Non-Surgical Uterine Fibroid Treatment: Methods, Benefits and Recovery

Fibroids, medically known as uterine leiomyomas, are benign (non-cancerous) tumors that originate from the smooth muscle layer (myometrium) of the uterus. They are quite common in women of reproductive age and typically grow slowly. They are not cancerous, and the vast majority do not undergo malignant transformation. However, depending on their location, size, and number, they may lead to various clinical symptoms.

Fibroids can exist as a single nodule or as multiple nodules within the uterine wall. Based on their location, they are divided into three main groups:

• Intramural fibroids: Located within the uterine muscle layer and are the most common type.
• Submucosal fibroids: Grow toward the inner cavity of the uterus (endometrial cavity).
• Subserosal fibroids: Develop toward the outer surface of the uterus and may extend into the abdominal cavity.

Some fibroids may be pedunculated and attach to the uterus via a thin stalk of tissue. The type of location plays a determining role in the symptoms that may occur.

How Do Fibroids Develop?

The mechanism of fibroid development (pathogenesis) is not fully understood; however, it is thought that hormonal and genetic factors play a role together. In particular, the hormones estrogen and progesterone are known to stimulate the growth of fibroid cells. For this reason, fibroids usually appear during reproductive age and tend to shrink after menopause.

At the cellular level, uncontrolled proliferation occurs as a result of genetic changes in uterine muscle cells. This proliferation (increase in cell number) forms nodular structures over time. An increase in the extracellular matrix (supporting tissue outside the cells) is also observed in fibroid tissue; this may cause the fibroid to be felt as a firm and distinct mass.

What Are the Symptoms of Fibroids?

Fibroids do not always cause symptoms. Many women learn they have fibroids during routine gynecological examinations. However, in some cases, fibroids can lead to clinical symptoms that may affect quality of life.

1. Menstrual Irregularities and Heavy Bleeding

The most common symptom is menorrhagia (heavy menstrual bleeding) and/or metrorrhagia (bleeding outside of menstruation). Especially submucosal fibroids can increase the amount of bleeding by enlarging the inner surface area of the uterus. Prolonged and heavy bleeding may lead to iron deficiency anemia over time. In such cases, symptoms such as fatigue, easy exhaustion, and dizziness may accompany.

2. Pelvic Pain and Pressure Sensation

Depending on the size of the fibroid, a feeling of fullness, pressure, or dull pain may be experienced in the lower abdomen. Large fibroids may exert mechanical pressure on surrounding organs. For example, pressure on the bladder may cause frequent urination; pressure on the rectum may lead to a sensation of constipation.

3. Abdominal Swelling

Especially large subserosal fibroids may cause visible abdominal swelling. This condition may sometimes be mistaken for weight gain.

4. Reproductive Problems

Depending on their location, fibroids may make it more difficult to achieve pregnancy. In particular, submucosal fibroids that distort the uterine cavity may affect embryo implantation. Additionally, there is evidence suggesting an association with recurrent pregnancy loss in some cases. However, not every woman with fibroids will develop infertility.

5. Pain During Sexual Intercourse

Some fibroids, especially those located on the posterior wall of the uterus, may cause pain (dyspareunia) during sexual intercourse.

The severity of symptoms varies depending on the number, size, and anatomical location of the fibroids. Two fibroids of the same size may produce completely different clinical pictures in different patients.

What Causes Fibroids?

Although the exact cause of fibroids is unknown, various risk factors have been identified. These factors may increase the likelihood of developing the condition but are not solely determinative.

Hormonal Factors

Estrogen and progesterone are known to support fibroid growth. Therefore:

• They are more common during reproductive age.
• They may show a tendency to grow during pregnancy.
• They generally shrink after menopause.

Hormonal imbalances may play a role in fibroid development, but not every hormonal change leads to fibroid formation.

Genetic Predisposition

An increased risk has been observed in women with a family history of fibroids. Certain genetic mutations are known to be detected more frequently in fibroid cells. This suggests that hereditary predisposition may play a role in pathogenesis.

Age and Reproductive History

Fibroids are most commonly seen between the ages of 30–50. Early menstruation (early menarche) and never having given birth have been associated with increased risk in some studies.

Obesity and Metabolic Factors

Increased body fat may lead to increased estrogen production. This may theoretically support fibroid development. Additionally, there is evidence suggesting a relationship between insulin resistance, metabolic syndrome, and fibroid prevalence.

Other Possible Factors

Some environmental factors, dietary habits, and chronic inflammatory processes are also suggested to play a role; however, there is no clear and definitive data on this subject.

Non-Surgical Fibroid Treatment Options: Interventional Radiology Approach

Fibroids, referred to as uterine leiomyomas, are benign tumors originating from the smooth muscle tissue of the uterus. Not every fibroid requires surgery; in some patients, non-surgical methods may be considered to control symptoms. In recent years, interventional radiology applications have offered minimally invasive (performed with small interventions) options aimed at preserving the uterus in suitable patients.

