The options at a glance

These options keep the uterus and do not remove fibroids with surgery. Some are still procedures. Your own doctor can tell you which ones fit your fibroids.

Fibroid treatment without surgery, at a glance. The options are listed from least to most involved. None is ranked as best.

Fibroid treatment without surgery, at a glance
OptionWhat it isUterus keptTypical recoveryWho it may suitSource
Monitoring (watchful waiting)Regular check-ins, and sometimes ultrasound, to follow symptoms and fibroid size.YesNoneFibroids that cause no symptoms or mild ones, or people near menopauseMedlinePlus2
MedicinesTablets, a hormone IUD or other medicines that ease bleeding or pain, or shrink fibroids for a time.YesNone, but symptoms can return when you stopHeavy bleeding as the main problem, or a bridge before a procedureNICHD3
Uterine fibroid embolization (UFE)A thin catheter in an artery delivers tiny particles that cut off the fibroids’ blood supply, so they shrink.YesAbout 1 to 2 weeks to return to normal activities (RadiologyInfo)Symptoms from one or many fibroids, when you want to keep the uterusRadiologyInfo4
MR-guided focused ultrasound (MRgFUS)Ultrasound energy, aimed with MRI, heats and destroys fibroid tissue through the skin.YesUsually a day or twoFewer, smaller fibroids; not many or very large onesRadiologyInfo4
Radiofrequency ablation (RFA)It uses heat from a needle-like probe to destroy fibroid tissue. Your doctor can explain which approach would apply.YesA few days in published studiesIn a review of laparoscopic RFA, the authors described it as treating small fibroids that are not on a stalk.Review and trial5,6

Monitoring (watchful waiting)

Fibroids are very common. In one ultrasound study, most women developed fibroids by age 50, and many had never been diagnosed7. If your fibroids cause no symptoms, you may not need treatment2.

Watchful waiting means follow-up pelvic exams or ultrasounds to see whether the fibroids grow2. Fibroids often shrink and stop causing symptoms after menopause2. Monitoring is still a plan: ask how often you should be checked, and which changes in bleeding, pressure or pain should bring you back sooner.

Medicines

Medicines mostly treat symptoms, especially heavy bleeding. They are not a one-time fix. Once you stop the treatment, fibroids can grow back and symptoms can return3.

  • Tranexamic acid helps blood clot. It is taken only during your period, for up to 5 days a cycle, to reduce blood loss8.
  • Hormonal birth control can help heavy bleeding and painful periods. Sometimes it can make fibroids grow larger3.
  • A progestin IUD reduces heavy, painful bleeding but does not treat the fibroids themselves. It is not recommended for very large fibroids that block the inside of the uterus3.
  • GnRH agonists shrink fibroids. They cause menopause-like side effects and bone loss, so they are used for a short time, often before surgery3.
  • Relugolix and elagolix combination pills block the hormones that feed fibroids, with low-dose hormones added back. In randomized trials, about 7 in 10 people taking them met the trials’ goal for less bleeding, compared with about 1 to 2 in 10 taking a placebo9,10.

Ask what each medicine is meant to do, how long you can take it, and what happens when you stop. Read fibroid medication questions for more.

Uterine fibroid embolization (UFE)

UFE is done by an interventional radiologist. The skin is numbed and you get medicine through an IV to relax, so UFE does not need general anesthesia4. A thin catheter travels through the arteries to the uterus, and tiny particles block the blood supply to the fibroids, so they shrink2.

You may go home the same day, or the next day if you stay overnight for pain control. You should be able to return to normal activities within about 1 to 2 weeks4.

The tradeoff is a higher chance of more treatment later. In the REST trial, about 32% of women treated with UAE had another procedure for failure or complications within 5 years11. In the EMMY trial, about 35% of UAE-treated women had a hysterectomy within about 10 years12. If a future pregnancy is your main goal, ask your doctor how UFE and myomectomy compare13. Read what UFE is and UFE success and regrowth.

MR-guided focused ultrasound (MRgFUS)

MRgFUS uses MRI to aim ultrasound energy at a fibroid and heat it, without damaging the tissue around it4. It is done as an outpatient in an MRI room. You get light sedation, so plan for a ride home. Most people resume normal daily activities within a day or two4.

