Among the uterus-sparing options listed in published sources are medication, myomectomy, uterine artery embolization, radiofrequency ablation, and endometrial ablation [1][2][3][4]. They do different things. Medication manages symptoms and does not remove fibroids [2][6]. Myomectomy removes fibroids while preserving uterine tissue [3]. Embolization is a minimally invasive treatment used most often for fibroid-related vaginal bleeding [4]. Hysterectomy removes the uterus, ends menstrual periods, and makes pregnancy impossible [5].

Why does hysterectomy appear so often in the numbers?

A national analysis of 271,885 US inpatient fibroid encounters from 2016 through 2022 found that hysterectomy accounted for 73.4% of procedures. Myomectomy accounted for 23.1%, and uterine fibroid embolization accounted for 3.5% [1].

That analysis describes procedures in those inpatient encounters. It does not state which operation is appropriate for an individual patient.

A uterine fibroid, also called a leiomyoma, is muscle and tissue growth that develops in the uterine wall or on the uterus’s surface [2]. Cleveland Clinic lists excessive or painful bleeding during periods, bleeding between periods, lower-abdominal fullness or bloating, frequent urination, pain during sex, low back pain, constipation or rectal pressure, chronic vaginal discharge, difficulty emptying the bladder completely, and increased abdominal distention among fibroid symptoms [2].

Black patients in the national analysis had higher odds of undergoing uterine fibroid embolization rather than hysterectomy compared with white patients. The adjusted odds ratio was 1.64, with a 95% confidence interval of 1.44 to 1.87 [1]. This finding describes procedure use. It does not identify the best treatment for an individual patient.

What should be checked before choosing a procedure?

Cleveland Clinic describes intramural fibroids as embedded in the muscular wall, submucosal fibroids as growing beneath the inner lining, subserosal fibroids as growing beneath the outer surface, and pedunculated fibroids as attached by a stalk or stem [2].

Tests used to find or assess fibroids include ultrasonography, magnetic resonance imaging, computed tomography, hysteroscopy, hysterosalpingography, sonohysterography, and laparoscopy [2]. Tests listed for heavy bleeding include pelvic ultrasound, blood tests, transvaginal ultrasound, MRI, a Pap test, cervical culture, endometrial biopsy, sonohysterogram, and hysteroscopy [2].

Ask which test has been used to assess your fibroids. Ask for the type and location of each fibroid to be written down. Ask which finding supports hysterectomy rather than a uterus-sparing procedure.

If bleeding is part of the reason for surgery, write down the amount and pattern before the appointment. Cleveland Clinic lists periods longer than seven days, soaking a pad or tampon every hour for several hours, needing more than one pad at a time, changing pads during the night, and passing clots the size of a quarter or larger several times a day as signs of heavy bleeding [2]. If you are going through at least two pads or tampons an hour and that continues for two to three consecutive hours, Cleveland Clinic says to seek prompt professional evaluation [2].

What can medication do?

Medication can manage symptoms. It does not remove fibroids. A review of medical treatment found no available option that permanently stops fibroid growth, and reported that symptoms return after effective therapy stops [6].

Tranexamic acid significantly reduced fibroid-associated heavy menstrual bleeding in the reviewed evidence, but it does not treat the fibroid directly, and long-term treatment data do not exist [6]. Cleveland Clinic lists over-the-counter pain medication, iron supplements, birth control options, GnRH agonists, elagolix, and tranexamic acid among medications used for fibroids [2].

Cleveland Clinic states that GnRH agonists shrink fibroids temporarily [2]. The review reports decreased menstrual bleeding, pelvic pain, and leiomyoma size in women treated with elagolix or relugolix [6]. Those findings do not mean that medication removes fibroids [6].

The direct evidence for contraceptive hormones in fibroid-related heavy menstrual bleeding is limited. A review of progestogen treatment concluded that evidence is lacking for progestogens in this setting [6]. Data are also sparse for the levonorgestrel intrauterine system, although one trial found it more effective at reducing menstrual bleeding than a combined oral contraceptive [6].

What does a myomectomy do?

A myomectomy removes uterine fibroids while keeping uterine tissue, so pregnancy remains possible [3]. Cleveland Clinic lists hysteroscopic, laparoscopic or robotic, and open abdominal approaches [3].

Recovery varies by approach. Cleveland Clinic reports a matter of days after hysteroscopic myomectomy, about two to four weeks after laparoscopic myomectomy, and up to six weeks at home after an open myomectomy [3].

Fibroids can appear again after myomectomy. Cleveland Clinic states that the risk of developing more later is higher for patients below age 40 who already have several fibroids [3]. The supplied source does not give one recurrence percentage for every type of myomectomy or every patient.

Listed risks include bleeding, infection, blood clots, damage to nearby organs, reaction to anesthesia, and an increased chance of needing a cesarean delivery [3]. Ask which risks apply to the approach being discussed.

What does uterine artery embolization do?

