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Research · Therapies

Uterine fibroid procedures

Hysterectomy ranked first for cutting heavy bleeding among second-line options. Embolization left women as satisfied as surgery, with faster recovery, but 15% to 32% needed more surgery within 2 years against 7%. Laparoscopic myomectomy meant less pain than open surgery. Pregnancy data after embolization and focused ultrasound are limited. FDA warns power morcellation can spread hidden cancer.

Checked 2026-11-13
Status
Surgical and radiology procedures done by physicians, mainly gynecologic surgeons and interventional radiologists. The FDA regulates the devices used. It advises limiting laparoscopic power morcellation to appropriately selected women having myomectomy or hysterectomy, only with a tissue containment system, and advises against it in women over 50 or after menopause [1][2].
Also called
myomectomy, open myomectomy, abdominal myomectomy, laparoscopic myomectomy, robotic myomectomy, hysteroscopic myomectomy, hysteroscopic resection, hysterectomy, laparoscopic hysterectomy, vaginal hysterectomy, uterine artery embolization, UAE, uterine fibroid embolization, UFE, MRI-guided focused ultrasound, MRgFUS, MR-HIFU, high-intensity focused ultrasound, HIFU, radiofrequency ablation, RFA, laparoscopic radiofrequency ablation, transcervical fibroid ablation, Acessa, Sonata, power morcellation
Used for
removing fibroids, stopping heavy periods, fibroid pain and pressure, keeping the uterus, avoiding hysterectomy, getting pregnant with fibroids, a permanent end to heavy bleeding, faster recovery than open surgery

Strong several reviews agree · Moderate one review or consistent trials · Limited one or a few small studies · Untested no study in people, listed with what it rests on

Shown to help6

Reported risks9

What it is used for, and what was found

Shown to help6

Moderate

Heavy bleeding and satisfaction after hysterectomy

Shown to cut heavy menstrual bleeding more than a hormonal IUD or endometrial ablation, ranking first in a network meta-analysis, with low-certainty evidence.

Compared with a levonorgestrel IUD and endometrial ablation [3]; uterine artery embolization [4]

The numbers and sources
Effect
Among second-line treatments for heavy menstrual bleeding, hysterectomy ranked first for reducing blood loss (mean rank 1.2, low certainty), and minimally invasive hysterectomy ranked first for satisfaction (mean rank 1.3, low certainty). Bleeding reduction depended on the type of hysterectomy (total or subtotal), not the route [3]. Ten years after randomization, 87% of women who had a hysterectomy and 78% who had embolization were satisfied or very satisfied, and generic quality of life did not differ [4].
Population
11 trials with 1,790 participants for bleeding and 27 trials with 4,284 for satisfaction [3]; 177 Dutch women with fibroids randomized to hysterectomy or embolization, 131 answering at 10 years [4].
Sources
[3], [4]
Caveats
The network covers heavy menstrual bleeding from any cause, not only fibroids, and the ranks rest on indirect comparisons [3]. Hysterectomy ends periods and the possibility of pregnancy.
Moderate

Recovery after embolization

Shown to need fewer blood transfusions than hysterectomy or myomectomy, with shorter hospital stays and a faster return to usual activities in every trial that measured them.

Compared with hysterectomy or myomectomy [5]

The numbers and sources
Effect
Blood transfusions were less likely after embolization than surgery (OR 0.07, 95% CI 0.01 to 0.52, 2 trials, 277 women). Procedures were shorter (2 studies), hospital stays shorter (7 studies) and return to usual activities faster (6 studies), though most of these could not be pooled [5].
Population
7 RCTs with 793 women with fibroids [5].
Sources
[5]
Caveats
The recovery outcomes were too varied to pool into one number [5].
Moderate

Heavy bleeding after embolization or myomectomy

Shown to reduce heavy bleeding about as much as myomectomy at 4 years, in one randomized trial and one pooled analysis.