It is not a good fit for everyone. People with many fibroids or very large fibroids, and people with many scars on the belly, may not be good candidates4. The 2023 ACR review covered newer evidence on MRgFUS1. Ask how many of these procedures the team does, and what results they track.

Radiofrequency ablation (RFA)

RFA uses heat to destroy fibroid tissue. A needle is placed into the fibroid with ultrasound guidance2. There are two ways to reach the fibroid.

  • Laparoscopic RFA goes through small cuts in the belly. In a 2019 review of 8 studies (581 patients), people missed about 4 days of work on average, and about 4 in 100 had another procedure during up to 3 years. The authors described it as a way to treat small fibroids that are not on a stalk5.
  • Transcervical RFA. Ask your doctor whether transcervical RFA is an option for your fibroids.

Pregnancy after RFA is still being studied. In one ongoing study, 22 pregnancies after laparoscopic RFA led to 11 live births, and miscarriage was more common than expected after both RFA and myomectomy14. Ask your doctor what is known for your situation.

Not surgery, but still a procedure

UFE, MRgFUS and RFA avoid a large cut, but each is still a procedure, with sedation or anesthesia, possible complications and follow-up. Laparoscopic RFA uses small cuts in the belly, so some doctors count it as surgery. Hysteroscopic myomectomy removes fibroids that bulge into the uterine cavity, using an instrument passed through the vagina and cervix17,20, but it is surgery.

Endometrial ablation treats the lining of the uterus to lower heavy bleeding. Bleeding is usually reduced to normal or lighter levels, not stopped19. Ask how it would affect a future pregnancy before you choose it.

Ask each doctor the same questions: what is done, what kind of anesthesia, how long recovery takes, and what happens if symptoms come back.

If surgery is on the table

Some people end up weighing surgery, and that is a reasonable thing to discuss. The main categories are:

  • Myomectomy removes the fibroids and keeps the uterus. New fibroids can grow afterward17.
  • Hysteroscopic myomectomy removes fibroids that bulge into the uterine cavity, using an instrument passed through the vagina and cervix17,20.
  • Hysterectomy removes the uterus, so pregnancy is no longer possible18.
  • Endometrial ablation treats the lining of the uterus to lower heavy bleeding. Bleeding is usually reduced to normal or lighter levels, not stopped19.

Read UFE vs myomectomy and UFE vs hysterectomy for questions to ask about each, or compare all fibroid treatments, including surgery, side by side.

Define what you are hoping to avoid

Before comparing options, name the concern: avoiding uterus removal, avoiding major surgery, preserving future pregnancy options, reducing recovery time, controlling bleeding without a procedure, or simply understanding all options.

Questions to ask

  • When I say “without surgery,” what options are we actually talking about?
  • Am I asking about alternatives to hysterectomy, fewer incisions, uterus preservation, shorter recovery, or no procedure at all?
  • What tradeoffs come with each meaning?

Ask about categories, not promises

Possible discussions may include watchful waiting, medication, UFE/UAE, MRgFUS, ablation-focused procedures, myomectomy routes, or other clinician-directed options. Some are procedures even if they are not open surgery.

Questions to ask

  • Which options are medication-only, which are minimally invasive procedures, and which are surgery?
  • Which options address bleeding, bulk/pressure symptoms, pain, or fertility questions?
  • What imaging, labs, or specialist input is needed before any of these can be discussed seriously?

Ask when urgency changes the conversation

Severe bleeding, fainting, pregnancy-related symptoms, fever, post-procedure symptoms, kidney obstruction language, or postmenopausal bleeding may require prompt clinician attention rather than routine decision-prep browsing.

Questions to ask

  • Which symptoms should make me contact you promptly or seek urgent care?
  • If anemia or bleeding is significant, what should be handled before comparing longer-term options?
  • What should I not wait on?

Start with the problem you are trying to solve

A useful fibroid visit often starts with the symptom or goal, not the procedure name. Patients commonly ask whether the first priority is heavy bleeding or anemia, pelvic pressure, urinary or bowel symptoms, pain, future pregnancy, uterus preservation, recovery time, quality of life, or uncertainty about report terms.

Questions to ask

  • What problem are we trying to solve first?
  • Which symptoms may be related to fibroids, and which could have other causes?
  • What information is still missing before we compare options?

