Uterine fibroids (also known as myomas) are benign tumours found in the muscular layer of the uterus. Around 20% of Caucasian-origin women have them, although they are more common in African-origin women with the frequency of these tumours varying between 50-80%. Fibroids are generally diagnosed via ultrasound scans.
Fibroids in the uterus can be situated in the external wall (subserosal fibroids), in the uterine wall (intramural), or the uterine cavity (submucosal).
Regarding the symptoms, most fibroids may cause none and can be diagnosed accidentally with an ultrasound scan during the gynaecological check-up. When a fibroid is big, especially measuring 5 or more centimetres, the patient can experience abdominal pains due to pressure on the surrounding organs, such as the bladder, rectum or intestine. The submucosal fibroids – inside the uterus and touching the endometrium – cause abundant menstruation, random spotting at any other time than the menstruation and anaemia more commonly.
Fibroids can have an impact on fertility depending on where they are situated. Submucosal fibroids affecting the endometrium hinder the chances of natural pregnancy or IVF treatment success the most as they can interfere with embryo implantation or favour uterine shedding and cause miscarriage. Myomas in the external layer of the uterus have low impact, whereas only the big intramural myomas can impede implantation by affecting the blood vessels carrying nutrients to the uterus.
Between 2 and 15% of pregnant women are diagnosed with fibroids which can slightly grow during the first trimester, but if they are small, they do not cause any complications. Sometimes fibroids can become exuberant and affect the blood flow in the uterus resulting in severe pains which may require hospitalisation. Besides, fibroids affecting the cervix can influence the position of the foetus or even impede the progress of labour as the cervix does not dilate correctly. Such situations increase the necessity of c-sections.
The treatment when the fibroid is small and asymptomatic solely requires regular check-ups. If a woman desires to have children or has very abundant periods and submucosal myomas, the ideal solution is resection via hysteroscopy. Surgical treatment like laparoscopy, laparotomy or blocking fibroid growth by obstructing the uterine arteria which pumps blood into the uterus can be considered when fibroids are intramural or subserosal and bigger than 6 centimetres. Current technologies allow fibroid destruction by guided puncture and radiofrequency.
Treatment with medicines still has limited success because they can moderately reduce the size but the fibroids regrow once the medication is stopped. Thus, the medicines are prescribed to alleviate the symptoms just before the surgical intervention.
Gregorio Manzanera Bueno
#fibroids
#hysteroscopy
#assistedreproduction
#fertilitytreatment
#donoreggreception
#IVF
#ICSI
#ivficsi
#artificialinsemination
#manzaneraclinic
#gynaecology