Compared with myomectomy [8][7]

The numbers and sources
Effect
At 4 years in FEMME, bleeding scores, rates of amenorrhea and rates of heavy bleeding did not differ between embolization and myomectomy. Of women still menstruating, 75% after embolization and 77% after myomectomy reported regular or fairly regular periods [8]. A meta-analysis found comparable improvement in abnormal uterine bleeding [7].
Population
254 UK women randomized [8]; 13 studies [7].
Sources
[8], [7]
Caveats
One randomized trial, and a meta-analysis mostly of observational studies [7].
Moderate

Laparoscopic compared with open myomectomy

Shown to cause less pain at 6 and 48 hours, about half the risk of fever and shorter hospital stays than open myomectomy, with no difference in fibroid recurrence.

Compared with open myomectomy, including mini-laparotomy [9]

The numbers and sources
Effect
Pain on a 0 to 10 scale was 2.40 points lower at 6 hours (1 study, 148 women) and 1.90 points lower at 48 hours (2 studies, 80 women), with no difference at 24 hours. Fever after surgery was less likely (OR 0.44, 95% CI 0.26 to 0.77, 6 studies, 635 women). Hospital stays were shorter, and recurrence, return to theater and conversion to open surgery did not clearly differ [9].
Population
9 RCTs with 808 premenopausal women [9].
Sources
[9]
Caveats
No trial reported uterine rupture, clots or deaths, so these could not be compared [9].
Limited

Symptoms after focused ultrasound

Limited evidence: symptom scores fell about 50% after MRI-guided focused ultrasound in pooled studies with no comparison treatment, and quality of life improved.

Compared with before treatment, in the same women [11][12]

The numbers and sources
Effect
Pooled, the treated share of fibroid volume (non-perfused volume) was 67.60% (95% CI 55.58 to 79.62), symptom severity scores changed about 54% (95% CI 41% to 66%) at 3, 6 and 12 months, and health-related quality of life improved [11]. Across uterine-sparing treatments, quality of life improved after every option, and least after focused ultrasound [12].
Population
Randomized, non-randomized and crossover studies of MR-guided focused ultrasound [11]; 85 studies with 17,789 women [12].
Sources
[11], [12]
Caveats
Mostly single-group studies, so part of the change may not be due to treatment. The reviewers note results improved as protocols aimed for total ablation [11].
Moderate

Symptoms and fibroid size after radiofrequency ablation

Shown in pooled studies, mostly without a comparison group, to shrink treated fibroids about 65% by 12 months and to improve bleeding and quality of life scores.

Compared with before treatment, in the same women [14][15]

The numbers and sources
Effect
Fibroid volume fell 46.0% at 3 months (95% CI 40.0 to 52.1, 11 studies) and 65.4% at 12 months (95% CI 56.1 to 74.7, 10 studies). All studies reported fewer women with abnormal, heavy or prolonged bleeding, mostly within 3 months, and quality of life scores improved, with most women back to work within 2 weeks [14]. A second meta-analysis found fibroid volume fell 66% at 12 months, quality of life rose 39 points and symptom severity fell 42 points, with return to normal activities after 5.2 days [15].
Population
30 studies, 3 of them randomized [14]; 32 articles with 1,283 women treated laparoscopically, transvaginally or transcervically, median age 42 [15].
Sources
[14], [15]
Caveats
Most studies had no comparison group, and the 3 randomized trials were not blinded [14]. Review [15] was funded by Gynesonics, maker of the Sonata system, and one author consulted for the company. Most studies excluded women wanting to keep fertility, so pregnancy data are insufficient [14].

Mixed results3

Moderate

Embolization compared with surgery: satisfaction and quality of life

Mixed results: satisfaction after embolization matched hysterectomy or myomectomy up to 5 years, but fibroid quality of life scores were lower than after myomectomy at 2 years.

