Early Vascular and Morphological Response After Transvaginal Radiofrequency Ablation of Uterine Fibroids: A...

Background/Objectives: Uterine fibroids are one of the most prevalent forms of benign tumors in women and may substantially impair quality of life due to heavy menstrual bleeding, pelvic pain, and pressure-related symptoms. Transvaginal radiofrequency ablation (TV-RFA) has emerged as a promising minimally invasive, uterus-sparing treatment approach. However, there exists a paucity of data regarding the early vascular response evaluated through quantitative Doppler parameters. This study aimed to assess the short-term clinical outcomes and ultrasound effectiveness of TV-RFA in treating symptomatic uterine fibroids, with particular emphasis on early vascular and morphological response. Methods: This retrospective study included 38 women who presented with symptomatic uterine fibroids and underwent TV-RFA between July 2024 and December 2025. Inclusion criteria were as follows: (1) presence of up to three intramural fibroids (FIGO types 3-6) and (2) maximum diameter of fibroids: ≤6 cm. Patients were assessed at baseline and at 1- and 3-month follow-up visits. Ultrasound evaluation included the measurement of fibroid dimensions and volume as well as quantitative Doppler parameters (Pixels Power, Ratio, and CM² Power Index). Clinical outcomes were assessed based on the intensity and duration of menstrual bleeding. Statistical analysis was performed using nonparametric tests with significance set at p < 0.05. Results: Significant reductions in fibroid dimensions and volume were observed at both follow-up time points, with the greatest effect at 3 months (p < 0.001). Doppler analysis demonstrated a marked decrease in vascularization parameters, particularly CM² Power Index and Pixels Power (p < 0.001), suggesting an early vascular response to treatment. Clinically, the proportion of patients experiencing heavy menstrual bleeding considerably reduced, accompanied by a significant shortening of bleeding duration (p < 0.001). No major complications requiring surgical intervention were reported. Conclusions: TV-RFA was associated with significant short-term reductions in fibroid vascularization, fibroid volume, and bleeding-related symptoms in this cohort of women with symptomatic uterine fibroids. Quantitative Doppler parameters may serve as valuable early markers of treatment response; however, further studies with larger cohorts and a longer follow-up duration are warranted.