Table of Contents
- The Number Problem: Too Many Fibroids for Surgery
- Why UFE Does Not Count Fibroids
- What Happens to Each Fibroid After Embolisation
- Recurrence: The Fear vs The Data
- The Part Nobody Mentions: Surgery Has the Same Recurrence Biology
- The Honest 10 to 20 Per Cent Conversation
- What This Means for Your Decision
1. The Number Problem: Too Many Fibroids for Surgery
Her ultrasound report listed eight fibroids. Different sizes, different locations, scattered throughout the uterine wall like raisins in a cake. The largest was 6 centimetres. The smallest was barely a centimetre. Her surgeon looked at the images and said: “There are too many to remove individually. Hysterectomy is the safest option.”
From a surgical perspective, that assessment is often genuinely reasonable. Myomectomy (surgically cutting out each fibroid) becomes increasingly risky as the count goes up. More fibroids mean more cuts in the uterine wall, more bleeding, more time under general anaesthesia, more tissue damage, and a higher chance of complications. At some point, the surgeon reaches a practical limit: removing eight or twelve fibroids from different depths and locations is technically dangerous and may leave the uterus so weakened that it cannot safely carry a pregnancy anyway.
So the woman hears “too many for surgery” and translates it, understandably, as “too many to treat.” She assumes if a surgeon cannot fix this, nobody can.
That assumption is wrong. Because UFE does not count fibroids.
2. Why UFE Does Not Count Fibroids
This is the fundamental difference, and it is worth understanding clearly.
Myomectomy removes fibroids one by one. Each fibroid is a separate surgical task: locate it, cut into the uterus, shell it out, control the bleeding, close the incision. More fibroids, more tasks, more risk. The surgeon operates on the fibroids.
UFE operates on the blood supply. The uterine arteries feed all the fibroids in the uterus. When the embolisation particles are injected into the uterine arteries, they flow into and block the branches feeding every fibroid simultaneously. Three fibroids or fifteen. Anterior or posterior. Large or small. Every fibroid that depends on the uterine artery blood supply loses that supply in one procedure.
Think of it this way: myomectomy is pulling weeds one by one with your hands. UFE is turning off the irrigation to the entire weed-infested area at once. The weeds die. The garden (the healthy uterine tissue) survives because it has access to water from a different source (collateral blood supply).
This is why the number of fibroids does not change the complexity of UFE the way it changes the complexity of surgery. The catheter goes in once. The particles are delivered once. All fibroids are treated.
3. What Happens to Each Fibroid After Embolisation
Each fibroid responds the same way: it loses its blood supply, the tissue dies, and the body begins absorbing it. But the timeline and degree of shrinkage can vary from fibroid to fibroid, even within the same uterus.
Smaller fibroids (under 3 cm) often shrink rapidly and may become nearly undetectable on imaging within 6 months. Larger fibroids (5 cm and above) shrink more gradually, typically reducing by 40 to 70 per cent in volume by 6 months, with continued slow shrinkage up to 12 months.
The important point for patients: you do not need the fibroids to vanish completely for the symptoms to resolve. A 7 cm fibroid that shrinks to 3.5 cm is no longer pressing on your bladder, no longer distorting the cavity, and no longer driving heavy bleeding. The goal of UFE is not to make the uterus fibroid-free on imaging. It is to make it fibroid-symptom-free in your life.
For a detailed look at how symptoms improve month by month after UFE, read our post-UFE recovery timeline.
4. Recurrence: The Fear vs The Data
“What if the fibroids come back?” This is the single most common fear women express about UFE. We addressed this question in depth in our dedicated recurrence blog. Here is the essential summary.
Treated fibroids do not regrow. The embolisation particles permanently block the blood supply. A fibroid that has been embolised is dead tissue. It does not regenerate. It does not reinflate. Five to ten year follow-up studies consistently confirm that treated fibroids stay shrunk.
New fibroids can develop from new cells. The same hormonal environment (primarily oestrogen and progesterone) that grew the original fibroids is still present in a premenopausal woman. Over years, new smooth muscle cells in the uterine wall can mutate and begin forming new fibroids. This is the biology of fibroid disease. It is not UFE failing. It is the condition itself behaving the way it behaves.
The rate of clinically significant new fibroids developing after UFE is relatively low. Most long-term studies report that the majority of women remain symptom-free at five years. And when new fibroids do appear, they tend to be smaller and more manageable than the originals.
5. The Part Nobody Mentions: Surgery Has the Same Recurrence Biology
This is the point that changes the conversation entirely, and it is almost never discussed.
Myomectomy physically removes existing fibroids. But like UFE, it cannot prevent new ones from forming. The same uterus, the same hormonal environment, the same biological tendency to produce fibroids. Published data shows that recurrence rates after myomectomy are actually comparable or even higher than after UFE, with some studies reporting 15 to 30 per cent recurrence at five years after surgical removal.
The reason is straightforward: surgery removes the fibroids that are visible and accessible. But tiny fibroids, seedling fibroids too small to see or feel during the operation, may already exist in the uterine wall. UFE treats these as well, because the particles block blood supply to the entire fibroid bed indiscriminately. Surgery, by definition, can only remove what the surgeon can see and reach.
So when someone says “fibroids might come back after UFE,” the honest follow-up question is: “Compared to what?” Compared to hysterectomy, yes, fibroids can return because the uterus is still there. Compared to myomectomy, UFE has equal or better long-term durability. Recurrence is a feature of fibroid biology, not a weakness of any particular treatment.
6. The Honest 10 to 20 Per Cent Conversation
No medical procedure works identically in every patient, and we would not be a clinic worth trusting if we did not say this clearly.
In roughly 10 to 20 per cent of UFE cases, the response may be less complete than expected. A fibroid may have collateral blood supply from sources other than the uterine arteries, which partially sustains it even after embolisation. Certain fibroid types (particularly pedunculated subserosal fibroids with a thin stalk) may be less suitable for UFE. And in some cases, the technical result is good but symptom relief falls short of what the patient hoped for.
When this happens, options remain open. A repeat embolisation can target residual supply. Additional targeted treatment can be considered. Or, depending on the clinical picture, a surgical approach may become appropriate. The point is: an incomplete response is a recognised possibility, it is manageable, and it does not leave you without a path forward.
What matters is that this is discussed before the procedure so expectations are realistic and grounded in data, not inflated by hope or fear.
7. What This Means for Your Decision
If you have multiple fibroids and have been told surgery is the only option, that assessment may be correct for surgery. It is rarely correct for UFE.
If you are worried about recurrence, understand that the biology is the same regardless of treatment. Treated fibroids stay treated. New ones can appear. That risk exists equally after myomectomy. And it disappears entirely after menopause.
UFE gives you durable, meaningful relief through the years that matter most, with a single procedure that treats every fibroid in the uterus simultaneously, preserves the organ, and carries lower complication rates than major surgery.
To discuss your fibroid case with Dr. Parul Garg:
Website: Book an Appointment
Phone / WhatsApp: +91-9211978100
Email: [email protected]
Three fibroids or fifteen. UFE does not count them. It treats them all.