Is the Recovery from Uterine Artery Embolization Different from Hysterectomy?

By: Dr. Derek Mittleider

9/9/2024

The recovery following uterine artery embolization (UAE) and hysterectomy is significantly different due to the nature of the procedures, the degree of invasiveness, and the impact that the degree of invasiveness has on the recovery timeline. Here are 7 reasons why UAE recovery is usually better:

1. Invasiveness

Hysterectomy: A major surgical procedure that involves the removal of the uterus. The degree of invasiveness depends on the surgical approach (abdominal, laparoscopic, or vaginal). Every approach involves one or more surgical incisions and stitches.

Uterine Artery Embolization (UAE): A minimally invasive procedure that does not involve an incision or stitches. Circulation to the uterus is decreased with tiny particles injected through a hair-sized tube. With decreased circulation, fibroids or adenomyosis in the uterus shrink.

2. Hospital Stay

Hysterectomy: Typically requires a hospital stay of 2 to 4 days.

UAE: In our practice, UAE is an outpatient procedure offered in an outpatient surgery center without an overnight hospital stay. Patients go home the same day.

3. Postoperative Pain

• Hysterectomy: Postoperative pain can be significant, especially with an abdominal hysterectomy. Pain management is usually necessary for several days to weeks.

• UAE: Patients experience cramping and pelvic pain for a few days after the procedure. Pain is usually less severe compared to a surgical hysterectomy and is managed with oral pain medications.

4. Recovery Time

• Hysterectomy: Full recovery usually takes 6 to 8 weeks. Patients are usually advised to avoid heavy lifting, strenuous activities, and sexual intercourse for several weeks due to surgical incision sites that need that time to heal.

• UAE: Recovery is much faster than surgical hysterectomy. Most women return to full activity within 1 to 2 weeks. A small percentage of patients may experience fatigue and mild discomfort beyond two weeks.

5. Scarring

Hysterectomy: Abdominal hysterectomy leaves a visible scar, while laparoscopic and vaginal approaches have minimal external scarring. 

UAE: Leaves minimal or no scar as it is performed without an incision through a small tube in the wrist. 

6. Future Fertility

Hysterectomy: With removal of the uterus, there is a permanent loss of fertility.

UAE: The uterus is maintained, and the potential for future fertility remains in the vast majority of patients. Future pregnancy after UAE is achievable at rates similar to women of similar age who have not undergone UAE [Mohan PP, Hamblin MH, Vogelzang RL. Uterine artery embolization and its effect on fertility. J Vasc Interv Radiol. 2013 Jul;24(7):925-30]. For patients who strongly desire future pregnancy, myomectomy may result in better outcomes than UAE [Zanolli NC, Bishop KC, Kuller JA, Price TM, Harris BS. Fibroids and Fertility: A Comparison of Myomectomy and Uterine Artery Embolization on Fertility and Reproductive Outcomes. Obstet Gynecol Surv. 2022 Aug;77(8):485-494].

7. Complications

• Hysterectomy: Higher risk of complications, reported as 9-13% depending on the surgical approach [Clarke-Pearson DL, Geller EJ. Complications of hysterectomy. Obstet Gynecol. 2013 Mar;121(3):654-673]. Complications can include infection, bleeding, blood clots, bowel injury, bladder injury, and injury to pelvic arteries and veins.

• UAE: Very low risk of complications, typically reported as 1-4% [Peng J, Wang J, Shu Q, Luo Y, Wang S, Liu Z. Systematic review and meta-analysis of current evidence in uterine artery embolization vs myomectomy for symptomatic uterine fibroids. Sci Rep. 2024 Aug 20;14(1):19252].

Summary

• There are significant differences in the post-procedural recovery between hysterectomy and UAE. In general, the recovery from UAE is faster and less painful with additional benefits that warrant careful consideration when considering treatment options


*All information subject to change. Images may contain models. Individual results are not guaranteed and may vary.