Compared with hysterectomy or myomectomy [5]; myomectomy [6][7]; hysterectomy [4]

The numbers and sources
Effect
Satisfaction did not differ between embolization and surgery within 24 months (OR 0.94, 95% CI 0.59 to 1.48, 6 trials, 640 women) or at 5 years (OR 0.90, 95% CI 0.45 to 1.80, 2 trials, 295 women) [5]. In the FEMME trial, fibroid quality of life scores at 2 years were 84.6 after myomectomy and 80.0 after embolization (adjusted difference 8.0 points, 95% CI 1.8 to 14.1), and 5.0 points at 4 years (95% CI -1.4 to 11.5), not significant [6]. A meta-analysis found higher symptom severity scores after embolization than myomectomy at 4 years [7]. At 10 years, quality of life did not differ between embolization and hysterectomy [4].
Population
7 RCTs with 793 women [5]; 254 UK women randomized to myomectomy or embolization [6]; 13 studies, 4 of them randomized [7]; 177 Dutch women [4].
Sources
[5], [6], [7], [4]
Caveats
Many eligible women in FEMME declined to be randomized because they preferred one treatment [6]. Nine of the 13 studies in [7] were observational.
LimitedStudied in women

Pregnancy after hysteroscopic removal of fibroids inside the uterus

One small trial found more pregnancies after hysteroscopic removal of submucous fibroids than with timed intercourse alone, but the difference could be chance.

Compared with expectant management with regular fertility-oriented intercourse for 12 months [10]

The numbers and sources
Effect
In women with otherwise unexplained subfertility and submucous fibroids, clinical pregnancy odds were higher after hysteroscopic myomectomy (OR 2.44, 95% CI 0.97 to 6.17, P = 0.06) and miscarriage did not clearly differ (OR 1.54, 95% CI 0.47 to 5.00). No data on live birth or complications were found [10].
Population
94 women with unexplained subfertility and submucous fibroids [10].
Sources
[10]
Caveats
Very low-quality evidence from one small trial [10].
Limited

Pregnancy after embolization compared with myomectomy

Limited evidence: one small trial found fewer live births after embolization than after myomectomy, while a larger trial found similar small numbers of pregnancies.

Compared with myomectomy [5][6][7]

The numbers and sources
Effect
In a subgroup of one trial, live birth (OR 0.26, 95% CI 0.08 to 0.84) and pregnancy (OR 0.29, 95% CI 0.10 to 0.85) were less likely after embolization than myomectomy [5]. In FEMME, 12 women after embolization and 6 after myomectomy reported pregnancies over 4 years, with 7 and 5 live births (hazard ratio 0.48, 95% CI 0.18 to 1.28) [6]. A meta-analysis reported comparable pregnancy rates [7].
Population
66 women in one trial subgroup [5]; 254 women in FEMME [6]; 13 studies [7].
Sources
[5], [6], [7]
Caveats
The Cochrane authors rated the live birth evidence very low quality, from a subgroup of a single study, and urged extreme caution in reading it [5]. Pregnancy was not the primary outcome of FEMME [6].

Not shown to help1

Limited

Pregnancy after focused ultrasound

Linked to lower pregnancy and live birth rates than myomectomy in pooled studies, live births 17% against 44%, with no head-to-head trials.

Compared with women who had myomectomy, in separate studies [13]

The numbers and sources
Effect
After high-intensity focused ultrasound, the pooled pregnancy rate was 23.3% (95% CI 11.5 to 37.6) and live birth rate 17.3% (95% CI 7.8 to 29.3), against 56.9% (95% CI 45.6 to 67.9) and 44.1% (95% CI 34.9 to 53.4) after myomectomy. Studies of younger women and of women trying to conceive reported better outcomes [13].
Population
Published studies of women with fibroids up to March 2024 [13].
Sources
[13]
Caveats
The groups come from different studies, which differ in age and in whether women were trying to conceive. The authors call for comparative trials [13].

Protocols studied

FEMME randomized women to myomectomy, open, laparoscopic or hysteroscopic, or to embolization of the uterine arteries under fluoroscopic guidance [6]. The hysterectomy trials compared abdominal, vaginal, laparoscopic, robotic, single-port laparoscopic and vaginal natural orifice routes [16]. Radiofrequency ablation was delivered laparoscopically, transvaginally or transcervically, with a mean procedure time of 49 minutes and discharge after a mean 8.2 hours [15]. Focused ultrasound was guided by MRI or by ultrasound [17].

