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Uterine fibroids are benign leiomyomas (fibroids) that develop in the walls of the uterus. Any woman, at any age, can have them. Initially, uterine fibroids are asymptomatic and do not require treatment. However, uterine fibroids need to be systematically monitored to make sure that nothing is wrong. Find out what the types of fibroids are and what their symptoms are. How is the treatment of fibroids?

Uterine fibroids(uterine fibroids, Latinmyoma , plmyomata uteri )) are benign leiomyoma tumors that arise from the muscle tissue of the uterus. Uterine fibroids very rarely (0.1-0.8 percent) malignant to form leiomyosarcoma (Latinleiomyosarcoma ).

Every fifth woman over 35 and every second menstruating 50-year-old suffers from uterine fibroids. Muscles make up 95 percent. all benign tumors of the reproductive organ.

Most fibroids are detected by chance. Once detected, uterine fibroids are usually only observed. You operate on those fibroids that cause pain, heavy (bleeding-like) periods, prolonged bleeding or excessively large periods. Surgery is also necessary when a large myoma puts pressure on the bladder, causes constant pressure, makes it difficult or impossible to urinate.

Uterine fibroids: causes

The causes of uterine fibroidsare not entirely clear, as none of the theories is 100% confirmed. The good news is that uterine fibroids arebenign uterine tumors . Only 1 percent. of them undergoes a malignant transformation into leiomyosarcoma.

The most frequently mentionedcause of uterine fibroidsis excessively high levels of estrogen or the hypersensitivity of cells to estrogens. However, not every woman with high estrogen levels develops uterine fibroids. When attempts were made to treat fibroids with progestogens, it turned out that in many cases it led to their growth. Hence, it is believed that progesterone may also cause the formation of uterine fibroids.

It also happens that fibroids occur, for example, after curettage of the uterus for other reasons. This is presumed to be a cellular response to an injury similar tothe reaction of the skin on which keloids are formed.

Some doctors support the theory that the reasons for the tendency to appear these benign nodules should be found in abnormalities in the development of the reproductive organsin the girl's fetal period .genetic factorscertainly play an important role, because uterine fibroids often run in families.

Many gynecological diseases, including uterine fibroids,are hereditary . Getting to know the history of the disease in the family can help to effectively determine whether we are at risk of developing certain diseases.

There areseveral risk factorsthat make a woman more likely to develop uterine fibroids. However, none of them is 100% determinant of the appearance of the disease. Obesity and overweight promote uterine fibroids.

The excess of adipose tissue, as doctors say - the development of the body of adipose tissue - leads to increased production of estrogens, which may affect the development of fibroids. Every 10 kg over the normal weight increases the risk of fibroids by 20%.

Interestingly, even weight loss does not inhibit estrogen production, precisely because the body of adipose tissue has been expanded. That is why it is very important not to gain weight and not to allow girls to gain weight.

Women who have longer periods are also more likely to develop uterine fibroids. A risk factor is the arrival of the first period before the age of 10. However, this also does not work for 100 percent. women.

Uterine fibroids: types

Myomas are made of smooth muscle, just like the wall of the uterus. They rarely appear as single tumors. Usually there are several or a dozen of them. They come in different sizes: from 2-3 cm up to the size of a soccer ball.

Most often, however, they do not exceed 10-12 cm. When there are many fibroids in the uterus, it loses its physiological shape and size. Doctors then talk aboutmyomatous uterus , which can even extend to the costal arches.

Depending on their location, fibroids are:

  • subserial- grow outside the uterus, towards the serosa that covers it from the side of the abdominal cavity
  • intramural- develop in the wall of the uterus, enlarging it both across and lengthwise and across
  • submucosa- grow towards the center of the uterus, towards the lining of the womb

The outside and inside of the uterus may developpedunculated fibroids . They areconnected to the uterine body by a band of connective tissue, the so-called peduncles (it looks like a balloon on a string).

Uterine fibroids: symptoms

Symptoms of uterine fibroidsdepend, inter alia, on on their location and size.

  • Sub-serum and intramural fibroids- sometimes they cause pain by putting pressure on adjacent internal organs. It may be pain in the lower abdomen or sciatica, there is a feeling of pressure on the bladder or rectum. Sometimes they lead to urinary retention or incontinence, other times they cause chronic constipation and even intestinal obstruction.
  • Submucosal fibroids- can cause painful, prolonged, heavy periods, with clots or bleeding between periods. These symptoms are explained by hindered contraction of the uterine blood vessels and prolonged healing of the mucosa exfoliated during menstruation. Heavy menstruation and long bleeding can lead to anemia and even heart failure. Women then experience weakness, headaches, shortness of breath and increased heart rate. Myomas that sit under the lining of the womb are sometimes the cause of infertility (making it difficult for an egg to implant), as well as miscarriages and premature births.
  • Pedunculated submucosal fibroids- it sometimes bulges into the uterine cavity and passes (is born) to the vagina through the cervix. When the myoma is born, it causes the uterus to contract strongly, similar to labor. Sharp pains and bleeding also occur when the myoma in the abdominal cavity twists.
According to an expertDr. Grzegorz Południewski, specialist in gynecology, expert of the "Zdrowa ONA" program

Myomasis a lesion often found in women. Not all types of it cause ailments, but all of them have the potential to have a significant impact on he alth. Myomas can affect the well-being of female patients, their fertility, impede childbirth, provoke hemorrhages, and ultimately lead to the need to remove the uterus. It would be worthwhile for the awareness of this disease to be greater and for women to consult a doctor beforehand for conservative or, as a last resort, surgical treatment.

Uterine fibroids: diagnosis

The gynecologist may suspect fibroids based on the symptoms. But for diagnosis, you need a gynecological examination and the result of a transvaginal ultrasound. Transvaginal ultrasound should be performed by an ultrasound gynecologist and in a proven office - then it is reliable.

After inserting the camera head intoof the vagina, the doctor can carefully examine the cervix, the inside of the uterine cavity and the ovaries, and determine the type and size of fibroids (the examination is able to detect even very small nodules when they do not show any symptoms).

Uterine fibroids: drug treatment

Myomas, whichdo not cause ailments, do not require treatment . They do not pose a he alth hazard. However, you should visit the gynecologist forcheckupsto see if the nodules are growing.

Specialists reassure that tumors that grow systematically but slowly are usually benign changes. They are only malignant in 0.2-0.5 percent. cases. Also, not all those that grow rapidly are malignant tumors.

Treatment of uterine fibroidsis varied - it is often not necessary to undergo surgery under general anesthesia and dissect the abdomen. Myomas are treated pharmacologically, as well as with laparoscopy or embolization.

According to research, in 2009 in our country, 127 361 hysterectomies (surgery to remove the uterus), 12 578 myomectomies (surgical removal of the fibroids) and 2619 vaginal resections were performed due to uterine fibroids. Surgical removal of the reproductive organ is still one of the most frequently used methods of treating women with uterine fibroids.

Myomas, which cause minor symptoms,are treated medicinally(painkillers or anti-inflammatory drugs), and in justified cases, hormonal drugs are given.

When fibroids are causing bleeding, an intrauterine device that releases the hormone into the uterus can help. However, this does not contribute to the reduction of large tumors. Such an effect is achieved by gonadoliberin (GnRH) analogs, which are used 3-4 months before the procedure of enucleation of fibroids to facilitate their removal.

But hormones are not a cure for fibroids, sometimes they can only help to reduce them.

Doctors use them less and less, because introducing women to the so-calledpharmacological menopauseis associated with strong symptoms characteristic of the menopause (hot flushes, insomnia or osteoporosis), which must be eliminated by administering other hormones. After stopping the hormonal drugs, fibroids may grow faster. Therefore, such therapy should not last longer than 6 months.

Removal of uterine fibroids: when and how?

In some cases, a surgical procedure is required to excise the fibroids. The doctor usually suggests it when:

  1. fibroids cause persistent ailments,e.g. bleeding,pains
  2. tumors prevent pregnancy
  3. the tumor grows rapidly , e.g. in three months it will grow from 10 to 25 cm (it is suspected that it is not a benign myoma, but a malignant sarcoma)
  4. pediculated fibroids are mobile- not because they are dangerous in themselves, but to prevent twisting of the "ribbon" attached to the uterus ( this would block the blood supply to the tissue, leading to tissue necrosis)

What is the best time to have uterine fibroids removed?

Regardless of the method used, fibroids are removedafter menstruation , in the first phase of the cycle (before day 14). Most likely, the woman is not pregnant then, moreover, there is less bleeding during and after the procedure on these days.

After abdominal surgery, you usually leave the hospital on the fourth day after the surgery, after laparoscopy - on the second day, after removal of the fibroids from the vaginal side - 24 hours later. The recovery time is an individual matter for every woman. But usually after a month he returns to form and forgets that the operation took place at all.

Myomas are most often removed during abdominal surgery, under epidural anesthesia (ductal or spinal).

Uterine fibroids surgery - laparoscopy

In the case of small subserial pediculosis nodules, sometimes the laparoscopic method can be used.

Usually, however, they are removed "incidentally" with the use of a laparoscope, eg when removing a cyst. Only completely he althy women can undergo laparoscopy.

Contraindications to the procedure include :

  • hypertension
  • neurological diseases
  • obesity
  • circulatory disorders
  • varicose veins
  • endocrine problems

The position in which it is performed - upside down - is dangerous for women who have high blood pressure or neurological diseases because it causes congestion in the brain.

Sometimes submucosal fibroids that are born into the vagina can be removed from the side of the vagina. This procedure is performed under spinal or short intravenous anesthesia.

Surgery to remove uterine fibroids

The extent of the operation is highly dependent on the age, size of fibroids, and overall he alth of the woman. It can be as follows:

  • removal of the fibroids(however, this does not guarantee that no new ones will appear) or
  • partial or complete (hysterectomy) removal of the reproductive organ

You shouldn't have your entire uterus excised unless it's absolutelynecessary.

The rule is: only remove what is sick. The woman needs to know what she will gain and lose as a result of the surgery and decide whether or not she accepts the proposed treatment. And what doctors suggest usually depends on the age of the woman.

  • In women who have not yet given birth and in those who want to have children

is performedsparing operations , i.e. fibroids are removed, preserving the entire uterus. During their enucleation, however, the uterine cavity may open. Then you need to insert an intrauterine device, which acts as a contraceptive, accelerates the healing of the operated area and protects against adhesions that prevent pregnancy. After three months, the IUD is removed and the woman may try to get pregnant.

It should be remembered, however, that pregnancy after fibroids surgery is one of the high risk and requires more frequent than usual visits to the gynecologist, and when the uterus has been opened - solution is performed by caesarean section. Natural childbirth may result in uterine rupture.

  • If a premenopausal woman has large tumors, heavy periods

andgood cytology , it is proposed to remove the uterine body, but leave the cervix. Whenthe cytology results are not good , the cervix is ​​also removed. If the woman is under the age of 47, the ovaries can also be left on, provided that there are no changes and samples were taken during the operation.

  • For women around 50

both those who still haveregular periodsand those who have entered the climacteric period, removing the fibroids (whether only the uterus or the uterus are removed). neck), , it is also proposed to remove the ovaries , because at this age their function in the body ceases. After the surgery, hormone replacement therapy (HRT) is introduced.

  • In women over the age of 60 , the entire reproductive organ is usually removed when the fibroids are removed.

Treatment of uterine fibroids: embolization of fibroids

The embolization of fibroids causes thrombosis around the myoma, which results in the closure of the blood supply to the tumor. A thin catheter is inserted into the uterine arteries, through which the contrast agent is first administered, and then the so-called PVA embolization preparation, which closes the vessels supplying the myoma with blood. This way, you can remove one or more fibroids at the same time.

The procedure is performed under local anesthesia. Usually, the next day after embolization, patients return home.As a result of ischemia, myomas are reduced on average by half three months after the procedure and by 70-80%. after half a year.

Sometimes, however, they fall into the uterine cavity and then need to be surgically removed. Treatments are performed in the case of non-pedunculated fibroids, not larger than 5-10 cm.NFZ does not finance embolization . So you have to pay for the procedure out of your own pocket.

Treatment of uterine fibroids: ulipristal acetate

Since 2012, a new orally administered drug based on an organic chemical compound from the group of steroid hormones has been available in Western Europe and Poland. The active substance isulipristal acetate , which stops bleeding 10 days after starting therapy, alleviating troublesome symptoms, and a three-month treatment reduces the size of the myoma by up to 30-50%.

Moreover, this effect persists after discontinuation of the preparation, thanks to which, in some patients, pharmacological treatment alone allows you to avoid surgery andallows you to get pregnant .

If surgery is still necessary, reducing the volume of the myoma with ulipristal acetate increases the chances of a conserving surgery. The new therapyis not yet reimbursed by the National He alth Fund , and the cost of the three-month treatment is over PLN 2,000. PLN.

According to new indications in Polandthe drug can be used twice in one patient . The treatment can be repeated, e.g. in the event of recurrence of symptoms, keeping a minimum interval of two menstruation from the end of the first treatment cycle.

Professor Jacques Donnez, the creator of ulipristal acetate, recently published an algorithm that allows a total of 12 months of use of the drug before surgical intervention. For now, however, it has only entered into force in Western Europe.

Uterine fibroids and pregnancy

Uterine fibroids in pregnancyare not treated - they grow with the developing fetus. When myomas are positioned so that they are not an obstacle -a woman can give birth by force of nature .

If they could cause any complications during labor, thencaesarean section is performed .

Myomas can be removed at the earliest six months after giving birth. However, if they do not cause any discomfort, it is not necessary. But you have to get rid of the fibroids before getting pregnant again.

Uterine fibroids: causes and treatment

Uterine fibroids develop in the walls of the uterus and are not malignant - they are benign leiomyomas, or fibroids. Uterine fibroids appear in different women, regardless of age. What are thethe causes of myomas? How are fibroids treated? These questions are answered by our expert - lek. med. Ewelina Śliwka-Zapaśnik from the LUX MED Center.

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Female diseases