Fibroids: What are Fibroids? Fibroids Symptoms, Treatment, Diagnosis

Uterine fibroids overview

Fibroids are tumors made of smooth muscle cells and fibrous connective tissue. They develop in the uterus. It is estimated that 70 to 80 percent of women will develop fibroids in their lifetime — however, not everyone will develop symptoms or require treatment.

The most important characteristic of fibroids is that they’re almost always benign, or noncancerous. That said, some fibroids begin as cancer — but benign fibroids can’t become cancer.

Cancerous fibroids are very rare. Because of this fact, it’s reasonable for women without symptoms to opt for observation rather than treatment.

Studies show that fibroids grow at different rates, even when a woman has more than one. They can range from the size of a pea to (occasionally) the size of a watermelon. Even if fibroids grow that large, we offer timely and effective treatment to provide relief.

Other facts about fibroids

Other key points about uterine fibroids:

• Uterine fibroids are the most common tumor of the reproductive tract.
• Women who are nearing menopause are at the greatest risk for fibroids.
• Fibroids are most often found during a routine pelvic exam.
• Symptoms may include heavy and prolonged periods, bleeding between periods and pelvic pain.
• There are a variety of treatment options available.

Types of fibroids

Along with the size and number of fibroids, the type can also affect treatment recommendations. The three main types of fibroids include:

• Subserosal fibroids: These are the most common fibroids. They can push outside of the uterus into the pelvis. Subserosal fibroids can grow large at times and sometimes have a stalk that attaches to the uterus (pedunculated fibroid).
• Intramural fibroids: These fibroids develop in the muscular wall of the uterus.
• Submucosal fibroids: These fibroids are uncommon. They can grow into the open space inside the uterus and may also include a stalk.

What causes fibroids?

The cause of uterine fibroids is not known, although studies demonstrate there may be a genetic component. There is no definite external exposure that a woman can have that causes her to develop fibroids.

Who is at risk for uterine fibroids?

Various factors can increase the risk of developing fibroids:

• Age: Fibroids become more common as women age, especially during their 30s and 40s and up to menopause. After menopause, fibroids are much less likely to form and usually shrink if they’re present.
• Family history: Having a family member with fibroids increases your risk. If a woman’s mother had fibroids, her risk of having them is about three times higher than average.
• Ethnic origin: African-American women are more likely to develop fibroids than other ethnicities .
• Obesity: Women who are overweight are at higher risk for fibroids. For very heavy women, the risk is two to three times greater than average.

What are the symptoms of uterine fibroids?

Most women with fibroids will experience no symptoms at all. However, large or numerous fibroids can cause the following symptoms:  

• Heavy or prolonged periods
• Bleeding between periods
• Pelvic pain and pressure
• Frequent urination
• Low back pain
• Pain during intercourse
• Difficulty getting pregnant

How are uterine fibroids diagnosed?

Fibroids are most often found during a physical exam. Your health care provider may feel a firm, irregular (often painless) lump during an abdominal or pelvic exam.

Scans can confirm a diagnosis. These tests are the two main options:

• Ultrasound: Ultrasound is the most commonly used scan for fibroids. It uses sound waves to diagnose fibroids and involves frequencies (pitch) much higher than what you can hear. A doctor or technician places an ultrasound probe on the abdomen or inside the vagina to help scan the uterus and ovaries. It is quick, simple and generally accurate. However, it relies on the experience and skill of the doctor or technician to produce good results.  Other tests such as MRI may be better for other conditions, such as adenomyosis.
• MRI: This imaging test uses magnets and radio waves to produce images. It allows your provider to gain a road map of the size, number and location of the fibroids. We can also distinguish between fibroids and adenomyosis, which sometimes gets misdiagnosed. We use MRI to confirm a diagnosis and help determine which treatments are best for you. MRI may also provide a better option for related conditions such as adenomyosis.

Other tests for uterine fibroids

In special circumstances or if doctors can’t identify the source of your pain, you may need additional testing:

• Hysterosalpingogram (HSG): Doctors typically use an HSG for women having trouble getting pregnant. It checks the inside of the uterus (uterine cavity) and fallopian tubes. After a doctor places a catheter (small tube) in the uterus, the doctor slowly injects a special dye for contrast and takes X-rays.
• Hysterosonogram: Doctors use a hysterosonogram to see the inside of the uterus. After they place a small catheter inside the uterus, they inject water while taking a series of ultrasound images. The test can confirm the presence of uterine polyps or intracavitary fibroids that can cause heavy bleeding.
• Laparoscopy: For laparoscopy, a doctor makes tiny incisions in or near the navel. The doctor then inserts a long, thin instrument (laparoscope) into the abdomen and pelvis. The laparoscope has a bright light and a camera. It allows your doctor to see the uterus and surrounding structures. The view can help your doctor determine if you have a condition such as endometriosis, which can cause pelvic pain.
• Hysteroscopy: For suspected abnormalities inside the uterus, a doctor uses a long, thin instrument with a camera and light. The doctor passes the instrument through the vagina and cervix into the uterus. No incision is needed. The doctor can look for fibroids or endometrial polyps within the cavity of the uterus with this approach. Your doctor may also remove some types of fibroids during this procedure.

