Uterine Fibroids: Types, Symptoms, Causes and Treatment Options

Fibroids are benign (non-cancerous) tumors that originate from the smooth muscle layer of the uterus and are the most common growths seen in the female reproductive system. These masses, which primarily develop due to hormonal changes and genetic predisposition, can significantly reduce quality of life with serious symptoms such as heavy menstrual bleeding, pelvic pain, and pressure on the bladder. In modern medicine, fibroid treatment no longer means large surgical incisions or loss of the uterus. Uterine fibroid embolization, performed by interventional radiologists, is the most comfortable and effective treatment option available today, preserving the uterus by blocking the vessels that feed the fibroid and requiring no general anesthesia.

What Is a Fibroid and How Does It Develop in the Uterus?

The development of fibroids begins when a single cell in the uterine wall—specifically in the muscle layer called the myometrium—starts to behave abnormally. Under normal conditions, the growth, division, and reproduction of cells in the body occur in perfect balance. However, in some cases, a smooth muscle cell in the uterine wall loses this balance, begins to multiply uncontrollably, and forms a dense connective tissue around itself. This process, in which a single cell divides uncontrollably and turns into a mass, usually progresses slowly.

When the structure of these masses is examined, they are found to be much firmer, denser, and more compact than normal uterine muscle tissue. Because of their rigid structure, as they expand toward surrounding soft tissues, they begin to distort the natural anatomy and flexibility of the uterus. Sometimes they remain as small as a pea and go unnoticed for years. At other times, they can grow to the size of a grapefruit or even a melon, altering the entire structure of the uterus and narrowing the living space of other organs within the pelvis. This variability in size stems from differences in growth rates and individual responses to hormonal changes.

What Factors Cause Fibroids?

It is not possible to point to a single cause behind the development of fibroids; rather, it is the result of a complex interaction between genetic inheritance, cellular mechanisms, and the body’s hormonal balance. Essentially, fibroids are masses that feed on the hormones estrogen and progesterone produced by the female body. These hormones are released intensively each month to prepare the uterine lining for a possible pregnancy. Fibroid cells contain receptors that capture these hormones, and as the level of circulating estrogen increases, these masses begin to grow rapidly—almost like a fertilized plant.

The fact that hormone levels are highest during the reproductive years explains why fibroids most commonly grow between the ages of 25 and 45. When a woman enters menopause, ovarian activity slows down and estrogen levels drop dramatically. Deprived of their source of nourishment, fibroids tend to shrink during this period. In addition to hormones, body fat tissue can act like an external hormone factory, producing extra estrogen. This shows how excess weight creates a favorable environment for fibroid growth. Genetic predisposition is also a major factor. The presence of fibroids in female family members indicates that certain genetic codes at the cellular level may be passed down through generations.

The main risk factors associated with fibroid formation and growth include:

• Genetic predisposition
• High estrogen levels
• High progesterone levels
• Obesity
• Advanced age
• Irregular dietary habits
• A diet rich in red meat
• Alcohol consumption

What Are the Symptoms of Fibroids That Make Life Difficult?

In many cases, fibroids are discovered incidentally during a routine gynecological examination or an ultrasound performed for an entirely different reason, as they often produce no symptoms. These silent masses are usually small and not located in a position that disrupts the function of the uterus. However, as they begin to grow or press toward the inner lining of the uterus, a series of symptoms that significantly affect patients’ daily lives and reduce quality of life may emerge. Proper evaluation of these symptoms is crucial in determining the most appropriate treatment method.

The most troubling symptom is undoubtedly abnormal bleeding. During menstruation, the uterus contracts rhythmically to expel its inner lining, which helps control bleeding. However, the presence of a hard mass in the uterine wall mechanically prevents the uterus from contracting properly. Blood vessels remain open, and bleeding can become difficult to stop. Patients often report that their periods last for days, are much heavier than normal, and include clotting. Continuous blood loss depletes the body’s iron stores, leading to severe anemia. This condition results in persistent fatigue, difficulty getting out of bed in the morning, shortness of breath when climbing stairs, and heart palpitations.

The most common symptoms of fibroids include:

• Heavy bleeding
• Clotted menstrual bleeding
• Prolonged menstrual periods
• Severe groin pain
• Chronic pelvic pain
• Anemia
• Palpitations
• Frequent urination
• Urinary incontinence
• Constipation
• Bowel sluggishness
• A feeling of abdominal bloating
• Lower back pain

Does the Location of Fibroids in the Uterus Affect Symptoms?

