Surgical treatments


Approach Appropriate population Description
Hysterectomy Women who require removal of uterus, who are close to menopause, or who do not desire fertility
  • Definitive therapy
  • Removes entire uterus and therefore prevents fibroid regrowth
  • Loss of fertility
  • Surgical morbidity including post-operative, pain, infection and urinary complications, and/or mortality,
  • Requires hospitalisation and is a costly procedure
Myomectomy Women with visible and/or palpable fibroids
  •  A surgical alternative to treat fibroids in women who wish to preserve their fertility
  • Recurrence of fibroids may occur; a,re-intervention rate of 10% to 25% has been reported
  • Surgical morbidity including post-operative, pain, infection, urinary complications, injury to bladder, bowel, and blood vessels, post-operative adhesions (can cause bladder obstruction and pain), and or/mortality
UAE (Uterine,Artery Embolisation) Women who have small uterine fibroids (<8cm) that are not subserous, submucosal, or pedunculated
  •  Minimally invasive surgical procedure
  • Morbidity including pain, possible, post-embolisation syndrome, possibility of severe complications
  • Impact on fertility is unknown
  • Costly; must be performed by an interventional radiologist
  • Re-intervention rate of 15% to 35%
Myolysis/cryomyolysis Women who do not desire fertility with several, small uterine fibroids
  • Preserves uterus, outpatient surgery
  • Risk of adhesions, less effective for large and multiple fibroids, under treatment or overtreatment, fertility not advised
MRgFUS (Magnetic,Resonance-guided focused Ultrasound Surgery) Women with small uterine fibroids (<8cm)
  •  Incisionless and bloodless (therefore, allows fast return to normal activities)
  • Insufficient data is available regarding the effect of MRgFUS on fertility, likeliness of recurrence of fibroids, and long-term effects
  • Experimental procedure only available at very few centres
  • Costly; must be performed by an interventional radiologist
LUAO (Laparoscopic,Uterine Artery Occlusion) Women with small or large fibroids, subserosal fibroids
  • Requires technical skill 
  • Dependent on fibroid location
  • Recurrence of fibroids may occur
  • Effect on fertility is unclear
  • Data on LUAO is limited, and there is insufficient long-term data available