Fibroid treatment options at a glance
The choice among fibroid treatment options depends on your own wishes and on the size and location of the fibroids (ACOG). Treatment is not always needed. Fibroids that cause no symptoms, are small, or occur in a woman nearing menopause often do not require it. The options below run from watching and waiting to removal of the uterus, and they differ in how invasive they are, how long recovery takes, whether you keep your uterus and how likely symptoms are to return.
Watchful waiting
Many fibroids cause no symptoms and need no treatment. A doctor may suggest scans from time to time and nothing more. Fibroids often shrink when a woman enters menopause, when estrogen levels fall (ACOG). Watching suits mild symptoms. It means keeping your appointments and reporting any change in bleeding or pain.
Medication
Medicines can ease the bleeding and pain that fibroids cause, but they do not remove the fibroids. Birth control pills and other hormonal methods are often used for heavy or painful periods, and they may let fibroids grow slightly. Tranexamic acid reduces the blood lost in a period. GnRH agonists stop periods and shrink fibroids, but they are typically used for less than 6 months without add-back therapy because of side effects such as bone loss, and fibroids usually return to their previous size when the medicine stops (ACOG). Medication therefore often bridges to menopause or to another treatment.
HIFU (focused ultrasound)
Podo Women's Clinic treats uterine fibroids with ultrasound-guided HIFU (high-intensity focused ultrasound) using the HIFUNIT9000 system. HIFU treats the fibroid through the skin of the abdomen, without an incision. The uterus is not removed; HIFU treats the fibroid tissue and leaves the uterus in place. Suitability depends on the size, number and position of the fibroids, and the treated fibroid shrinks gradually rather than disappearing.
HIFU candidates are chosen on a scan. HIFU is offered for fibroids up to about 12 cm in size and up to 12 fibroids in number. Subserosal fibroids that project outward from the surface of the uterus (pedunculated subserosal fibroids) are not treated with HIFU. Before treatment, the size, type and location of each fibroid are assessed by ultrasound to decide whether HIFU is suitable.
Evidence for focused ultrasound is newer than for surgery. ACOG says of MRI-guided ultrasound surgery that more treatments may be needed afterward and that more research is needed to say whether it is effective. NICE found the short-term evidence adequate but noted that further treatment may be required, that the effect on later pregnancy is uncertain and that patients should be told about the risk of skin burns (NICE).
HIFU side effects and risks, including skin burns and the chance of repeat treatment, are described with published figures in the safety guide.
Uterine fibroid embolization
In uterine artery embolization (UAE), tiny particles are injected into the blood vessels that lead to the uterus. They cut off the blood flow to the fibroids and make them shrink. It can be done as an outpatient procedure in most cases (ACOG). A Cochrane review of seven trials and 793 women found no clear difference in patient satisfaction between embolization and surgery over two to five years. Embolization meant a shorter hospital stay and a faster return to usual activities, but more women needed a further operation: about 15 to 32 percent within two years, against an assumed 7 percent after hysterectomy or myomectomy (Cochrane, 2014).
Myomectomy
Surgical removal of the fibroids while the uterus stays in place. It can be done through the cervix (hysteroscopic), through small abdominal incisions (laparoscopic) or through an open incision (ACOG). Fibroids do not regrow after surgery, but new fibroids may develop, and more surgery may then be needed. Myomectomy has risks, including bleeding and infection. It can sometimes cause internal scarring that leads to infertility, and a cesarean birth may be needed in a later pregnancy (ACOG). A Cochrane review found that laparoscopic myomectomy brought less pain after surgery, less fever and a shorter hospital stay than open surgery, with no difference in recurrence.
Hysterectomy
Removal of the uterus. It ends fibroid symptoms, and it is the only treatment after which fibroids cannot come back, because the uterus is gone. It also ends the possibility of pregnancy and is a major operation, with a hospital stay of a few days (ACOG). It is used when other treatments have not worked or are not possible, or when the fibroids are very large.
HIFU vs embolization: how they compare
Two meta-analyses compared the two. One found that women who had embolization had greater relief of symptoms, a lower reintervention rate (relative risk 0.25) and a lower pregnancy rate, although its authors could not conclude that HIFU favors a wanted pregnancy because of confounding factors (Liu et al., 2021). The other found a higher reintervention rate after HIFU than after embolization (relative risk 4.06), with no significant advantage for HIFU in symptom scores (Yan et al., 2022). In these comparisons HIFU avoids a catheter and an incision, while embolization had the stronger record for symptom relief and fewer repeat procedures.