In addition to their size, the location of fibroids within the uterus also determines the type of problems a patient may experience. Masses located in the inner lining of the uterus, called the endometrium, are known as submucosal fibroids. Even if they are small, they are the type that most significantly increase bleeding and negatively affect fertility, as they directly occupy the area where the embryo would implant and disrupt the rich vascular network.

Masses located within the thick muscular wall of the uterus are called intramural fibroids. This type can enlarge the uterus to massive proportions, making it appear as if there is a pregnancy. The enlarged uterus begins to put pressure on other organs within the pelvis. Subserosal fibroids, which grow toward the outer surface of the uterus, generally do not affect the bleeding cycle much. However, they can grow uncontrollably into the abdominal cavity and press on the bladder. This constant pressure reduces bladder capacity, causing a persistent need to urinate day and night. It may also lead to issues such as incomplete emptying of the bladder or urinary leakage when coughing. If the mass presses toward the intestines from the back wall of the uterus, the digestive system may be affected, leading to chronic constipation.

How Is a Diagnosis Made in Suspected Fibroid Cases?

When a patient presents with complaints such as heavy bleeding, persistent groin pain, or a palpable swelling in the abdomen, the diagnostic process usually begins with standard imaging methods. Transvaginal or abdominal ultrasonography examines the structure of the uterus using sound waves and can largely detect the presence and approximate size of masses. It is indispensable as a first-line method because it is practical, fast, and does not involve radiation.

However, when the situation becomes more complex, the number of masses increases, or when planning a modern uterus-preserving treatment, the limited imaging provided by ultrasound may be insufficient. At this point, pelvic Magnetic Resonance Imaging (MRI) comes into play. MRI is the gold standard diagnostic tool that provides a millimetric map of the masses within the uterus and clearly defines their boundaries with surrounding tissues. Especially when contrast material is administered intravenously, it reveals how well these masses are vascularized. Knowing whether the masses are actively supplied by blood vessels is crucial for predicting the success of non-surgical treatment methods.

How Has Surgical Fibroid Treatment Evolved Over Time?

For many years, the medical field has primarily relied on surgical methods as the sole solution for fibroids. One of the most common of these is hysterectomy, in which the uterus is completely removed along with the masses. Although hysterectomy is a definitive solution that eliminates the disease at its root, it is a highly radical procedure resulting in organ loss. Removing the uterus not only means losing reproductive ability but can also disrupt pelvic anatomy, alter hormonal balance, and cause significant psychological distress.

Another surgical option is myomectomy, which aims to remove only the masses while preserving the uterus. However, because the uterus is a highly vascular organ, removing fibroids from within the muscle tissue can result in severe bleeding. Additionally, the incisions and sutures made in the uterine wall may lead to adhesions within the abdomen during the healing process, potentially causing infertility or chronic pelvic pain in the future. Most importantly, microscopic fibroid foci that are not visible during surgery may remain in the uterus, creating a risk of recurrence over time and possibly requiring additional surgeries.

What Is Uterine Fibroid Embolization, a Uterus-Preserving Treatment?

Modern medicine, aware of the physical and psychological burden of surgical methods, has shifted its focus from sacrificing organs to eliminating the problem at its source. One of the most successful outcomes of this approach is uterine artery embolization, commonly known as fibroid embolization, performed in the field of interventional radiology. Its principle is based on a highly elegant and rational mechanism: instead of surgically removing the mass, it cuts off its blood supply, effectively starving it.

We can think of the uterus as a house and fibroids as additional rooms built later that make the house smaller and dysfunctional. While surgical methods aim to demolish these rooms by breaking walls or even destroying the entire house, embolization treatment simply shuts off the plumbing supplying these extra rooms. Deprived of nourishment, the masses lose vitality, shrink over time, and are rendered inactive by the body. Throughout this process, the house—the uterus—remains completely intact. This method, which does not require general anesthesia or large surgical incisions, represents a major turning point in fibroid management.

How Is Non-Surgical Fibroid Treatment with Embolization Performed Step by Step?

Fibroid embolization is a delicate procedure performed in sterile angiography units equipped with advanced imaging systems. To ensure patient comfort, sedative medications are administered through the arm during the procedure. Then, similar to a cardiac angiogram, the right groin artery or wrist artery is numbed with local anesthesia. A very fine needle, about the thickness of a pen tip, is inserted through this numbed area.