Risks

Reported risks9

StrongVery common

Another procedure after embolization

Shown to raise the need for further surgery against hysterectomy or myomectomy, 15% to 32% within 2 years against 7%. In one trial, 35% had a hysterectomy within 10 years.

The numbers and sources
How common
Very common: more than 1 in 10 people.
Effect
Further surgery was more likely after embolization than surgery within 2 years (OR 3.72, 95% CI 2.28 to 6.04, 6 trials, 732 women) and within 5 years (OR 5.79, 95% CI 2.65 to 12.65, 2 trials). If 7% need more surgery within 2 years of hysterectomy or myomectomy, 15% to 32% did after embolization [5]. Against myomectomy, reintervention (OR 1.84, 95% CI 1.62 to 2.10) and later hysterectomy (OR 4.04, 95% CI 3.45 to 4.72) were more likely at 4 years [7]. Pooled, 14.4% (95% CI 9.8 to 19.6) needed another procedure within 5 years [12]. In the EMMY trial, 28 of 81 women (35%) had a hysterectomy within 10 years of embolization [4].
Population
7 RCTs with 793 women [5]; 13 studies [7]; 85 studies with 17,789 women [12]; 81 Dutch women [4].
Sources
[5], [7], [12], [4]
Caveats
Heterogeneity was moderate to high in the pooled estimates (I² 45% to 65%) [5].
ModerateVery common

Another procedure after myomectomy

Linked to further treatment within 5 years in 12% after myomectomy and 7% after hysteroscopic removal of fibroids inside the uterus, in pooled studies.

The numbers and sources
How common
Very common: more than 1 in 10 people.
Effect
At 60 months, reintervention was 12.2% (95% CI 5.2 to 21.2) after myomectomy and 7% (95% CI 4.8 to 9.5) after hysteroscopic treatment [12].
Population
85 studies with 17,789 women [12].
Sources
[12]
Caveats
One meta-analysis with substantial differences between study populations [12].
LimitedVery common

Another procedure after focused ultrasound

Linked to further treatment within 5 years in 29% to 54% after focused ultrasound in pooled studies, more after MRI-guided than ultrasound-guided treatment.

The numbers and sources
How common
Very common: more than 1 in 10 people.
Effect
One meta-analysis found 53.9% (95% CI 47.2 to 60.4) needed another procedure within 60 months [12]. A second found reintervention rates of 1%, 7%, 19% and 29% at 12, 24, 36 and 60 months, lower after ultrasound-guided than MRI-guided treatment, and 15% at 60 months when more than half the fibroid volume was ablated [17].
Population
85 studies with 17,789 women [12]; 18 studies with 5,216 women [17].
Sources
[12], [17]
Caveats
The two pooled estimates at 5 years differ widely, and both rest on observational studies [12][17].
LimitedVery common

Another procedure after radiofrequency ablation

Limited evidence: further treatment for fibroid symptoms reached 4.2%, 8.2% and 11.5% by years 1, 2 and 3 after radiofrequency ablation in one industry-funded pooled analysis.

The numbers and sources
How common
Very common: more than 1 in 10 people.
Effect
The annual cumulative reintervention rate for fibroid symptoms was 4.2%, 8.2% and 11.5% through 3 years [15]. Hysterectomy after ablation ranged from 1.0% (2 of 205) to 24.1% (15 of 62) across studies with 45 days to 74 months of follow-up [14].
Population
1,283 women in 32 articles [15]; 30 studies [14].
Sources
[15], [14]
Caveats
Few studies followed women long enough [14]. Review [15] was funded by Gynesonics.
ModerateVery common

Complications of embolization and surgery

Shown to double minor complications within a year against surgery. Major complications did not clearly differ, and one trial found complications in 24% against 29% after myomectomy.

