Do fibroids come back after treatment?
They can. Myomectomy, embolisation and HIFU preserve the uterus; as long as the uterus remains and hormones are active, new fibroids may develop or a surviving part of a treated fibroid may regrow. The likelihood is higher in younger women, in those with many fibroids and when the first treatment did not inactivate the whole fibroid. The method that removes the possibility of new fibroids is hysterectomy, which is neither suitable nor necessary for every woman.
"Regrowth" and "new fibroids" are not the same
When a patient says "my fibroid came back", two different processes may be at work. The first is regrowth of a part of the treated fibroid that stayed alive. The second is other foci, too small to see at the time of treatment, growing over the years and appearing as new fibroids. For most women fibroids are not a single focus but a tendency of the uterus, one that lasts until menopause.
How does recurrence look with each method?
- Myomectomy: the removed fibroid does not return, but small foci left in the uterus can grow. New fibroids are reported more often in women who had many.
- Embolisation: fibroid tissue whose blood supply was not fully cut off can regrow; new vessels may form.
- HIFU: the part of the fibroid that was not inactivated (a low ablation ratio) can regrow; long-term series report reintervention in a proportion of patients.
- Medication: the effect lasts while the drug is taken; once stopped, the fibroid usually returns to its previous size.
New fibroids and reintervention are possible after every uterus-sparing method; guidelines advise that patients be informed of this before treatment.
Studies comparing methods use different definitions of reintervention and different follow-up periods; the rates cannot simply be placed side by side.
Source: 2021 · Obstetrics & Gynecology — klinik guideline
What raises the risk of recurrence?
- Younger age: the longer the time to menopause, the longer the window for new fibroids.
- Multiple fibroids: new foci are more likely than in women with a single fibroid.
- Tissue left by the first treatment: a low ablation ratio in HIFU, incompletely blocked blood supply in embolisation.
- Large, richly perfused fibroids: the response to energy or to vessel occlusion may be more limited.
In long-term follow-up after HIFU, a low ablation ratio, multiple fibroids and younger age have been reported as independent risk factors for reintervention.
Reintervention does not mean the method failed; by the nature of fibroid disease it also occurs after surgery.
Source: 2024 · International Journal of Hyperthermia2021 · International Journal of Hyperthermia
What does follow-up look at?
During the first year after treatment, follow-up imaging tracks how the fibroid shrinks and how symptoms progress; after that, an annual gynaecological check is enough for most women. Finding a new fibroid on imaging does not by itself call for treatment: the decision again rests on symptoms, location and the woman’s plans. Heavy bleeding that returns, increasing pressure or a pregnancy plan are good reasons to bring the check-up forward.
The chance of recurrence does not settle the choice of method on its own. Accepting a bigger procedure for a lower chance of recurrence, or choosing a lighter one and accepting that a second procedure may be needed later, is a personal balance weighed together with your physician. We discuss the recurrence criticism directed at HIFU, and what the evidence says, in detail on a separate page.