From this point, the interventional radiologist guides thin, flexible, and steerable tubes called catheters through the vascular system toward the uterus. Since there is no incision in the skin, all internal movements are monitored in real time on the angiography screen. Once the main uterine arteries are reached, even finer microcatheters—about the thickness of a hair—are advanced directly into the small vessels feeding the fibroids. Once positioned, specially designed embolic particles, about the size of grains of sand and fully compatible with the human body, are injected into the vessel.

These tiny particles travel with the blood flow and lodge within the vascular bed of the fibroids, permanently blocking blood flow like a dam. While the normal uterine tissue remains unaffected due to its rich collateral blood supply, the fibroids, which rely entirely on continuous blood flow, are deprived of oxygen and begin to die. Once this meticulous procedure, which typically takes 45 minutes to 1 hour, is completed, gentle pressure is applied to the entry site, and a small bandage is placed.

What Are the Advantages of This Interventional Radiology Treatment?

This non-surgical treatment approach eliminates the challenges and risks of traditional surgery, providing significant comfort for the patient. It is especially ideal for women who are hesitant about surgery, wish to avoid the risks of general anesthesia, or cannot take extended time away from daily life. The absence of incisions and open wounds reduces the risk of infection to nearly zero. The lack of significant blood loss and the preservation of the uterus are additional major benefits.

The key advantages of this modern fibroid treatment approach include:

• Complete preservation of the uterus
• No need for general anesthesia
• No surgical incisions
• No sutures required
• No blood loss
• Low risk of infection
• Short hospital stay
• Rapid recovery
• Quick return to daily life
• Very low risk of recurrence
• No intra-abdominal adhesions
• No cosmetic deformity
• Ability to treat all fibroid foci at once

What Should Patients Expect After Non-Surgical Fibroid Treatment?

The biggest question patients usually have after the procedure is the level of pain they will experience. As the fibroids lose vitality due to blocked blood vessels, the body reacts biologically to the lack of oxygen in the tissue. This may cause cramp-like pain in the groin area, sometimes severe, along with mild fever and nausea. However, this pain is not from a surgical wound but is a clear indication that the fibroids are breaking down and the treatment is working.

During the first night in the hospital, this process is largely controlled with strong painkillers administered intravenously and advanced analgesia pumps. Most patients are discharged the next morning, able to walk on their own. After a few days of rest at home with standard oral pain medications, patients typically return to work and normal social life within a week. Bleeding patterns improve dramatically from the first month, while pressure and pain symptoms gradually diminish as the fibroids shrink. Follow-up imaging clearly shows how the masses dry out and shrink over time.

Why Should You Consult an Interventional Radiologist for Non-Surgical Fibroid Treatment?

If your doctor has told you that you have fibroids and your symptoms—such as heavy bleeding or persistent pain—are making life unbearable, you do not have to undergo major surgery before evaluating your options. Every individual’s body structure, disease progression, and treatment expectations are different. Sacrificing not only your reproductive ability but also an essential part of your womanhood is no longer the first option with today’s medical advancements.

Interventional radiology acts like the navigation system of modern medicine, aiming to deliver the greatest benefit with the least harm. Based on the evaluation of high-quality MRI imaging, it can be clearly determined whether you can regain your health without losing your uterus, without surgical incisions, and without exposure to heavy anesthesia.

Prof. Dr. Özgür KILIÇKESMEZ

Prof. Dr. Özgür Kılıçkesmez is one of Türkiye’s leading interventional radiology and neuroradiology specialists, focusing on minimally invasive endovascular treatments. His primary areas of expertise include aneurysm and stroke treatments, embolization procedures, non-surgical treatments of thyroid and parathyroid diseases, interventional oncology, and peripheral vascular interventions. He currently serves as the Head of the Interventional Radiology and Neuroradiology Department at Istanbul Memorial Göztepe Hospital.
Graduating from Istanbul University Cerrahpaşa Faculty of Medicine in 1997, Prof. Dr. Kılıçkesmez received advanced training in interventional radiology and oncology as a Clinical Fellow at London Guy’s & St Thomas’ and King’s College Hospital between 2012 and 2013. He earned the title of Professor in 2020 and, in the same year, became the Founding Interventional Radiologist at SBÜ Çam and Sakura City Hospital. He also holds the EBIR (European Board of Interventional Radiology) certification.
Prof. Dr. Kılıçkesmez has 94 international and 40 national publications and over 2500 citations. He serves as a reviewer for prestigious journals such as the American Journal of Roentgenology (AJR) and Diagnostic & Interventional Radiology. With his clinical and academic expertise, he is a nationally and internationally recognized authority in stroke treatment, brain aneurysm, embolization, tumor ablation, and minimally invasive treatments of thyroid/parathyroid diseases.