UFE vs Myomectomy: What the FEMME Trial Shows

Quick Answer

Both keep the uterus. In the FEMME trial, myomectomy gave somewhat better quality of life at 2 years, but the difference was no longer significant at 4 years. UFE is less invasive with a shorter stay; myomectomy has a lower chance of repeat treatment and stronger, though still limited, evidence for pregnancy.

Both uterine fibroid embolization (UFE) and myomectomy treat fibroids while keeping your uterus, and both work. The largest head-to-head trial, FEMME, found that myomectomy gave slightly better quality-of-life scores at 2 years, but the gap had narrowed and was no longer statistically significant by 4 years. UFE is less invasive with a shorter hospital stay, while myomectomy has a lower chance of needing another procedure and somewhat stronger evidence if pregnancy is your priority.

Neither option is right for everyone. Here is what the trials actually show, side by side, so you can weigh them against your own goals.

How the two treatments work

Myomectomy is surgery to remove the fibroids themselves and repair the uterine wall. Depending on the size, number and location of your fibroids, it may be done through an abdominal incision, through small laparoscopic or robotic incisions, or through the cervix for fibroids inside the cavity. ACOG's 2021 practice bulletin recommends myomectomy for patients who want to keep the uterus or have a future pregnancy, and who are counseled about the risk of recurrence. It also says a minimally invasive approach should be considered when feasible.

UFE (also called uterine artery embolization, UAE) leaves the fibroids in place and cuts off their blood supply. A doctor guides a thin catheter through an artery in the wrist or groin into both uterine arteries and releases tiny particles. The fibroids shrink and soften over the following months. ACOG recommends UFE for patients who want to keep the uterus and who are counseled about the limited data on pregnancy afterward. Our main page on uterine fibroid embolization (UFE) covers the procedure in detail.

UFE vs myomectomy side by side

Factor	UFE	Myomectomy
Uterus kept	Yes	Yes
Incision	Small puncture in wrist or groin artery	Abdominal, laparoscopic or robotic incisions, or through the cervix
Fibroids	All treated at once, left in place to shrink	Removed; tissue can be examined
Quality of life at 2 years (FEMME)	80.0 points	84.6 points (adjusted difference 8.0 in favor of myomectomy)
Quality of life at 4 years (FEMME)	Gap narrowed to 5.0 points	No longer a statistically significant difference
Complications (FEMME)	24%	29%
Further treatment	More likely (Cochrane review)	Less likely, but new fibroids can grow
Pregnancy evidence	Limited; small studies mixed	Stronger in one small trial; still limited
Hospital stay and recovery	Shorter (Cochrane review)	Longer, varies with the surgical approach

What the FEMME trial found

FEMME is the largest randomized trial to compare these two treatments directly. It enrolled 254 women with symptomatic fibroids at 29 UK hospitals and assigned 127 to each treatment. The results were published in the New England Journal of Medicine in 2020.

At 2 years, the average fibroid quality-of-life score (UFS-QOL) was 84.6 after myomectomy and 80.0 after UFE. After adjustment, myomectomy was ahead by 8.0 points, a statistically significant difference.
Complications occurred in 29% of the myomectomy group and 24% of the UFE group.
At 4 years, the gap had narrowed to 5.0 points and was no longer statistically significant. There was no difference in bleeding scores, in rates of stopped periods or heavy bleeding, or in ovarian reserve hormones.

The fair summary is that myomectomy had the edge early, and both groups were doing similarly well by 4 years. Keep in mind that about one in five women did not provide the main 2-year data, and not everyone received the treatment they were assigned.

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This article is part of our Fibroid Treatment Guide.

Repeat treatment

This is UFE's main trade-off. A 2014 Cochrane review pooled 7 randomized trials (793 women) that compared UFE with hysterectomy, myomectomy or both. Satisfaction at 2 years was similar. But further procedures were more common after UFE. The reviewers estimated that if 7% of women need further surgery within two years of hysterectomy or myomectomy, between 15% and 32% would need it within two years of UFE. Major complications showed no clear difference, minor complications were more common with UFE, and blood transfusion was less likely with UFE.

