UFE for Large Fibroids: Realistic Shrinkage and Results

Yes, large fibroids can often be treated with uterine fibroid embolization (UFE). In a 2010 study of 71 women with a fibroid larger than 10 cm or a greatly enlarged uterus, fibroids shrank by an average of 44% in volume, symptoms improved substantially for most, and there were no serious complications. The honest part is that "shrink" does not mean "disappear." A big fibroid usually becomes a smaller fibroid, so it helps to know in advance what that means for your belly, your bladder and your periods.

If you are still deciding whether UFE fits you at all, start with am I a candidate for UFE? This page focuses only on size.

What counts as a "large" fibroid?

There is no official definition. Studies tend to draw the line at about 10 cm across, or at a uterus that has grown to several times its usual volume. The two studies most often cited used these cut-offs:

• A 2010 Dutch study (Smeets and colleagues) included women with a dominant fibroid over 10 cm and/or a uterine volume over 700 cm3.
• A 2003 Japanese study (Katsumori and colleagues) compared 47 women with at least one fibroid of 10 cm or more (average 12.4 cm, up to 19 cm) with 105 women whose fibroids were all smaller.

Size is usually measured on MRI or ultrasound. If your report lists several fibroids, the one that matters most is often the largest, or the one pressing on the bladder or bulging into the uterine cavity.

What the studies found

Both large-fibroid studies concluded that size alone should not rule out UFE. Smeets and colleagues wrote that "a large fibroid burden should not be considered a contraindication." Katsumori and colleagues found "no increased risk ... on the basis of tumor size."

What 44% shrinkage looks like in real life

Fibroid shrinkage is reported as a change in volume, and volume falls much faster than width. A fibroid that loses about 44% of its volume gets only around 18% narrower. As a rough example, a 12 cm fibroid might measure about 10 cm afterward. That can be enough to take pressure off the bladder and soften the bump of the abdomen, but it may not give you a completely flat stomach.

Bleeding often responds differently from bulk. In the US FIBROID Registry, a study of more than 2,000 women, smaller fibroid size, a submucosal location and heavy bleeding as the main complaint all predicted greater symptom improvement after one year. Put simply, if heavy periods are your main problem, UFE can work well even with a large fibroid. If the size of your abdomen is your main concern, expect a gradual, partial change.

Timing also matters. ACOG's patient guide says it may take 2 to 3 months to notice a change in symptoms and that fibroids may keep shrinking for a year or more. The CIRSE 2015 guideline says the maximal effect is usually seen at about 6 months.

This article is part of our Fibroid Treatment Guide.

Is UFE riskier when fibroids are big?

Older case reports raised concern that very large fibroids might cause more serious problems after embolization, because a lot of tissue loses its blood supply at once. The two studies above were set up to test that worry. In Katsumori's study, major complications were somewhat more frequent with fibroids 10 cm or larger (3 of 47 women) than with smaller ones (2 of 105), but the difference could have been due to chance. Four of the five major complications were surgery to remove dying fibroid tissue that had come loose. Minor complications were similar between groups.

In general, the CIRSE 2015 guideline reports that passage of fibroid tissue through the cervix occasionally needs a procedure in about 5% of cases and major infection in 2.5%. Cramping, low fever and nausea in the first few days (post-embolization syndrome) are expected and usually managed at home. Call your doctor promptly for pain that medicine does not control, a fever above 101°F, nausea or vomiting, or bleeding or pain where the catheter went in, which are the warning signs ACOG lists.

When surgery may suit you better

UFE is not the right answer for every large fibroid. Surgery may be the better fit if:

• You want the bulk gone now. Myomectomy removes the fibroid in one operation. UFE shrinks it over months. Compare the two in UFE vs myomectomy.
• You want certainty. The EMMY researchers noted that hysterectomy remains the choice when a woman wants certainty that bleeding will stop. See UFE vs hysterectomy.
• You hope to get pregnant. Pregnancy data after UFE are limited, and myomectomy is usually discussed first.
• Your fibroid has grown quickly or looks unusual on MRI. Rare cancers need to be ruled out, and UFE leaves no tissue to examine.

