How UFE Can Treat Large Uterine Fibroids Without Surgery

Large uterine fibroids can cause significant symptoms, including heavy menstrual bleeding, pelvic pressure, abdominal enlargement, pain, and frequent urination. When fibroids become large or multiple fibroids develop together, some women may assume that major surgery is the only treatment option. However, uterine fibroid embolization (UFE) offers a minimally invasive approach that can treat symptomatic fibroids without removing the uterus.

For women exploring uterine fibroid embolization for large fibroids, understanding how the procedure works, what it can treat, and what recovery involves can help them have a more informed conversation with a healthcare provider.

What Are Large Uterine Fibroids?

Uterine fibroids are noncancerous growths that develop in or around the uterus. They can vary greatly in size, number, and location. Some remain small and cause no symptoms, while others can grow large enough to put pressure on nearby organs.

Large fibroids may contribute to:

• Heavy or prolonged menstrual bleeding
• Pelvic pressure or fullness
• Abdominal swelling or enlargement
• Pelvic or lower back pain
• Frequent urination
• Constipation or pressure on the bowel
• Pain during sexual activity
• Anemia caused by heavy menstrual bleeding

Not every large fibroid requires treatment. Treatment is generally considered when fibroids cause symptoms or affect quality of life. Imaging such as ultrasound or MRI can help doctors evaluate the size, number, and location of fibroids and determine which treatment options may be appropriate.

Can UFE Treat Large Fibroids?

Yes, UFE can be used to treat symptomatic uterine fibroids, including patients with multiple or large fibroids. The procedure does not require the doctor to surgically remove each fibroid. Instead, it targets the blood supply feeding the fibroids.

During UFE, an interventional radiologist guides a thin catheter into the arteries supplying the uterus. Tiny embolic particles are then delivered through the catheter to reduce blood flow to the fibroids. With their blood supply reduced, the fibroids gradually shrink over time.

This is one reason UFE can be considered when a patient has several fibroids or fibroids that would otherwise require extensive surgery.

How Does UFE Work on Large Fibroids?

The basic principle behind UFE is relatively straightforward: fibroids depend on blood flow to grow and maintain their tissue.

Before treatment, imaging is used to assess the uterus and identify the fibroids. During the procedure, the physician uses X-ray imaging called fluoroscopy to guide a catheter through a blood vessel to the uterine arteries.

Once the catheter reaches the appropriate arteries, small particles are injected. These particles reduce blood flow to the fibroids while the uterus continues to receive blood through its other blood vessels.

The treated fibroids then gradually shrink. RadiologyInfo notes that, on average, fibroids shrink to approximately half of their original volume following UFE, although individual results can vary.

For someone with a large fibroid, this gradual reduction in size can also reduce the pressure the fibroid places on surrounding organs.

Why Consider UFE Instead of Surgery?

Traditional surgical treatments for fibroids can include myomectomy, which removes fibroids, or hysterectomy, which removes the uterus. UFE provides another option for appropriately selected patients who want a minimally invasive treatment.

Unlike open surgery, UFE does not require a large abdominal incision. A catheter is inserted through a small access point, commonly through an artery in the groin or wrist, depending on the physician's approach.

Potential advantages of UFE include:

• No large surgical incision
• Uterus remains in place
• Treatment of multiple fibroids during one procedure
• Shorter recovery than many surgical procedures
• No need to surgically remove each individual fibroid
• Improvement in symptoms caused by fibroid-related bleeding or bulk

RadiologyInfo reports that UFE is substantially less invasive than open or laparoscopic surgery and that patients generally return to normal activities sooner than after surgical treatment.

What Happens to a Large Fibroid After UFE?

A large fibroid does not disappear immediately after UFE. Instead, the reduction in blood supply causes the fibroid to gradually shrink.

As the fibroid becomes smaller and softer, symptoms associated with its size may improve. For example, a patient experiencing pelvic pressure may notice less pressure as the fibroid decreases in volume. Similarly, symptoms related to pressure on the bladder or bowel may improve in some patients.

The timeline can vary from person to person. Follow-up imaging may be used to evaluate how the fibroids are responding to treatment.

It is important to understand that UFE is designed to control and shrink fibroids rather than physically remove them from the body.

Can UFE Treat Multiple Large Fibroids?

One important feature of UFE is that it can address multiple fibroids during the same treatment session. Rather than removing individual growths one at a time, UFE reduces blood flow to the fibroids supplied by the treated uterine arteries.

