Uterine fibroids

One in 2 women over the age of 40 will usually develop uterine fibroids (medical term: leiomyomas), regardless of whether or not treatment is required.

Uterine fibroids are benign growths that develop in the wall of the uterus; they can range in size from very tiny to several inches. Rarely may they occupy the whole pelvic (see figure) or abdominal area. Fortunately, today, due to regular check-ups, they can be detected when smaller. They thrive due to estrogens and their growth stops after menopause.

Uterine fibroids typically grow within the uterine wall, either inside the uterine cavity (submucosal), or in the wall of the uterus (intramural) or on the outside of the uterus (subserosal). A subcategory of the latter is the pedunculated fibroids;these fibroids are attached to the outside of the uterus by a stalk, within the abdominal area. It is often likely that more than one fibroid may grow in one or more sites described above (see figure).

Symptoms:
There are three types of symptoms:

1. Bleeding either during period (menorrhagia) or unpredictable bleeding between periods (uterine bleeding). Usually in the long-term or sometimes suddenly, they may even lead to severe anemia requiring transfusion;
2. Infertility and/or 2nd trimester miscarriages if they distort the uterine cavity;
3. High-pressure phenomena; due to their size, they bring pressure on adjacent organs causing e.g. constipation, pollakiuria etc.
A combination of some or all of these symptoms in one case is not uncommon.

Info: Uterine fibroids do not usually cause any pain unless they are necrotic (degenerated), but not in all cases.

Uterine fibroids treatment:
Treatment for fibroids may include medications or surgery (conservative or radical), which is usually specific to each patient, considering the following crucial factors: the patient’s age; the pregnancy desire; the type of symptoms; the fibroid location; the number and size. Example I: a fibroid – even a small one – found within the uterine cavity (submucosal) causing bleeding or preventing conception should be removed (by hysteroscopy, nearly always); Example II: A fibroid within the uterine wall (intramural), which does not distort the uterine cavity, may usually be monitored. If, on the other hand, it distorts the uterine cavity (causing bleeding and/or preventing fertility), it should also be removed surgically; Example III: The fibroids on the outside wall of the uterus (subserosal and pedunculated fibroids), even those reaching many inches in size, unless they cause high-pressure symptoms to adjacent pelvic organs, may be monitored conservatively.

- There is a great range of recommended surgical procedures for removing large fibroids depending on each surgeon’s experience and training. Over the last two decades, laparoscopic surgery has nearly replaced open surgery for fibroid removal in all state-of-the-art clinics. There is an exception in case of a great number of fibroids (over 10).

- For women who desire faster results, especially for those who have undergone failed medication treatment, surgical fibroid removal (myomectomy), and ideally laparoscopic or robot-assisted surgery (laparoscopic or robotic myomectomy) is the ideal conservative surgical solution.

- Finally, women who have already procreated and followed a failed medical treatment or having undergone a recent or previous fibroid removal, and now they desire a definiteandpermanent solution, they may be considered as ideal candidates for laparoscopic total removal of the uterus with or without ovarian preservation (laparoscopic or robotic hysterectomy).