On the other hand, UFE treats every fibroid at once. For women with many fibroids, or with a large fibroid that would be hard to remove without taking the uterus, it can be a way to keep the uterus and avoid a major operation.

After UFE: passing tissue and follow-up

As fibroids break down, some women pass tissue or have a brownish discharge for a while. This is more common with fibroids that touch the uterine lining. Most of the time it settles without treatment, but it can occasionally need a procedure. Our guide to passing fibroid tissue after UFE explains what is normal.

A follow-up scan a few months later shows how much the fibroids have shrunk and whether any part still has a blood supply. That helps explain your symptoms and guides what to do if they come back. For the procedure itself, results and recovery, see our full guide to uterine fibroid embolization (UFE), and compare every option in our fibroid treatment guide.

Questions to ask about your large fibroid

• Which fibroid is causing most of my symptoms, and how big is it on MRI?
• Is my main goal (less bleeding, less pressure, a smaller belly) one that UFE is likely to meet?
• Does anything on my MRI make you less comfortable treating it with UFE?
• Would you plan an overnight stay or extra pain control because of the size?
• When would you repeat imaging, and what happens if symptoms persist?

Frequently Asked Questions

Is there a maximum fibroid size for UFE?

No agreed upper limit exists. Published studies have treated fibroids up to 19 cm, and researchers concluded that size alone should not rule out UFE, though each case needs individual review.

Will my belly go flat after UFE?

Usually not completely. A fibroid that loses about 44% of its volume becomes only around 18% narrower, so the bulge often softens and shrinks gradually rather than vanishing.

How long does it take a large fibroid to shrink?

ACOG says symptoms may take 2 to 3 months to change and fibroids may keep shrinking for a year or more. The CIRSE 2015 guideline puts the maximal effect at about 6 months.

Should I take medication to shrink the fibroid before UFE?

This is a question for your doctor. We did not find good evidence that pre-treatment medication improves UFE results for large fibroids, so it is not routine in the studies discussed here.

Can UFE be repeated if a large fibroid comes back?

Repeat embolization is sometimes done, as are myomectomy and hysterectomy. In the 2010 large-fibroid study, 14% of women had a hysterectomy during about 4 years of follow-up.

Keep Reading

• Uterine Fibroid Embolization (UFE) in New York City
• Am I a Candidate for UFE? A Practical Checklist
• UFE vs Myomectomy: Results, Recovery and Fertility Compared
• UFE vs Hysterectomy: What 10 Years of Trial Data Show
• Passing Fibroid Tissue After UFE: Why It Happens and When to Call
• UFE Success Rate: What 1, 2, 5 and 10-Year Studies Show
• Fibroid Treatment Guide: every option, compared

Sources

1. Smeets et al., Cardiovasc Intervent Radiol, 2010 — UAE for a large fibroid burden, long-term follow-up (71 women)
2. Katsumori et al., AJR, 2003 — is a large fibroid a high-risk factor for UAE? (152 women)
3. Hehenkamp et al., Am J Obstet Gynecol, 2007 — EMMY trial 2-year results, UAE vs hysterectomy
4. Spies et al., Obstet Gynecol, 2005 — FIBROID Registry 1-year outcomes (2,112 patients)
5. van Overhagen & Reekers, Cardiovasc Intervent Radiol, 2015 — CIRSE Standards of Practice: uterine artery embolization for symptomatic leiomyomata
6. ACOG patient FAQ, Uterine Artery Embolization (last reviewed May 2026)

Medically reviewed by David Fox, MD, FACS, RPVI. This article is general information, not a substitute for a medical evaluation.

Living with heavy periods, pelvic pressure or other fibroid symptoms? Schedule a consultation with Dr. David Fox at Fox Vein & Vascular in Manhattan to find out whether uterine fibroid embolization is right for you. Call (212) 362-3470 or request a UFE consultation online.