Complications Of Uterine Leiomyomas: A Comparative Review of Uterine Fibroid Embolization and Myomectomy in Management and Outcomes

Uterine leiomyomas (fibroids) are the most common benign gynaecological tumors in women of reproductive age and may result in significant complications. Uterus-preserving treatment options recommended by the American College of Obstetricians and Gynaecologists (ACOG) and central to this review are Uterine Fibroid Embolization (UFE) and myomectomy. This review compares UFE and myomectomy in terms of recurrence, fertility preservation, and quality-of-life outcomes. A comparative analysis was conducted using major electronic databases, including PubMed, Google Scholar, Scopus, and Science Direct, with searches restricted to human studies published in English between January 2013 and May 2025. Fibroids are most prevalent among women aged 30 to 50 years and disproportionately affect Black women. Myomectomy, though more invasive, is preferred in women desiring future fertility. UFE has a higher intervention rate (OR 1.84; 95% CI 1.62–2.10; P < 0.01; I2 = 39%), hysterectomy rate (OR 4.04; 95% CI 3.45–4.72; P < 0.01; I2 = 59%), and symptom-severity score (OR − 4.02; 95% CI 0.82, 7.22; P = 0.01; I2 = 0%) compared to myomectomy at a four-year follow-up. UFE has a lower risk of early complications (OR 0.44; 95% Cl 0.20-0.95; P = 0.04; I 2 = 25%) and readmission rate (OR 1.16; 95% Cl 1.01-1.33; P=0.04; I 2 = 0%) in comparison with myomectomy. Both procedures effectively relieve symptoms and preserve the uterus, but data on fertility outcomes are inconclusive. Treatment decisions should be personalized based on patient preferences and clinical context. KEYWORDS: Uterine Fibroid Embolization; Fibroids; Myomectomy; Fertility Preservation; Minimally Invasive Procedures