The numbers and sources
How common
Very common: more than 1 in 10 people.
Effect
Minor complications within one year were more likely after embolization (OR 1.99, 95% CI 1.41 to 2.81, 6 trials, 735 women), and up to 5 years (OR 2.93, 2 trials). Major complications within a year (OR 0.65, 95% CI 0.33 to 1.26) and complications during the procedure (OR 0.91) did not clearly differ [5]. In FEMME, complications around and after the initial procedure occurred in 24% after embolization and 29% after myomectomy [6]. Against myomectomy, early complications were less likely after embolization (OR 0.44, 95% CI 0.20 to 0.95) [7].
Population
7 RCTs with 793 women [5]; 254 women in FEMME [6]; 13 studies [7].
Sources
[5], [6], [7]
Caveats
Trials were not large enough for rare serious events, and definitions of minor complications varied [5].
LimitedUncommon

Spreading hidden cancer with power morcellation

FDA states about 1 in 225 to 1 in 580 women having fibroid surgery may have a hidden uterine sarcoma, which laparoscopic power morcellation can spread.

The numbers and sources
How common
Uncommon: between 1 in 1,000 and 1 in 100 people.
Effect
The FDA estimates a hidden uterine sarcoma in about 1 in 225 to 1 in 580 women having surgery for fibroids, and a leiomyosarcoma in about 1 in 495 to 1 in 1,100. Before 2014, the clinical community estimated as few as 1 in 10,000. Studies show women whose hidden sarcoma was morcellated had lower disease-free survival than women treated with manual morcellation or none. No reliable method predicts which women with fibroids have a sarcoma [1]. The risk rises with age, particularly over 50. The FDA advises against power morcellators in women after menopause or over 50, or who can have tissue removed whole through the vagina or a mini-laparotomy, and advises contained morcellation only. Uncontained morcellation has also spread benign tissue, such as parasitic myomas, sometimes needing more surgery [2].
Population
Published literature summarized by the FDA [1][2].
Sources
[1], [2]
Caveats
The FDA notes the survival studies have limitations [1]. A containment system cannot prevent spread from handling tissue before it is bagged, or cancer that has already spread [2].
ModerateStudied in pregnancyUncommon

Uterine rupture in a later pregnancy after myomectomy

Linked to uterine rupture in about 0.3% to 0.9% of later pregnancies after myomectomy, more often when the uterine cavity had been entered during surgery.

The numbers and sources
How common
Uncommon: between 1 in 1,000 and 1 in 100 people.
Effect
Across 13,381 pregnancies after myomectomy, uterine rupture occurred in 0.30% (40 cases, 95% CI 0.21 to 0.41). It occurred in 6.82% (3 of 44) when the cavity had been entered and 1.19% (4 of 336) when it had not (OR 6.07). Laparoscopic, open or robotic surgery did not change the risk significantly [18]. An earlier review found rupture in 0.93% of 756 viable deliveries, 0.47% with labor and 1.52% before labor, 5 of 7 before 36 weeks [19].
Population
13,381 pregnancies in 31 studies from 2013 to 2023 [18]; 1,034 pregnancies and 756 deliveries in 11 studies [19].
Sources
[18], [19]
Caveats
Observational studies, with too little data to give the risk during a trial of labor [18].
ModerateHow often is not known

Urinary tract injury with laparoscopic hysterectomy

Shown to raise urinary tract injuries in laparoscopic compared with abdominal hysterectomy. Laparoscopic and vaginal routes allowed return to normal activities about 11 to 13 days sooner.

The numbers and sources
How common
How often is not known: the sources give no rate.
Effect
Urinary tract injuries were more likely in laparoscopic than abdominal hysterectomy (OR 2.16, 95% CI 1.19 to 3.93, 18 RCTs, 2,594 women). If ureter injury occurs in 0.2% of abdominal hysterectomies, it would occur in 0.2% to 2% of laparoscopic ones. Return to normal activities was 13.01 days sooner after laparoscopic and 10.91 days sooner after vaginal hysterectomy than after abdominal hysterectomy. Adverse events were rare overall [16].
Population
63 RCTs with 6,811 women having hysterectomy for benign disease [16].
Sources
[16]
Caveats
Not limited to fibroids. Rare events make the comparisons imprecise [16].
StrongHow often is not known

Heart disease and stroke after hysterectomy

Linked to about 11% to 19% more cardiovascular disease and about 10% more stroke after hysterectomy in cohort studies, more when done before menopause or with ovary removal.

