UFE vs Radiofrequency Ablation (Acessa, Sonata)

Quick Answer

Radiofrequency ablation (Sonata through the cervix, Acessa through small incisions) destroys fibroids one at a time and has a quick recovery, but its evidence is mostly from single-arm studies. UFE treats all fibroids at once through an artery and has randomized trials with up to 10 years of follow-up, with a higher recovery burden in the first week.

Radiofrequency ablation (RFA) and uterine fibroid embolization (UFE) both treat fibroids without removing the uterus, but they work differently. RFA heats and destroys individual fibroids one at a time, either through the cervix (the Sonata system) or through small abdominal incisions (the Acessa system). UFE blocks the blood supply to all fibroids at once through a small artery puncture. UFE has the longer track record, with randomized trials and 10-year data. RFA's evidence comes mostly from single-arm studies, but it may suit women with a few fibroids of a suitable size and location.

Because the two have rarely been compared head to head, choosing between them is mostly about your fibroid map, your goals and your doctor's experience.

How each treatment works

Radiofrequency ablation places a small probe into each fibroid, guided by ultrasound, and uses radiofrequency energy to heat and destroy the tissue. The body then gradually reabsorbs it and the fibroid shrinks. There are two main approaches in the US:

Transcervical RFA (Sonata): the device goes through the vagina and cervix into the uterus, so there is no skin incision. The FDA cleared Sonata in August 2018.
Laparoscopic RFA (Acessa): the surgeon works through small incisions in the abdomen, using a camera and an ultrasound probe to find and treat each fibroid.

UFE uses a thin catheter, entered through an artery at the wrist or groin, to deliver tiny particles into both uterine arteries. The fibroids lose their blood supply and shrink over months. It treats every fibroid in the uterus during one procedure, without needing to find each one. Our main page on uterine fibroid embolization (UFE) explains the procedure in full.

UFE vs RFA side by side

Factor	UFE	Transcervical RFA (Sonata)	Laparoscopic RFA (Acessa)
Route	Small artery puncture at wrist or groin	Through the cervix, no incision	Small abdominal incisions
Fibroids treated	All at once, via blood supply	Each targeted one by one	Each targeted one by one
Main evidence	Several randomized trials, up to 10-year follow-up	Single-arm study of 147 women, 3-year follow-up	135-woman 3-year study; meta-analysis of 8 studies
Further procedures	15% to 32% within 2 years (Cochrane estimate); 28.4% hysterectomy by 5 years (EMMY)	About 8% to 9% surgical reintervention at 3 years	11% at 3 years; 4.4% pooled across studies
Return to activity	Median 8 days off work in one trial	More than half within 1 day	About 4 days of missed work on average
ACOG 2021	Recommended for those who want to keep the uterus, with counseling	The Level B statement names the laparoscopic approach	Level B: "can be considered," with counseling
Pregnancy data	Limited	Limited	Limited; maker's labeling says not recommended if planning pregnancy

These numbers come from very different study designs and patient groups, so they cannot be compared directly. A single-arm study of carefully selected patients often looks better than a randomized trial of a broader group.

What the RFA research shows

Sonata. The SONATA study treated 147 women in the US and Mexico, with no comparison group, and was funded by the manufacturer. At 12 months, 64.8% had at least a 50% drop in menstrual bleeding and 95.1% had some reduction. The largest fibroid shrank by an average of 62.4%, more than half of women were back to normal activity within a day, and 99.3% had avoided further surgery. At 3 years, about 8% to 9% had needed surgery for heavy bleeding, and 94% were satisfied.

Acessa. In a 3-year study of 135 women, 11% had needed another procedure, and symptom severity scores fell by 32.6 points. A 2019 meta-analysis of 8 studies (581 patients) found a pooled reintervention rate of about 4.4%, adverse events in about 1.8%, and an average of about 4 days of missed work. ACOG's 2021 bulletin says laparoscopic RFA "can be considered" as a minimally invasive option for women who want to keep the uterus and are counseled about the limited data on pregnancy (a Level B recommendation).

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This article is part of our Fibroid Treatment Guide.

What the UFE research shows

UFE has been tested against surgery in several randomized trials. A 2014 Cochrane review of 7 trials (793 women) found satisfaction at 2 years similar to surgery, but a higher chance of further procedures. In the 10-year EMMY trial, about two-thirds of women avoided hysterectomy, and quality of life matched the hysterectomy group. The large US FIBROID Registry (2,112 eligible patients) found symptom and quality-of-life scores improved by about 41 points at 3 years. For the full numbers, see our article on UFE success rates.

The trade-off is recovery. Cramping and pain in the first days after UFE are common. In the FIRSTT trial, women took a median of 8 days off work after UFE, and 75% used prescription opioid pain medicine at home.

Insurance coverage

Coverage depends on your plan. As one example, Aetna's fibroid policy (reviewed April 2026) considers both UFE and radiofrequency ablation, including laparoscopic and transcervical approaches, medically necessary as alternatives to hysterectomy or myomectomy when fibroid symptoms persist. Other insurers set their own rules, so check your plan before scheduling. Our guide to insurance coverage for UFE explains prior authorization and appeals.

When RFA may be the better choice

You have a small number of fibroids of a size and location your doctor can reach with the device
You want the shortest possible recovery, and the fibroids are suited to the transcervical approach
You cannot have X-ray contrast dye, or have kidney problems or a bleeding disorder that make an artery procedure riskier (CIRSE 2015 lists these as relative reasons to avoid UFE)
A fibroid shares its blood supply with an ovary in a way that makes embolization less suitable

When UFE may be the better choice

You have many fibroids or a large, diffusely enlarged uterus
You want the option with the longest follow-up and randomized trial data
Your fibroids are hard to reach from inside the uterus or by laparoscopy
You want to avoid surgical incisions

Neither treatment should be done during pregnancy or with suspected cancer. If you hope to become pregnant, discuss it before choosing either one, because the data for both are limited. Myomectomy is often the first option to consider; our UFE vs myomectomy comparison explains why. To see every treatment side by side, visit our fibroid treatment guide.

Questions to ask your doctor

How many fibroids do I have, where are they, and can each one be reached with RFA?
Do you perform RFA, UFE or both, and how many have you done?
Which approach would you choose for my imaging, and why?
What is my realistic chance of needing another procedure?
How much time off work should I plan for?
Will my insurance cover the option you recommend?

A doctor who offers only one of these treatments may naturally favor it. Hearing from both a gynecologist and an interventional specialist is a reasonable way to get a balanced view.

Frequently Asked Questions

Is radiofrequency ablation better than UFE?

Neither has been shown to be better in large head-to-head trials. RFA may suit a few accessible fibroids and offers a fast recovery, while UFE treats all fibroids at once and has longer-term randomized trial data.

What is the difference between Sonata and Acessa?

Both use radiofrequency energy to destroy fibroids. Sonata reaches them through the cervix with no incision; Acessa is laparoscopic, done through small abdominal incisions.

How long does recovery take after RFA?

In the SONATA study, more than half of women returned to normal activity within a day. A meta-analysis of laparoscopic RFA found about 4 days of missed work on average.

Can I get pregnant after RFA or UFE?

Data are limited for both. ACOG asks that patients be counseled about limited pregnancy data for laparoscopic RFA and for UFE, and Acessa's maker states it is not recommended for women planning a future pregnancy.

Does insurance cover RFA for fibroids?

Some plans do. Aetna's 2026 policy, for example, considers laparoscopic and transcervical RFA medically necessary for persistent fibroid symptoms. Check your own plan.

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 Radiofrequency Ablation: Sonata, Acessa and Embolization Compared