HIFU vs myomectomy: how they compare
For women who want to conceive, myomectomy is described as the current standard (Anneveldt et al., 2021), and a 2025 meta-analysis found lower pooled pregnancy and live birth rates after HIFU (23.3 and 17.3 percent) than after myomectomy (56.9 and 44.1 percent). Its authors cautioned that the HIFU studies were of limited quality and that comparative trials are needed (Chen et al.). A systematic review of 21 studies took a more favorable view, finding that reproductive outcomes after HIFU appeared non-inferior to standard care, but it also called for a randomized trial (Anneveldt et al., 2021). Another meta-analysis found no significant difference between HIFU and surgery in reintervention or pregnancy rates (Yan et al., 2022).
The evidence is mixed. If a pregnancy is part of your plan, tell your doctor before any treatment is chosen.
Fibroid treatment without hysterectomy
Several options leave the uterus in place: medication, myomectomy, embolization, radiofrequency ablation and focused ultrasound. Each keeps the possibility of pregnancy open to a different degree, and none stops new fibroids from forming. Embolization has been linked to a lower pregnancy rate than comparison treatments in a 2023 meta-analysis (Yan et al.). Ask which of them fits your fibroids, and what the evidence is for your situation.
Recovery compared
Recovery differs widely. Medication needs none. Embolization and hysteroscopic myomectomy are often done without an overnight stay, and hysterectomy may mean a few days in hospital (ACOG). Laparoscopic myomectomy shortens the stay compared with open surgery (Cochrane). After HIFU you go home the same day, following about 4 hours of observation at the clinic. Daily activities can resume, and flying is possible, from about 3 days after HIFU, subject to the follow-up check. Results and recovery vary from person to person.
How to decide
Your symptoms, the fibroids' size and position, whether you want a future pregnancy, and how much recovery time you can take all matter. A scan and an honest conversation about the trade-offs come first. At Podo, HIFU is the non-surgical option we offer; we will tell you if another treatment would suit you better. This page is general information and is not a diagnosis; a consultation is needed to decide whether a procedure suits you.
Questions
Is there one right treatment for fibroids?
No. The choice depends on your symptoms, the size, number and position of the fibroids, any plan for pregnancy and the recovery time you can take. A scan and a frank talk about the trade-offs come first.
Can fibroids return after treatment?
Only hysterectomy removes the possibility. After any treatment that leaves the uterus in place, new fibroids can form while hormones remain active. Follow-up scans are used to watch for them.
Does HIFU suit every fibroid?
No. HIFU is offered for fibroids up to about 12 cm in size and up to 12 fibroids in number. Subserosal fibroids that project outward from the surface of the uterus (pedunculated subserosal fibroids) are not treated with HIFU. A scan decides.
How does HIFU compare with embolization?
HIFU treats the fibroid through the skin with no catheter and no incision. In meta-analyses, embolization gave greater symptom relief and fewer repeat procedures, while the pregnancy data for both are limited (Liu et al., 2021; Yan et al., 2022). Which suits you depends on your fibroids and your plans.
Which fibroid treatment is used for women who want to get pregnant?
Myomectomy is generally the standard choice because it removes the fibroids and keeps the uterus. HIFU and embolization are options with less evidence for later pregnancy, so tell your doctor early if you plan to conceive.
Sources
- ACOG patient FAQ: Uterine fibroids
- NHS: Fibroids
- NICE HealthTech guidance HTG277 (formerly IPG413): MR-guided focused ultrasound for uterine fibroids, recommendations
- Cochrane review, 2014: uterine artery embolization for symptomatic uterine fibroids (PubMed)
- Cochrane review, 2014: minimally invasive surgical techniques versus open myomectomy (PubMed)
- Liu et al., 2021: uterine artery embolization compared with HIFU, meta-analysis (PubMed)
- Yan et al., 2022: HIFU compared with embolization and surgery for fibroids, meta-analysis (PubMed)
- Chen et al., 2025: reproductive outcomes of HIFU and myomectomy for fibroids, meta-analysis (PubMed)
- Anneveldt et al., 2021: reproductive outcomes after HIFU for fibroids, systematic review (PubMed)
- Yan et al., 2023: pregnancy after uterine artery embolization, meta-analysis (PMC)
Read about this at Podo
About the reviewer
Dr. Mo Hyung-jin, MD, PhD, board-certified OB-GYN specialist, is the medical director of Podo Women's Clinic. He developed the pelvic ligament suspension technique used at the clinic for stress urinary incontinence and pelvic organ prolapse. Profile