These methods stand out with smaller incisions, shorter hospital stays, and the potential for faster recovery compared to open or closed surgery. However, each patient’s clinical characteristics are different; the treatment plan must be determined through a joint evaluation by a gynecology and obstetrics specialist and an interventional radiology specialist.

Uterine Artery Embolization (UAE)

The most commonly applied interventional radiology method in non-surgical fibroid treatment is known as uterine artery embolization (UAE).

How Is the Procedure Performed?

The UAE procedure is usually performed through a small vascular access made from the groin or wrist. With the help of a thin catheter, the uterine arteries supplying the uterus are reached. Then, special particles (embolizing agents) that will reduce the blood flow feeding the fibroid are delivered into these vessels.

With the reduction of blood flow, ischemia (reduced blood supply) develops in the fibroid tissue. This may contribute over time to the shrinkage of the fibroid and alleviation of symptoms. The procedure generally does not require general anesthesia; it can be performed under sedation and local anesthesia.

In Which Situations Can It Be Considered?

Uterine artery embolization may be evaluated in the following situations:

• Severe menstrual bleeding (menorrhagia)
• Development of anemia
• Pressure symptoms (such as bladder pressure, frequent urination)
• Desire to preserve the uterus
• Patients not suitable for surgery or who do not want surgery

However, different approaches may be required in submucosal fibroids that significantly distort the uterine cavity or in the presence of active infection. Additionally, method selection should be made carefully in patients planning pregnancy.

Possible Process and Expectations

In the first days after the procedure, groin pain, pelvic pain, and mild fever may occur. This condition is called “post-embolization syndrome” and is usually temporary. Fibroid shrinkage does not occur immediately; volume reduction develops gradually over weeks to months.

The response rate and degree of symptom relief may vary in each patient. Therefore, detailed pre-procedure information is important.

MRgFUS (Magnetic Resonance-Guided Focused Ultrasound)

Another non-surgical option applied in some centers is the MRgFUS (Magnetic Resonance-guided Focused Ultrasound) method. In this technique, high-intensity ultrasound waves are focused on fibroid tissue under magnetic resonance imaging guidance.

The focused energy creates thermal ablation (destruction by heat) in the fibroid tissue. No skin incision is made during the procedure. MR imaging increases targeting accuracy and allows real-time monitoring of heat distribution.

This method is not suitable for every fibroid type. The size, number, and location of the fibroid are determining factors for suitability. Additionally, long-term outcome data may vary depending on patient selection.

Radiofrequency Ablation of Uterine Fibroids

Radiofrequency ablation (RFA) of uterine fibroids (uterine leiomyomas) is a minimally invasive method used in the treatment of symptomatic fibroids. This technique is based on the principle of creating controlled thermal damage by delivering energy directly to the fibroid tissue. The aim is to reduce the volume of the fibroid rather than surgically removing it and to alleviate related symptoms.

Radiofrequency energy is a high-frequency alternating electrical current. This energy, delivered through a special probe placed into the fibroid, causes a temperature increase between 60–100°C in the tissue. This rise in temperature leads to denaturation of cellular proteins and cellular death called coagulation necrosis. Over time, shrinkage and fibrotic transformation (increase in connective tissue) occur in the fibroid tissue.

The procedure can be performed laparoscopically (through small incisions in the abdomen), transvaginally, or percutaneously (with a needle through the skin) under ultrasound guidance. The application method is determined according to the location and size of the fibroid. Imaging guidance ensures correct placement of the probe and protection of surrounding tissues.

Radiofrequency ablation may be considered especially in medium-sized fibroids that are limited in number and cause significant bleeding or pressure symptoms. Mild to moderate pelvic pain may occur in the first days after the procedure. Fibroid shrinkage usually begins within weeks and may continue over months.

This method is not suitable for every patient. Factors such as extension of the fibroid into the uterine cavity, the presence of multiple large fibroids, or plans for pregnancy may affect the treatment decision. Therefore, patient selection and treatment planning should be carried out individually by a gynecology and obstetrics specialist and the relevant interventional team.

Advantages and Limitations of Non-Surgical Methods

The potential advantages of interventional radiology methods include:

• No large surgical incision
• Generally short hospital stay
• Faster return to daily life
• Preservation of the uterus

However, there are also some limitations:

• The fibroid may not be completely eliminated; reduction is the goal.
• Although rare, recurrence of symptoms may occur.
• Not every patient may be anatomically and clinically suitable.

Additionally, changes in menstrual patterns or temporary hormonal effects may be observed in some patients. Especially in older age groups, ovarian function may be affected; this requires individual risk assessment.

Why Is Patient Selection Important?

The most critical point in non-surgical fibroid treatments is correct patient selection. Factors such as:

• Location type of the fibroid
• Size and number
• Relationship with the uterine cavity
• Patient’s age
• Pregnancy plans
• General health status

should be evaluated in detail.

This evaluation is usually performed with pelvic ultrasonography and magnetic resonance imaging (MRI). Imaging findings play an important role in determining whether the interventional procedure is technically feasible.