Uterine artery embolization is a minimally invasive treatment used most often for fibroid-related vaginal bleeding [4]. It works through a tiny puncture and is less invasive than myomectomy or hysterectomy [4].

Cleveland Clinic reports that as many as 90% of patients are back to normal activities inside 10 days, with most people resuming activity in the first one to two weeks [4]. The same source reports that 32% of people had fibroid symptoms five years after the procedure [4].

Menstrual cycles shut down permanently after the procedure in about 1% to 5% of people, according to Cleveland Clinic [4]. Uterine artery embolization should not be performed in someone with a pelvic infection or an allergic reaction to contrast dyes [4].

Ask how the procedure relates to your symptoms and fibroid findings. Ask what recovery window applies to your work and home responsibilities. Ask what published information applies to future symptoms.

What about radiofrequency ablation and other procedures?

Radiofrequency ablation and endometrial ablation appear in published treatment lists for fibroids and heavy bleeding alongside myomectomy, embolization, and hysterectomy [2]. The supplied facts do not provide recovery windows or recurrence figures for those procedures.

Ask what the procedure does to the fibroid, what it does to bleeding, whether the uterus remains, what recovery involves, and what published information exists about future symptoms. The supplied facts do not state whether endometrial ablation is appropriate for a particular fibroid type or whether it preserves the possibility of pregnancy [2].

What does hysterectomy change?

A hysterectomy is surgery that removes the uterus and, most likely, the cervix [5]. Afterward, pregnancy is not possible and menstrual periods stop [5].

A total hysterectomy removes the uterus and cervix. A supracervical hysterectomy removes the upper part of the uterus and leaves the cervix. A total hysterectomy with bilateral salpingo-oophorectomy also removes the fallopian tubes and ovaries, which triggers immediate menopause. A radical hysterectomy also removes the upper vagina and surrounding tissue and is typically used for cancer [5].

The ovaries are not always removed. Whether they are removed depends on the type of surgery and the reason for it [5]. Recovery generally takes four to six weeks. Vaginal and laparoscopic routes tend to heal faster than an abdominal operation [5].

What questions should you bring to the appointment?

Use this checklist before agreeing to a hysterectomy.

  • What type of fibroids do I have, and where are they located? [2]
  • Which imaging test supports the recommendation for hysterectomy? [2]
  • What symptom is the surgery intended to treat?
  • Is hysteroscopic, laparoscopic, robotic, or open myomectomy an option to discuss? [3]
  • If myomectomy is not an option, what finding makes it unsuitable?
  • Is uterine artery embolization an option to discuss for my symptoms and fibroid findings? [4]
  • What recovery window applies to each procedure being discussed? [3][4][5]
  • What published recurrence or future-symptom information applies to each option? [3][4]
  • Will the surgery remove my cervix? [5]
  • Will my ovaries be removed? If yes, why? [5]
  • If my ovaries are removed, what does immediate menopause mean for me? [5]
  • Does this option preserve the possibility of pregnancy? [3][5]
  • If I choose medication, what symptom is it meant to manage, and what happens when treatment stops? [2][6]
  • If I am told to wait, what bleeding change should lead me to seek prompt professional evaluation? [2]

Ask: “What uterus-sparing options were considered, and why do you think they do not fit my findings?”

What to do next

  1. Write down your bleeding pattern, including the heaviest hour, the number of pads or tampons used, clot size, bleeding between periods, and bleeding after sex.
  2. Bring the checklist to your appointment and mark each question that remains unanswered.
  3. Ask which imaging test supports the proposed surgery and whether another listed test is needed [2].
  4. Say: “I understand hysterectomy is an option. Before I decide, I want to know whether myomectomy or uterine artery embolization fits my findings.”
  5. Ask whether medication could manage the symptom while you consider a procedure, and what medication cannot do [2][6].
  6. Ask whether the cervix and ovaries would be removed, and what that would mean for periods, pregnancy, and menopause [5].
  7. If you are going through at least two pads or tampons an hour for two to three consecutive hours, seek prompt professional evaluation rather than waiting for a routine appointment [2].

Related on Ruby: fibroid treatment without surgery and fibroid treatment options

Sources

  1. Elhakim 2025, Disparities in utilization of uterine fibroid embolization, JAMA Network Open, PMC. https://pmc.ncbi.nlm.nih.gov/articles/PMC12441870/
  2. Cleveland Clinic, Uterine fibroids. https://my.clevelandclinic.org/health/diseases/9130-uterine-fibroids
  3. Cleveland Clinic, Myomectomy. https://my.clevelandclinic.org/health/treatments/15448-myomectomy
  4. Cleveland Clinic, Uterine artery embolization. https://my.clevelandclinic.org/health/treatments/17954-uterine-artery-embolization
  5. Cleveland Clinic, Hysterectomy. https://my.clevelandclinic.org/health/treatments/4852-hysterectomy
  6. Barseghyan 2023, The efficacy of medical management of leiomyoma-associated heavy menstrual bleeding, F&S Reports, PMC. https://pmc.ncbi.nlm.nih.gov/articles/PMC10958631/