before you decide
A few questions can help you weigh the two:
- How important is it to me to keep my uterus?
- Could I take 2 months away from work and family duties, or closer to 1?
- How would I feel if I needed a second procedure in a few years?
- Do I have other conditions, such as adenomyosis, that change the picture?
If a hysterectomy has been recommended and you are not sure, it is reasonable to ask whether UFE is an option for your fibroids. ACOG's own bulletin lists both, and a Cochrane review found similar satisfaction at 2 years. Our guide to getting a second opinion before hysterectomy explains what to bring and what to ask. To compare every fibroid treatment in one place, see our fibroid treatment guide.
Frequently Asked Questions
Is UFE as effective as hysterectomy?
Over the long term, quality of life was similar. In the EMMY trial there was no difference between groups at 5 or 10 years, although 35% of UFE patients had a hysterectomy by 10 years.
How much faster is recovery after UFE?
In the EMMY trial, women returned to paid work after an average of 28.1 days following UFE vs 63.4 days after hysterectomy. The REST trial reported a median hospital stay of 1 vs 5 days.
What are the chances I will need a hysterectomy after UFE?
In EMMY, 23.5% of UFE patients had a hysterectomy by 2 years, 28.4% by 5 years and 35% by 10 years. Put the other way, about two-thirds avoided hysterectomy.
Does either option cause early menopause?
In EMMY, hormone markers of ovarian reserve changed after both UFE and hysterectomy, with no significant difference between groups. Older women may reach menopause after either treatment.
Can I choose UFE if my doctor recommended a hysterectomy?
Often, yes. ACOG lists UFE as an option for women who want to keep the uterus. Ask whether your fibroids are suitable and consider a second opinion with a UFE specialist.
Keep Reading
- Uterine Fibroid Embolization (UFE) in New York City
- Told You Need a Hysterectomy for Fibroids? Get a Second Opinion
- UFE vs Myomectomy: Results, Recovery and Fertility Compared
- UFE Success Rate: What 1, 2, 5 and 10-Year Studies Show
- UFE Recovery Day by Day: What to Expect Week by Week
- Will UFE Cause Early Menopause? Ovarian Function and Age
- Fibroid Treatment Guide: every option, compared
Sources
- de Bruijn et al., Am J Obstet Gynecol, 2016 — EMMY trial 10-year results (177 women)
- van der Kooij et al., Am J Obstet Gynecol, 2010 — EMMY trial 5-year results
- Hehenkamp et al., Am J Obstet Gynecol, 2007 — EMMY trial 2-year results
- Volkers et al., Cardiovasc Intervent Radiol, 2006 — EMMY trial pain and return to work
- Hehenkamp et al., Hum Reprod, 2007 — ovarian reserve after UAE vs hysterectomy (EMMY)
- Edwards et al., N Engl J Med, 2007 — REST trial, UAE vs surgery (157 women)
- Moss et al., BJOG, 2011 — REST trial 5-year results
- Gupta et al., Cochrane Database Syst Rev, 2014 — UAE for symptomatic fibroids (7 trials, 793 women)
- de Bruijn et al., Acta Obstet Gynecol Scand, 2025 — QUESTA, UAE vs hysterectomy for adenomyosis (101 women)
- ACOG Practice Bulletin No. 228, Obstet Gynecol, 2021 — Management of symptomatic uterine leiomyomas
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.
