Uterine Fibroids

Uterine fibroids, also known as uterine myomas or leiomyomas, are among the most prevalent benign tumours in women. They originate from the excessive growth of smooth muscle cells in the uterine wall and can develop in various locations within the uterus. Fibroids can present as single or multiple tumours. It is estimated that approximately one-fourth of women in this region experience uterine fibroids, often incidentally detected during ultrasound examinations due to their asymptomatic nature.

Uterine fibroids can be categorized into four main types:

1. Subserosal fibroids: These fibroids grow outward from the uterus into the abdominal cavity. They typically exhibit milder clinical symptoms and may require significant growth before becoming noticeable.
2. Submucosal fibroids: These fibroids develop within the inner lining of the uterus (endometrium). They tend to cause more pronounced clinical symptoms, with increased menstrual bleeding being the most common manifestation.
3. Intramural fibroids: This is the most common type of fibroid, situated within the muscular wall of the uterus.
4. Cervical fibroids: These fibroids grow near the cervix and are less frequently observed in clinical practice.

Approximately 70% of women will develop uterine fibroids in their lifetime, and about one in every two to three women of reproductive age is affected. The following factors are considered to increase the risk of uterine fibroids:

1. Nulliparity (never having given birth)
2. Obesity
3. Family history of the condition

The majority of women with uterine fibroids do not experience symptoms, and the condition is often discovered incidentally during medical check-ups. Depending on the number, size, and location of the fibroids, some patients may experience heavier menstrual bleeding, while a small portion may have accompanying menstrual pain. Large fibroids can cause abdominal pain or a protruding abdomen, and if they exert pressure on the bladder, it can lead to increased urination. Other symptoms include abnormal vaginal bleeding, pain during sexual intercourse, and lower back pain.

Uterine fibroids are typically non-cancerous tumours and do not directly develop into cancer. In extremely rare cases (approximately 0.1% to 0.3% of all uterine fibroid cases), uterine fibroids may transform into a rare form of cancer called leiomyosarcoma. The likelihood of fibroids progressing to malignant tumours is only possible if they exhibit abnormal growth rates or continue to grow after menopause.

The impact on fertility varies depending on the size and location of the fibroids. Generally, uterine fibroids have a low likelihood of causing infertility. If you are planning to conceive and have uterine fibroids, it is advisable to consult a gynaecologist for a thorough evaluation.

Transvaginal ultrasound

Transvaginal ultrasound examination is the most convenient and accurate non-invasive diagnostic method. This procedure involves using an ultrasound probe placed in the vagina to visualize the uterus and detect fibroids. Due to the close proximity of the vagina to the uterus, transvaginal ultrasound can identify fibroids as small as 4-5mm².

Abdominal Ultrasound

Abdominal ultrasound is a diagnostic method that uses sound waves to create images of the uterus. It is particularly useful for examining larger fibroids due to its deeper penetration.

Magnetic Resonance Imaging (MRI)

MRI is a highly accurate imaging technique that can assess the size and location of fibroids within the uterine wall. It can be used in conjunction with ultrasound to distinguish between uterine fibroids and adenomyosis.

Ultrasound examination is one of the most commonly used methods for diagnosing uterine fibroids. It can be performed abdominally or transvaginally, allowing doctors to visualize the fibroids and evaluate their characteristics such as size, number, and location. Hysteroscopy is another procedure that can be used to further examine submucosal fibroids and provide an opportunity for inspection and removal of polyps. Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) can provide more detailed imaging information, offering a better understanding of the location and nature of fibroids. However, these imaging techniques are typically reserved for cases where further evaluation of fibroid location, size, or suspicion of malignancy is necessary, considering their higher cost.

Generally, if there are no significant symptoms or complications, regular observation is sufficient and surgical treatment is unnecessary. However, in some cases, individual patients may require medication to alleviate symptoms such as heavy menstrual bleeding and pain. It's important to note that these medications can only help control the symptoms and cannot cure uterine fibroids. Over time, fibroids may naturally shrink after menopause. However, surgical treatment may be considered if there is excessive menstrual bleeding, severe pain that cannot be controlled by medication, continuous fibroid growth, or if they are affecting fertility. It's worth noting that even after surgery, there is still a chance of fibroid recurrence.

Doctors will discuss with you the most suitable treatment options based on your symptoms, the size, and location of the fibroids. These options may include:

Medication therapy

Currently, there are no medications available to make fibroids shrink or disappear. For patients with mild symptoms, doctors typically prescribe pain relievers to manage menstrual pain and hormone medications to regulate menstrual cycles and reduce excessive bleeding.

Surgical treatment

• Myomectomy

After fibroid removal surgery, there is still a chance of recurrence, and symptoms may not completely improve. The more numerous and larger the fibroids, the higher the surgical risks, and there may be scars on the uterine wall. There are three methods for surgical removal of uterine fibroids, and the doctor will recommend the most appropriate one based on the size, number, and location of the fibroids:

• Hysteroscopic myomectomy

• Laparoscopic myomectomy

• Abdominal myomectomy

• Hysterectomy

Hysterectomy is a surgical procedure that offers a definitive cure for uterine fibroids; however, it is only recommended for individuals who do not plan to have any more children. There are two types of hysterectomy surgeries: minimally invasive and traditional surgery.

• Laparoscopic Hysterectomy

• Open Hysterectomy

• Uterine Artery Embolization

Uterine artery embolization is a conservative and minimally invasive interventional treatment. It involves the insertion of a catheter through the femoral artery to selectively block the main arteries that supply blood to the uterine fibroids. This causes the fibroids to shrink and undergo necrosis due to reduced blood flow. UAE is suitable for women who wish to preserve their uterus or improve their fertility.

Virtus Obstetrics and Gynaecology specialists