Myomectomy is not a one-time answer either. ACOG asks doctors to counsel myomectomy patients about the risk of recurrence, because new fibroids can grow in a uterus that is kept. For more on how long UFE results last, see our article on UFE success rates.

If you want to get pregnant

This is where the choice matters most, and where the evidence is weakest for both. Here is what exists:

Mara 2008: a randomized trial of 121 women with reproductive plans and intramural fibroids larger than 4 cm (58 UFE, 63 myomectomy), followed for about 2 years. Myomectomy produced 33 pregnancies and 19 deliveries, compared with 17 pregnancies and 5 deliveries after UFE. The authors concluded that myomectomy "appears to have superior reproductive outcomes in the first 2 years."
Cochrane 2014: found "some indication" that UFE may be associated with less favorable fertility outcomes than myomectomy, but rated the evidence very low quality, from a subgroup of a single study.
FEMME at 4 years: 12 women became pregnant after UFE and 6 after myomectomy, with 7 and 5 live births. This sounds like it favors UFE, but the trial was not designed to study fertility, the numbers are small, and the statistical range was wide enough to be consistent with no real difference. The study team concluded there was no evidence that either treatment is unsuitable for women wanting pregnancy, but more research is needed.

On balance, guidelines treat myomectomy as the standard choice if pregnancy is a near-term goal and the fibroids can be removed safely. UFE may still be reasonable for some women, for example those with many fibroids or several prior surgeries, after a frank discussion. Our article on pregnancy after UFE goes deeper.

When myomectomy may be the better choice

You hope to get pregnant in the next few years and your fibroids can be removed safely
You have one or a few fibroids in accessible spots
A fibroid sits mostly inside the uterine cavity, where hysteroscopic removal through the cervix may be simpler
A fibroid hangs on a thin stalk
You want to lower your chance of a second procedure
Imaging raises any question that tissue should be examined

When UFE may be the better choice

You have many fibroids spread through the uterus
You want to avoid surgery, general anesthesia or a longer hospital stay
You have had previous abdominal or pelvic surgery, or medical reasons that raise surgical risk
Pregnancy is not a goal, or you accept the limited data after counseling
Fibroid regrowth after an earlier myomectomy

UFE is not a good fit during pregnancy, with an active pelvic infection, or with suspected cancer of the uterus or ovaries. Fibroids that grow quickly, or that grow after menopause, need evaluation before any treatment.

Making the decision

It may help to rank what matters most to you: the fastest recovery, the lowest chance of another procedure, or the strongest odds of a future pregnancy. Each treatment wins on a different one of these.

Bring your imaging, ideally an MRI, to both a gynecologic surgeon and a UFE specialist. Ask each one how they would treat your specific fibroids, what recovery looks like and how likely you are to need more treatment. The right answer depends on your goals for pregnancy, your fibroid map and how much recovery time you can manage. To see every option in one place, visit our fibroid treatment guide.

Frequently Asked Questions

Is myomectomy better than UFE?

Neither is better for everyone. In the FEMME trial, myomectomy had higher quality-of-life scores at 2 years, but the difference was no longer statistically significant at 4 years. UFE is less invasive, while myomectomy is less likely to need a repeat procedure.

Which is better if I want to get pregnant?

Myomectomy is usually preferred when pregnancy is a near-term goal. A 2008 randomized trial found more pregnancies and deliveries after myomectomy, though overall fertility evidence for both treatments is limited.

Can fibroids come back after either treatment?

Yes. New fibroids can grow after myomectomy, and ACOG advises counseling about recurrence. After UFE, further procedures are more common than after surgery, according to a Cochrane review.

Which has the faster recovery?

A Cochrane review of 7 randomized trials found a shorter hospital stay and faster return to usual activities after UFE than after surgery.

Can I have UFE after a previous myomectomy?

Often, yes. A 2025 French study reported pregnancies after UFE in some women with complex surgical histories, including prior myomectomy. Your doctor will review your imaging and surgical history.

Keep Reading

Sources

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.

UFE vs Myomectomy: Results, Recovery and Fertility Compared