This can be particularly relevant for patients who have a large number of fibroids. The suitability of UFE depends on the individual's anatomy, symptoms, fibroid characteristics, overall health, and treatment goals.

Imaging is an important part of this evaluation because the number, size, and location of fibroids can influence the treatment approach.

What Symptoms May Improve After UFE?

The purpose of treating fibroids is often to reduce symptoms and improve quality of life. UFE may help address symptoms such as:

1. Heavy Menstrual Bleeding

Fibroids can contribute to heavy or prolonged menstrual periods. Reducing the blood supply to the fibroids can help decrease fibroid-related bleeding in many patients.

2. Pelvic Pressure

Large fibroids can create a feeling of heaviness, fullness, or pressure in the pelvis. Shrinking the fibroid may reduce this bulk-related discomfort.

3. Frequent Urination

A large fibroid can sometimes press against the bladder. As the fibroid shrinks, pressure on the bladder may decrease.

4. Abdominal Enlargement

Some women notice an enlarged or swollen-looking abdomen when fibroids become large. Reducing fibroid volume may help reduce the physical bulk caused by the growths.

5. Pelvic or Back Pain

Fibroid-related pressure and discomfort may improve after successful treatment, although pain can have many possible causes and individual outcomes differ.

RadiologyInfo reports that nearly 90% of patients undergoing UFE experience significant or complete resolution of fibroid-related symptoms in follow-up studies, including symptoms associated with bleeding and bulk.

What Is Recovery Like After UFE?

Because UFE is minimally invasive, recovery is generally shorter than recovery from major abdominal surgery. The exact experience varies depending on the patient and the treatment setting.

Some patients experience cramping, pelvic discomfort, fatigue, nausea, or other temporary symptoms after the procedure. These symptoms are often managed with medications recommended by the treating medical team.

Patients should follow their provider's instructions regarding activity, medications, hydration, and follow-up appointments.

Many UFE procedures are performed on an outpatient basis, although some patients may require observation or an overnight stay depending on their individual circumstances and the treating facility.

How Is UFE Different From Fibroid Surgery?

UFE and surgery treat fibroids in fundamentally different ways.

A myomectomy physically removes fibroids from the uterus. A hysterectomy removes the uterus. UFE, on the other hand, treats fibroids by reducing their blood supply so they can shrink.

The appropriate option depends on several factors, including symptoms, fibroid size and location, the number of fibroids, overall health, and reproductive plans.

UFE can preserve the uterus, but its effects on fertility are not fully understood. Patients who are considering future pregnancy should discuss their reproductive goals and all available treatment options with their gynecologist and interventional radiologist before choosing UFE.

Is UFE Right for Everyone With Large Fibroids?

No. Having a large fibroid does not automatically mean that UFE is the right treatment.

Before recommending UFE, a physician may review medical history, symptoms, medications, reproductive plans, and imaging results. MRI or ultrasound can help determine whether the fibroids are appropriate for embolization.

UFE is generally not performed when a patient has no symptoms, is pregnant, has certain pelvic infections or inflammation, or when there is concern that a growth could be cancerous. A thorough evaluation is therefore important before treatment.

What Should You Ask Your Doctor About UFE?

If you have large or multiple fibroids, consider asking your healthcare provider:

• How large are my fibroids?
• How many fibroids do I have?
• Where are they located?
• Are my symptoms likely caused by my fibroids?
• Am I a candidate for UFE?
• What should I expect during recovery?
• How will we monitor the fibroids after treatment?
• Could UFE affect my future pregnancy plans?
• What other treatment options are available for my specific situation?

These questions can help you understand the potential benefits and limitations of each approach.

Treating Large Fibroids Without Major Surgery

Large uterine fibroids can be challenging, particularly when they cause heavy bleeding, pelvic pressure, pain, or bladder and bowel symptoms. However, a large fibroid does not necessarily mean that a major surgical procedure is required.

Uterine fibroid embolization for large fibroids offers a minimally invasive treatment approach that works by reducing the blood supply to fibroids, allowing them to shrink over time. It can be used to treat symptomatic fibroids and can address multiple fibroids during the same procedure.

If you are experiencing symptoms from large fibroids, talk with a qualified healthcare professional about your diagnosis and treatment options. USA Fibroid Centers provides evaluation and minimally invasive treatment options for women dealing with symptomatic uterine fibroids. A personalized consultation can help determine whether UFE may be appropriate for your fibroid size, location, symptoms, and individual treatment goals.