How are uterine fibroids treated?

Since most fibroids stop growing and may even shrink as women approach menopause, your doctor might initially recommend observation. However, some fibroids might require more active treatment, depending on:

• Extent of symptoms
• Your age
• Your fertility goals
• Number and size of the fibroids
• Any previous fibroids treatments
• Other health conditions present

Learn more about fibroid treatment.

What are the complications of uterine fibroids?

It is uncommon for fibroids to cause severe health consequences. However, women can have heavy bleeding that can lead to dangerous anemia, or lack of red blood cells.

Rarely, large fibroids can press on the bladder and the channel (ureter) that sends urine there from the kidney. This pressure can lead to kidney damage. Other complications include infertility and repeated pregnancy loss.

Fibroid Tumors – UNC Department of Obstetrics & Gynecology

What are fibroid tumors?

Fibroids are benign (non-cancerous) tumors, or growths, within the muscle wall of the uterus.  Each fibroid is thought to arise from a single cell which grows into a mass.  Both estrogen and progesterone hormones (products of the ovaries) are thought to promote the growth of fibroids.  Some fibroids will remain stable in size over many years while others will appear suddenly and grow quite rapidly.  Whether or not treatment is needed depends on the size, location, and rate of growth of the fibroids.  Symptoms are caused by the size of the fibroids themselves (heaviness or pressure in the pelvis), or by pressure on surrounding organs such as the bladder or large intestine.   Very rarely, about 1 in 10,000 cases, a fibroid may develop into a sarcoma, or very aggressive cancer.Many fibroids produce no symptoms at all, and are simply noted during the course of routine annual examinations and Pap smears.  Others will cause heavy and prolonged periods.  In still other situations, the size and position of the fibroid(s) may cause pain during intercourse, increased menstrual cramps, or decreased bladder capacity.

Are there medical treatments for fibroids?

Hormonal treatments have relatively little effect on fibroids.  In fact, birth control pills can sometimes make them grow.  An exception to this seems to be the progesterone-containing IUD, Mirena, which reduces menstrual flow, and in one recent study, has been shown to shrink fibroids slightly.  Once in place, this IUD is effective  contraception for seven years.Fibroids are mostly dependent on estrogen to stimulate their growth.  For this reason, they often grow until menopause, then shrink, and can grow again if Hormone Replacement Therapy (HRT) is used after menopause.   Shutting off ovarian function by the use of Lupron can result in a 30-60% decrease in fibroid size over two to three months, but they will re-grow within a few months after stopping the drug.  For this reason, Lupron has its best role as a medication to shrink fibroids in order to make a planned surgery easier.

What surgical treatments are there for fibroids?

Myomectomy

The uterus can be preserved when fibroids can be removed and the uterine muscle itself repaired. This procedure is called a myomectomy.

A myomectomy can be performed through an open incision, or in some cases, laparoscopically.  Most experts believe that about 9-10 centimeters (about 4 inches) diameter is the largest size fibroid that should be removed laparoscopically.  A few important points to remember about myomectomy:

• If four or fewer fibroids are present, the chance of regrowth of fibroids over the subsequent 5 years after myomectomy is about 10 %.
• If more than four fibroids are present when they are removed, the chance of regrowth after myomectomy is more than doubled.
• Tests such as ultrasounds and MRI scans cannot accurately count fibroids when more than four or five are present.
• For this reason, the exact number of fibroids present (and therefore the chances of regrowth after myomectomy) many times cannot be determined until the myomectomy surgery is begun.
• Adhesions, or scar tissue, commonly forms after myomectomy, and can cause fertility problems and pain.

Hysterectomy

When symptoms are severe enough, when fibroids are growing particularly quickly, when there are so many that myomectomy is impractical, or when a person wants to be certain that the fibroids will not grow back, then removal of the uterus and fibroids together makes sense.  When the uterus and cervix are removed together, it is called a complete hysterectomy.  In most cases the ovaries can be left in place.The types of hysterectomy that are possible in an individual situation depends on the size of the uterus and fibroids, how much previous surgery has been done, and whether or not you have had a vaginal delivery in the past.   Laparoscopic hysterectomy can be performed to remove a uterus as large as a five month pregnancy (about up to the navel) or larger in some cases.  Vaginal hysterectomy can be done if there is enough room in the pelvis and there are not too many adhesions of bowels to the uterus.  Sometimes, we will do laparoscopy to remove adhesions, then do the rest of the surgery vaginally.  If either the laparoscopic or vaginal approach will not work, then an abdominal incision is made (traditional laparotomy), although in our experience this is necessary in only 5-10% of cases.In many cases, we will remove the uterus, but leave the cervix (mouth of the uterus) in place.  Click on supracervical hysterectomy to learn more.

