Uterine Fibroids

Uterine myomas, also known as fibroids or leiomyomas, are benign tumors formed from the smooth muscle tissue of the uterus. These tumors are not cancerous and very rarely evolve into malignant neoplasms. Fibroids can vary significantly in size, from microscopic to large masses that can distort the shape of the uterus.

The fibroids are categorized according to their location in the uterus:

• Intramural Fibroids
  Develop within the uterine wall (myometrium) and are the most common type. They can cause uterine enlargement and are often associated with heavy periods and pain.
• Submucosal Fibroids
  Located beneath the endometrium (inner lining of the uterus) and protrude into the uterine cavity. This type often causes severe bleeding problems and can affect fertility.
• Subserosal Fibroids
  Develop on the outer surface of the uterus and can grow significantly without causing bleeding. However, they may apply pressure on adjacent organs.

The exact cause of fibroids remains unknown, but research has identified various factors contributing to their development:

• Hormonal Factors
  Estrogen and progesterone, the main female hormones regulating the menstrual cycle, appear to promote fibroid growth. This is why fibroids tend to grow during reproductive age and shrink after menopause.
• Genetic Factors
  Family history plays a significant role. Women with mothers or sisters who have fibroids have higher risk of developing the condition.
• Ethnicity
  Women of African descent have triple the risk of developing fibroids compared to other women, and their symptoms tend to be more severe.
• Obesity
  Obesity increases the risk due to increased estrogen levels.

Approximately 25-50% of women with fibroids have symptoms, which can include:

Menstrual Disorders

• Menorrhagia: Heavy and prolonged period
• Metrorrhagia: Bleeding between periods
• Dysmenorrhea: Intense pain during period
• Prolonged period: Duration longer than 7 days

Pain and Discomfort

• Pelvic pain that may be chronic
• Back pain
• Abdominal swelling
• Feeling of heaviness in the pelvis

Pressure on Adjacent Organs

• Urinary problems: Frequency, urgency, or difficulty urinating
• Intestinal problems: Constipation or feeling of pressure on intestine
• Sexual problems: Pain during intercourse

Fibroid diagnosis includes a combination of clinical examination and imaging methods:

• Clinical Examination
  The gynecologist performs vaginal examination to palpate the uterus and detect any abnormalities in size, shape, or texture.
• Pelvic Ultrasound
  This is the most common diagnostic method. Ultrasound can detect the presence, location, and size of fibroids.
• Magnetic Resonance Imaging (MRI)
  Provides detailed uterine imaging and is ideal for determining the exact size, location, and number of fibroids.
• Hysteroscopy
  A diagnostic procedure where a thin telescope is inserted into the uterus for direct visualization of the submucosal fibroids.

Treatment of fibroids depends on symptom severity, tumor size and location, patient age, and reproductive desires.

• Conservative Management
  
  • Monitoring
    For asymptomatic fibroids, monitoring with regular examinations is often suggested.
• Pharmaceutical Treatment
  • Hormonal contraception: Can reduce the heavy bleeding
  • Gonadotropin-releasing hormone antagonists: Can temporarily reduce the fibroid size
  • Aromatase inhibitors: Reduces estrogen levels
  • Iron supplements: For anemia treatment
• Surgical Options
  • Myomectomy
    Surgical removal of fibroids while preserving the uterus. Ideal for women who wish to preserve their fertility.
  • Hysterectomy
    Complete removal of the uterus is definitive treatment for women who do not plan to have children and have severe symptoms.
  • Minimally Invasive Techniques
  • Uterine Artery Embolization (UAE)
    A procedure where small particles are used to block fibroid blood supply, causing their shrinkage.
  • MRI-Guided Focused Ultrasound (MRgFUS)
    A non-invasive technique using focused ultrasound to destroy fibroid tissue.

Fibroids can affect fertility in various ways:

• Distortion of the uterine cavity: Can prevent embryo implantation
• Tubal obstruction: Can block the fallopian tubes
• Blood flow alteration: Can affect endometrial blood supply
• Inflammatory response: Can create hostile environment for conception

Pregnancy and Fibroids

During pregnancy, fibroids may:

• Grow due to increased hormonal levels
• Cause complications such as pain or preterm labor
• Require closer pregnancy monitoring

Most women with fibroids have excellent prognosis. Serious complications are rare but can include:

• Severe anemia: From heavy bleeding
• Fibroid torsion: Rare complication causing intense pain
• Malignant degeneration: Extremely rare (much less than 1%)

An annual visit to the gynaecologist is recommended in order to detect pathologies to the asymptomatic women. However it crucial to visit a gynaecologist if you have:

• Heavy or prolonged period
• Bleeding between periods
• Intense pelvic pain
• Difficulty conceiving
• Bladder or bowel pressure symptoms
• Increased abdominal circumference

Uterine fibroids are a common and curable condition. With modern diagnostic methods and various treatment options, most women can achieve significant improvement of their quality of life. Timely diagnosis and appropriate treatmen are keys to optimal condition management.

Individualized approach, considering age, symptoms, reproductive desires, and patient's general health status, is essential for selecting the most appropriate therapeutic strategy. With close collaboration with an experienced gynecologist and adherence to medical recommendations, women with fibroids can live full and healthy lives.

Kostis Nikolopoulos offers personalized management options, surgical or conservative management.

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