The numbers and sources
How common
How often is not known: the sources give no rate.
Effect
Cardiovascular disease was more frequent after hysterectomy (HR 1.19, 95% CI 1.09 to 1.29), as was stroke (HR 1.11, 95% CI 1.01 to 1.22), with raised risk after premenopausal hysterectomy and none found after postmenopausal surgery [20]. A second meta-analysis found HR 1.11 (95% CI 1.09 to 1.13) for cardiovascular disease and 1.09 for stroke, a larger effect with oophorectomy, and no significant link with death from any cause [21]. A third found RR 1.16 (95% CI 1.03 to 1.30) for cardiovascular disease, 1.31 for hypertension, and a link with hysterectomy before age 50 but not after [22].
Population
28 studies with 2,942,404 women [20]; 43 cohort studies [21]; 17 studies with 1,233,495 women [22].
Sources
[20], [21], [22]
Caveats
Observational studies. Women who have hysterectomies may differ in health from those who do not, and the reasons for surgery were not always separated, so the link may not be caused by the operation [21][22].

Claims tested and not found

  1. That women are less satisfied after embolization than after surgery. Satisfaction did not differ within 2 years (OR 0.94) or at 5 years (OR 0.90) [5], and 10 years after the EMMY trial, satisfaction was comparable, 78% against 87% [4].
  2. That fibroids come back more often after laparoscopic than open myomectomy. Recurrence did not differ between laparoscopic and open myomectomy [9].
  3. That the route of hysterectomy changes how much bleeding is reduced. Bleeding reduction depended on whether the hysterectomy was total or subtotal, not on the route [3].
  4. That laparoscopic myomectomy carries more risk of later uterine rupture than open surgery. The type of myomectomy, laparoscopic, open or robotic, did not significantly change the rupture risk [18].