What about uterine artery embolization (UAE)?

This procedure is done by interventional radiologists.  It involves introducing a catheter into the artery and the top of the leg, threading it into the arteries supplying the fibroid or fibroids, then injecting some plastic granules that plug off the blood vessels, essentially starving the fibroid of its blood supply. Typically, this procedure takes 1-2 hours, requires an overnight stay in the hospital for pain control, and has a recovery period of 1-2 weeks.  The larger the fibroids treated, the greater the pain and the longer the recovery period. Fibroids shrink between 30-60 %.  The rate of recurrence of fibroids over many years is uncertain, as the procedure is relatively new.  Patients are usually advised that they should not plan to become pregnant after this procedure, as it is not certain that the uterine wall will be strong enough after this procedure to carry a pregnancy.  There is also a 5-10% chance that one or both ovaries will stop functioning after this procedure.We have seen a number of women who have had UAE, and then, when their symptoms were not cured, went on to have laparoscopic hysterectomy.  There has not been a scientific study to directly compare the two methods, but these patients have told us that the pain after the procedure was less after hysterectomy than it was after UAE.

Fibroids Treatment | UCSF Health

Uterine Artery Embolization (UAE)

Uterine artery embolization is a relatively new procedure and an alternative to open surgery for fibroids. Embolization is a technique that blocks the blood flow to the fibroid or fibroids, causing them to shrink and die. This also often decreases menstrual bleeding and symptoms of pain, pressure, urinary frequency or constipation.

UAE is performed in a radiology suite rather than an operating room, by an interventional radiologist. An intravenous (IV) line will be placed before beginning the procedure, and you will be sedated. You will remain awake, but sleepy, throughout the procedure.

A needle is placed in an artery in your leg, at the groin crease. A small catheter is then placed into the artery and X-rays are taken of the arteries — a test called an arteriogram — that supply the fibroids. The catheter is then used to select these arteries and slowly inject particles called polyvinyl alcohol, which are the size of a sand grain. The particles block the flow of blood. After the left and right uterine arteries are embolized, another arteriogram is performed to confirm the procedure is complete.

Afterward, you must rest in bed for six hours, lying flat with your leg straight. The amount of pain patients experience varies. The most significant pain usually occurs immediately following the procedure and over the next six hours. Patients usually stay overnight in the hospital, so we can monitor the arterial access site and provide adequate pain control. You will be discharged the next morning. Most women can return to full activity in a week.

When blood flow to the fibroid is blocked, the fibroid gets no oxygen and will begin to die. This process happens over days to months. During this time the fibroid shrinks by about 40 to 50 percent and the uterus by about 30 to 40 percent. Our experience and the scientific literature suggest that symptoms will improve in 80 to 90 percent of patients. For some, UAE is ineffective. Serious complications occur in less then four percent of patients.

Read more about uterine artery embolization.

What Is a Myoma? Causes, Types, Symptoms, and Treatments

Uterine fibroids are non-cancerous tumors that grow in the uterus.  They are also known as myomas. If your doctor has diagnosed you with a myoma (or uterine fibroid), it is important to know that it is the most common benign tumor of a woman’s uterus and can be treated. So, what is a myoma? Read on for more information on the causes, symptoms and treatment options.

What Is a Myoma?

Myomas are smooth, non-cancerous tumors that may develop in or around the uterus. Made partly of muscle tissue, myomas seldom develop in the cervix, but when they do, there are usually myomas in the larger, upper part of the uterus as well. (i) Myomas in this part of the uterus are also called fibroids or leiomyomas.

Doctors can see or feel most myomas during a pelvic examination. Those that cause symptoms can be removed surgically or by less invasive procedures.

The Symptoms of Myomas (a.k.a. Uterine Fibroids)

Most myomas cause symptoms at some point. (i) The most common symptom is vaginal bleeding, which may be irregular or heavy. (i) Other symptoms may include: (i)

• Heavy bleeding
• Anemia
• Fatigue and weakness
• Painful intercourse
• Pain, bleeding, or a discharge from the vagina if myomas become infected
• A feeling of pressure or a lump in the abdomen, in rare cases
• Difficulties urinating, dribble at the end of urination, or urine retention if a myoma blocks the flow of urine. Urinary tract infections are more likely to develop in women with myomas

Large myomas may partially block the urinary tract or may bulge into the vagina, called a prolapse. