What are fibroids (uterine fibroids) and why does they occur?

Fibroids are the most common uterine tumor found in women. Myoma occurs in almost a quarter of women of childbearing age. According to one version, it is believed that it is formed in the smooth muscles of the uterus. Although the cause of fibroids (the mechanism that triggers its formation) is not exactly known, its appearance in childbearing age and the subsequent decrease in volume during menopause indicates that it is associated with the hormone estrogen. Its formation during periods of increased estrogen, such as pregnancy, confirms this point of view.

Where exactly do fibroids form in the uterus?

Fibroids can occur and develop in different places. For example, they can grow on the wall of the uterus (intramural), just under the outer lining of the uterus (subserous), into the uterus itself (submucous), and also be located outside it, while attaching to the uterus with a pedicle (pedunculated fibroids).

Figure 1. Areas of uterine fibroids formation and their types.

Are fibroids harmful? What kind of problems do they cause?

Fibroids are usually benign tumor, and cases of detection of fibroids with malignant (cancerous) cells are extremely rare. However, in cases of detection of fast-growing fibroids during routine observations, risks of cancer cell development should not be neglected. Fibroids, depending on their size and location in the uterus, can cause many problems. For example, while fibroids that grow into the uterus cause problems such as irregular bleeding, difficulty conceiving, and miscarriage (loss of pregnancy), fibroids that grow outward without being noticed for a long time can be detected by accident. Fibroids located in the front of the uterus press on the bladder, which causes frequent urination and a feeling of pressure in the front of the uterus. Fibroids pressing against the back of the intestine can cause complaints such as difficulty defecating, constipation, and pain during sexual intercourse.

Do fibroids affect pregnancy?

Fibroids, depending on the location, can cause problems such as difficulty conceiving or not being able to conceive (infertility), difficulty continuing pregnancy (miscarriage, termination of pregnancy). Thus, the formation of fibroids under the placenta leads to insufficient provision of the fetus with nutrients, as well as to a delay in fetal growth. Fibroids begin to grow during pregnancy due to hormonal changes and can increase in size by two or more times compared to the period before pregnancy. Besides, the process of fibroids degradation (cell death occurring inside the fibroids) can cause pain. Even in cases of successful onset and course of pregnancy, depending on the location, fibroids can also cause additional problems, such as difficult labor, an increase in the likelihood of cesarean section, and an increase in the number of postpartum bleeding.

A uterus surgery. Careful removal of uterine fibroids by its localization.

How is fibroids treatment done?

Treatment of fibroids is usually carried out individually, depending on the patient’s problems. Small-volume fibroids that are detected randomly and do not cause the patient complaints or problems can be tracked without any treatment. Large fibroids that cause complaints in patients (inability to conceive, miscarriage, pain, irregular bleeding, etc.) require potential treatment, and treatment planning is carried out depending on the condition of the patients, as well as the location and type of fibroids.

After the surgical removal of fibroids, the part of the uterus where the fibroid was is carefully closed.

What are the existing methods of treating fibroids?

There are many different treatments for fibroids. Some medications may allow reducing the size of the fibroids. However, if the patient does not go through menopause after stopping taking medications, the fibroids will start to grow again. Therefore, medical therapy of fibroids is not a common method of treatment. Removal of fibroids (myomectomy) makes it possible to provide a long-term cure for fibroids. Fibroids removal (myomectomy) can be performed by open surgery (laparoscopic myomectomy), closed surgery (laparoscopic myomectomy), vaginal surgery (vaginal myomectomy), or by hysteroscopy (hysteroscopic myomectomy). Treatment planning and how it will take place is coordinated with the patient after taking into consideration personal and fibroids condition. When making a decision, both advantages and disadvantages of different treatments should be considered and discussed by comparing them with each other. Another form of treatment for fibroids is selective occlusion (clogging) of the blood vessels that feed the fibroids, using angiography (embolization of the uterine arteries). The disadvantages of this method are the lack of a pathological study of the tumor, which is considered a myoma, as well as the fact that the complete removal of the myoma does not occur, and it remains in the patient’s body.

Removed fibroids before being sent for pathological examination.

Can the fibroids removal surgery be performed during a caesarean section?

The question of removing fibroids during a cesarean section has always been a subject of discussion. Some experts do not recommend performing a myomectomy during a cesarean section. They argue that during myomectomy heavy bleeding can occur since the blood flow in the uterus is too strong during pregnancy. While other specialists consider it appropriate to remove fibroids in cases where they are small in size or in situations in which myomectomy may be required for health reasons. The characteristics of the patient and fibroids, the experience of the doctor, the hospital conditions as well as the ability to meet the need for blood can be considered decisive factors in making decisions and planning treatment.

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