Related

GnRH drugs for fibroidsTranexamic acidUlipristal acetate

Sources

  1. US Food and Drug Administration. Power morcellation during gynecologic laparoscopic surgeries. 2026. https://www.fda.gov/medical-devices/surgery-devices/power-morcellation-during-gynecologic-laparoscopic-surgeries
  2. US Food and Drug Administration. UPDATE: Perform only contained morcellation when laparoscopic power morcellation is appropriate: FDA Safety Communication. 2020. https://www.fda.gov/medical-devices/safety-communications/update-perform-only-contained-morcellation-when-laparoscopic-power-morcellation-appropriate-fda
  3. Bofill Rodriguez M, Dias S, Jordan V, et al. Interventions for heavy menstrual bleeding; overview of Cochrane reviews and network meta-analysis. Cochrane Database of Systematic Reviews. 2022. https://doi.org/10.1002/14651858.cd013180.pub2
  4. de Bruijn AM, Ankum WM, Reekers JA, et al. Uterine artery embolization vs hysterectomy in the treatment of symptomatic uterine fibroids: 10-year outcomes from the randomized EMMY trial. American Journal of Obstetrics and Gynecology. 2016. https://doi.org/10.1016/j.ajog.2016.06.051
  5. Gupta JK, Sinha A, Lumsden MA, et al. Uterine artery embolization for symptomatic uterine fibroids. Cochrane Database of Systematic Reviews. 2014. https://doi.org/10.1002/14651858.cd005073.pub4
  6. Daniels J, Middleton LJ, Cheed V, et al. Uterine artery embolisation versus myomectomy for premenopausal women with uterine fibroids wishing to avoid hysterectomy: the FEMME RCT. Health Technology Assessment. 2022. https://doi.org/10.3310/zdeg6110
  7. Peng J, Wang J, Shu Q, et al. Systematic review and meta-analysis of current evidence in uterine artery embolization vs myomectomy for symptomatic uterine fibroids. Scientific Reports. 2024. https://doi.org/10.1038/s41598-024-69754-0
  8. Sirkeci F, Moss J, Belli AM, et al. Effects on heavy menstrual bleeding and pregnancy of uterine artery embolization (UAE) or myomectomy for women with uterine fibroids wishing to avoid hysterectomy: The FEMME randomized controlled trial. International Journal of Gynecology & Obstetrics. 2023. https://doi.org/10.1002/ijgo.14626
  9. Bhave Chittawar P, Franik S, Pouwer AW, et al. Minimally invasive surgical techniques versus open myomectomy for uterine fibroids. Cochrane Database of Systematic Reviews. 2014. https://doi.org/10.1002/14651858.cd004638.pub3
  10. Bosteels J, van Wessel S, Weyers S, et al. Hysteroscopy for treating subfertility associated with suspected major uterine cavity abnormalities. Cochrane Database of Systematic Reviews. 2018. https://doi.org/10.1002/14651858.cd009461.pub4
  11. Zheng S, Rong Y, Zhu H, et al. Role of magnetic resonance-high intensity focused ultrasound (MR-HIFU) in uterine fibroids management: an updated systematic review and meta-analysis. Videosurgery and Other Miniinvasive Techniques. 2021. https://doi.org/10.5114/wiitm.2021.109760
  12. Sandberg EM, Tummers FHMP, Cohen SL, et al. Reintervention risk and quality of life outcomes after uterine-sparing interventions for fibroids: a systematic review and meta-analysis. Fertility and Sterility. 2018. https://doi.org/10.1016/j.fertnstert.2017.11.033
  13. Chen Y, Yi J, Lin S, et al. Reproductive outcomes of high-intensity focused ultrasound ablation and myomectomy for uterine fibroids: a systematic review and meta-analysis. Reproductive BioMedicine Online. 2025. https://doi.org/10.1016/j.rbmo.2024.104436
  14. Chen I, Berman JM, Balk EM, et al. Radiofrequency Ablation for the Treatment of Uterine Fibroids: A Systematic Review and Meta-Analysis by the AAGL Practice Committee. Journal of Minimally Invasive Gynecology. 2025. https://doi.org/10.1016/j.jmig.2024.09.011
  15. Bradley LD, Pasic RP, Miller LE. Clinical Performance of Radiofrequency Ablation for Treatment of Uterine Fibroids: Systematic Review and Meta-Analysis of Prospective Studies. Journal of Laparoendoscopic & Advanced Surgical Techniques. 2019. https://doi.org/10.1089/lap.2019.0550
  16. Pickett CM, Seeratan DD, Mol BWJ, et al. Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database of Systematic Reviews. 2023. https://doi.org/10.1002/14651858.cd003677.pub6
  17. Dou Y, Zhang L, Liu Y, et al. Long-term outcome and risk factors of reintervention after high intensity focused ultrasound ablation for uterine fibroids: a systematic review and meta-analysis. International Journal of Hyperthermia. 2024. https://doi.org/10.1080/02656736.2023.2299479
  18. Groffils C, Paelinck L, van Wessel S, et al. Systematic Review of Pregnancy After Myomectomy: The Risk of Uterine Rupture. Obstetrics and Gynecology International. 2026. https://doi.org/10.1155/ogi/6048559
  19. Gambacorti-Passerini Z, Gimovsky AC, Locatelli A, et al. Trial of labor after myomectomy and uterine rupture: a systematic review. Acta Obstetricia et Gynecologica Scandinavica. 2016. https://doi.org/10.1111/aogs.12920
  20. Attachaipanich T, Kaewboot K, Attachaipanich S. Cardiovascular outcomes after hysterectomy: a systematic review and meta-analysis. Baylor University Medical Center Proceedings. 2026. https://doi.org/10.1080/08998280.2026.2633069
  21. Chen Y, Li F, Liang L, et al. Examining the association of hysterectomy with and without oophorectomy on cardiovascular disease and all-cause, cardiovascular or cancer mortality: A systematic review and meta-analysis. BJOG. 2024. https://doi.org/10.1111/1471-0528.17843
  22. Wang Z, Li X, Zhang D. Impact of hysterectomy on cardiovascular disease and different subtypes: a meta-analysis. Archives of Gynecology and Obstetrics. 2022. https://doi.org/10.1007/s00404-021-06240-2

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