Map options without ranking them

Common categories include watchful waiting or monitoring, medications for bleeding or symptoms, UFE/UAE, myomectomy, hysterectomy, radiofrequency or other ablation-focused procedures, and MR-guided focused ultrasound. Which options are relevant depends on symptoms, goals, imaging, medical history, pregnancy considerations, and clinician evaluation.

Questions to ask

  • Which options are reasonable to discuss for my symptoms and goals?
  • Which options are intended to control bleeding, reduce bulk symptoms, preserve the uterus, or provide definitive treatment?
  • Which specialist should help answer each part of the decision?

Bring imaging and labs to the clinician

ProcedurePath does not read reports. Bring official reports and images to your clinician and ask how fibroid size, number, location, cavity distortion, adenomyosis, anemia labs, and prior treatment history change the conversation.

Questions to ask

  • How do size, number, location, or cavity distortion affect what we should discuss?
  • Do I need MRI, sonohysterography, hysteroscopy, labs, or another specialist before deciding?
  • If fertility or future pregnancy matters, who should be part of the discussion?

Common questions

What is UFE?

A procedure in which tiny particles are placed through a catheter to block blood flow to the fibroids1.

What is MR-guided focused ultrasound?

It uses focused sound waves, guided by MRI, to heat and destroy fibroid tissue. The ACR 2023 update reviewed newer evidence on it1.

What is radiofrequency ablation for fibroids?

It uses heat from a needle-like probe to destroy fibroid tissue2. Your doctor can explain which approach would apply.

Do medicines make fibroids go away?

Most medicines ease symptoms rather than remove fibroids. GnRH agonists shrink fibroids for a time, but fibroids can grow back and symptoms can return when you stop3.

Will I need more treatment later?

In the REST trial, 9% of UFE patients needed repeat embolization or hysterectomy in the first year15. In the EMMY trial, about 35% of UAE-treated women had a hysterectomy within about 10 years12.

Is waiting okay?

For fibroids without symptoms, treatment is often not needed7,16.

Do all fibroids need treatment?

No. Many fibroids are never diagnosed7. Guidelines focus on treatment of symptomatic fibroids16.

What are the main types of treatment?

Medicines, minimally invasive procedures such as UFE and MR-guided focused ultrasound, and fibroid surgery options ranging from laparoscopic myomectomy to hysterectomy1,17.

Is hysterectomy the only way to treat fibroids?

No. UFE, MRgFUS, and RFA are fibroid treatments that keep the uterus. Which one fits depends on your symptoms, where your fibroids are, and whether you hope to be pregnant later, so talk with your doctor16.

Can I see more than one specialist?

Yes. Treatments are offered by gynecologists and by interventional radiologists, and the ACR criteria were written by a panel that included both1.

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Sources

  1. ACR Appropriateness Criteria, fibroids, 2023 (PMID 38823944) ↩︎
  2. MedlinePlus, uterine fibroids ↩︎
  3. NICHD, medication-related fibroid treatments ↩︎
  4. RadiologyInfo, uterine fibroid treatment ↩︎
  5. Laparoscopic RFA meta-analysis, 2019 (PMID 30253997) ↩︎
  6. Transcervical RFA, SONATA US cohort (PMID 31308763) ↩︎
  7. Baird et al., 2003 (PMID 12548202) ↩︎
  8. MedlinePlus, tranexamic acid ↩︎
  9. Relugolix combination therapy trials (PMID 33596357) ↩︎
  10. Elagolix trials (PMID 31971678) ↩︎
  11. REST trial, 5-year results (PMID 21481151) ↩︎
  12. EMMY trial, 10-year results (PMID 27393268) ↩︎
  13. Mara 2008, UFE compared with myomectomy (PMID 17943348) ↩︎
  14. ULTRA study, pregnancy after RFA (PMID 38422502) ↩︎
  15. REST trial, 1-year results (PMID 17251532) ↩︎
  16. ACOG Practice Bulletin 228 (PMID 34011888) ↩︎
  17. ACOG, uterine fibroids FAQ ↩︎
  18. ACOG, hysterectomy FAQ ↩︎
  19. ACOG, endometrial ablation FAQ ↩︎
  20. ACOG, hysteroscopy FAQ ↩︎