Jaipur: Heavy menstrual bleeding, severe period pain, pelvic pressure, lower abdominal heaviness and frequent urination are often considered a normal part of a woman’s life. However, these symptoms may actually indicate uterine fibroids or adenomyosis—two common gynecological conditions that can significantly affect a woman’s health, fertility and quality of life if left untreated.
While hysterectomy (removal of the uterus) has traditionally been one of the commonly performed treatments for severe disease, advances in Interventional Radiology (IR) are offering selected women minimally invasive, uterus-preserving alternatives.
According to Dr Deepak Agarwal, Interventional Radiologist, Jaipur, modern image-guided procedures such as Uterine Artery Embolization (UAE) and Microwave Ablation (MWA) are expanding treatment options for appropriately selected women who wish to avoid major surgery.
Understanding Uterine Fibroids
Uterine fibroids are non-cancerous (benign) tumors that develop from the muscle layer of the uterus. They may occur as a single fibroid or multiple fibroids and vary greatly in size and location.
Although the exact cause remains unclear, hormonal influences, genetic factors and changes within uterine muscle cells are believed to contribute to their development.
Common symptoms include:
- Heavy or prolonged menstrual bleeding
- Severe menstrual pain
- Pelvic heaviness or pressure
- Frequent urination
- Constipation
- Lower abdominal swelling
- Pain during intercourse in some women
- Difficulty conceiving in selected cases
- Iron-deficiency anemia due to excessive menstrual blood loss
“Many women silently tolerate these symptoms for years, believing them to be a normal part of menstruation. Persistent heavy bleeding or pelvic pain should never be ignored because timely diagnosis can open the door to less invasive treatment options,” says Dr Deepak Agarwal.
Adenomyosis: A Different Yet Common Condition
Although fibroids and adenomyosis often produce similar symptoms, they are entirely different diseases.
In adenomyosis, tissue similar to the inner lining of the uterus grows within the muscular wall of the uterus, causing it to become enlarged and thickened.
Women with adenomyosis commonly experience:
- Extremely painful menstrual cramps
- Heavy menstrual bleeding
- Chronic pelvic pain
- Pelvic heaviness
- Pain during menstruation
- Enlarged uterus
According to Dr Deepak Agarwal, accurate diagnosis is essential because treatment planning differs significantly between fibroids and adenomyosis.
Ultrasound is usually the first imaging investigation, while MRI provides more detailed information regarding the size, location, vascularity and extent of disease, helping determine the most appropriate treatment strategy.
Not Every Woman Needs Surgery
Treatment depends on the severity of symptoms, size and location of the lesion, age of the patient and whether she wishes to have children in the future. Medicines and hormonal therapies may be used to control bleeding and pain.
For fibroids, surgical options traditionally included myomectomy, in which the fibroid is removed while attempting to preserve the uterus, and hysterectomy, in which the uterus is removed.
For severe adenomyosis that does not respond adequately to medical treatment, hysterectomy has traditionally been considered a definitive treatment.
Today, however, minimally invasive image-guided procedures performed by Interventional Radiologists are providing additional uterus-preserving treatment options for appropriately selected patients.
“The goal is not simply to avoid surgery,” explains Dr Deepak Agarwal. “The goal is to choose the safest, most effective and most appropriate treatment based on the patient’s symptoms, age, reproductive plans, imaging findings and overall health.”
Uterine Artery Embolization (UAE): Treating Fibroids Without Removing the Uterus
One of the most established minimally invasive treatments for uterine fibroids is Uterine Artery Embolization (UAE).
In this procedure, performed under image guidance, a thin catheter is introduced through a tiny puncture in the wrist or groin artery. Using real-time X-ray guidance, the catheter is advanced into the uterine arteries supplying the fibroid.
Tiny medical-grade embolization particles are then delivered to selectively reduce the blood supply to the fibroid.
Without adequate blood flow, the fibroid gradually shrinks over the following weeks and months, leading to significant improvement in symptoms such as heavy menstrual bleeding, pelvic pressure and pain.
Unlike conventional surgery, there is no large incision, no removal of the uterus and no surgical scar.
“Uterine Artery Embolization works by targeting the blood supply of the fibroid rather than removing the uterus. For many appropriately selected women, it offers an effective uterus-preserving alternative to major surgery,” says Dr Deepak Agarwal.
Studies have also demonstrated encouraging results of UAE in carefully selected patients with adenomyosis, although detailed MRI evaluation and proper patient selection remain extremely important.
Microwave Ablation: A Newer Image-Guided Treatment
Another evolving minimally invasive option is Microwave Ablation (MWA).
During this procedure, a specialized microwave antenna is accurately positioned inside the fibroid under ultrasound or CT guidance.
Controlled microwave energy generates heat within the fibroid tissue, producing thermal destruction of the lesion while preserving surrounding healthy tissue as much as possible.
Over time, the treated fibroid gradually shrinks, resulting in symptom improvement.
“Microwave Ablation and Embolization are two different technologies,” explains Dr Deepak Agarwal.
“In embolization we block the abnormal blood supply, whereas in microwave ablation we directly destroy the target tissue using controlled heat. The choice depends on the number, size and location of fibroids, MRI findings and the patient’s clinical requirements.”
Research has demonstrated encouraging reductions in fibroid size and symptom relief following microwave ablation. Its role in adenomyosis continues to evolve as more long-term clinical evidence becomes available.
Benefits of Minimally Invasive Interventional Radiology
Compared with major surgery, image-guided interventional radiology procedures may offer several advantages for appropriately selected patients:
- No large surgical incision
- Uterus-preserving treatment
- Less blood loss
- Reduced post-procedure pain in many patients
- Shorter hospital stay
- Faster recovery
- Early return to routine activities
- Minimal scarring
- Image-guided precision
Because these procedures are minimally invasive, many women are surprised to learn that treatment can often be performed through only a tiny puncture rather than a large abdominal operation.
Individualized Treatment is the Key
Despite these advances, experts emphasise that not every fibroid or adenomyosis patient is suitable for minimally invasive treatment.
Treatment decisions depend upon:
- Number of fibroids
- Size of fibroids
- Location within the uterus
- Severity of symptoms
- MRI findings
- Age
- Fertility wishes
- Previous surgeries
- Overall health
Dr Agarwal emphasized that women who wish to conceive in the future should discuss fertility-related considerations in detail with their gynecologist and interventional radiologist before choosing a treatment.
Expanding Women’s Healthcare Through Interventional Radiology
According to Dr Deepak Agarwal, Interventional Radiologist at AEIRC (Advanced Endovascular & Interventional Radiology Centre), Jaipur, increasing awareness is helping women understand that hysterectomy is no longer the only option for many cases of symptomatic fibroids.
“Every woman deserves to know all available treatment options before deciding on surgery. With advances in Interventional Radiology, procedures like Uterine Artery Embolization and Microwave Ablation are allowing many appropriately selected patients to preserve their uterus while effectively controlling symptoms. The most important step is early diagnosis, detailed imaging and multidisciplinary consultation.”
As awareness of minimally invasive therapies continues to grow, Interventional Radiology is rapidly emerging as an important pillar in the treatment of uterine fibroids and selected cases of adenomyosis, offering women evidence-based, uterus-preserving alternatives with faster recovery and improved quality of life.
For women experiencing persistent heavy menstrual bleeding, severe period pain or pelvic pressure, timely consultation with a gynecologist and an experienced Interventional Radiologist can help determine the most appropriate personalised treatment plan.
