Prof Saim Yılmaz, MD
"Giant uterine myomas may be treated with embolization in select cases"
Can embolization be applied in giant fibroids?
It is generally accepted that fibroids with diameters over 10 cm are not very suitable for embolization. Such fibroids are generally more prone to necrosis. For this reason, they are overly affected by embolization, die more easily, and often their middle parts decompose and become liquefied. This extensive necrosis (tissue death) that occurs in the fibroid may cause symptoms such as sweating, weakness, loss of appetite, and nausea, which can last for months if it cannot be expelled. If these complaints last too long and bother the patient, removal of the uterus (hysterectomy) may be required as a last resort.
In giant fibroids, myomectomy can be easily performed if the fibroid is growing outward and is attached to the outer surface of the uterus by a thin stalk. However, except in this rare case, myomectomy is not appropriate, especially for intramural or near the internal surface (submucous) fibroids as the risks of operation such as bleeding, infection, deformation and adhesion are higher. Therefore, hysterectomy rather than myomectomy is preferred for giant fibroids. However, there are many patients with very large fibroids who are unsuitable or unwilling to undergo a hysterectomy. In these patients, it is possible to successfully perform embolization therapy using some special techniques. In such patients, it may be beneficial to avoid aggressive embolization, to perform embolization in two sessions if necessary, and to use special techniques to facilitate expulsion from the vagina if the giant fibroid is located submucosally.
We must state that in the last 10 years, we have applied embolization treatment in many giant fibroids with diameters ranging from 10 cm to 24 cm in our center, and we have achieved 80-90% successful results.