We read with interest the publication in CardioVascular and Interventional Radiology on results from the randomized prospective Emmy trial [1]. The Emmy trial was designed to compare uterine artery embolization (UAE) and hysterectomy as a treatment for symptomatic fibroids. From the beginning in 1995 [2] the knowledge on UAE is increasing and extensive. Most published data and acknowledged information are based on large case series. Nowadays UAE is no longer considered experimental and has definitely found its place in the whole spectra of treatment options for symptomatic uterine fibroids. One of the advantages of UAE is the significantly earlier recovery after the procedure compared to hysterectomy [3]. A structural comparison of individual pain experience between UAE and hysterectomy has never been published in a randomized trial before. Unfortunately, no conclusions can be drawn from the publication by Hehenkamp et al. with regard to pain experience in patients after UAE and hysterectomy, since the study was not designed for this purpose. Many participating centers performed only a few UAEs, without a fixed pain management protocol. We feel that a fixed and extensive pain management protocol is crucial when performing UAE. At our center, where we perform an average of 140 UAEs per year, a dedicated pain management protocol is followed. In the Emmy trial, several analgesic approaches have been mentioned such as epidural anesthesia, opiates, nonsteroidal anti-inflammatory drugs (NSAIDs), paracetamol, and combinations. All analgesics used before, during, and after the procedure until discharge were recorded. Three subdivisions in terms of pain management could be extracted: paracetamol and NSAIDs only, opiates and or NSAIDs, and epidural anaesthesia. After discharge most patients were on medication such as paracetamol and/or NSAIDs. Pain after discharge was obviated and patient analgesic use recorded during 6 weeks. As already expected, patients from the hysterectomy arm had significantly higher pain scores during the first 24 hours after treatment. Average pain scores> 5 during hospitalization occurred in 31% of the UAE group versus 52% in the hysterectomy arm (p= 0.012). The majority of patients in both groups needed opiates during the first 24 hours as the strongest analgesic option. Consequently, these patients had higher pain scores, except for three individuals in the UAE arm who needed epidural anesthesia because of unbearable pain despite the administration of opiates. Many protocols have been described for UAE, varying from standard epidural anaesthesia to patient-controlled analgesia (PCA) in combination with NSAIDs and paracetamol [4]. Some authors even advocate performing UAE under general anesthesia [5]. Interpatient variations occur and pain experience as well as pain intensity is unpredictable [6]. No correlations have been detected concerning age, embolization technique, and embolization material size and type (spherical or nonspherical particles), as well as size and/or localization of uterine fibroids, although a clear and significant relation was demonstrated between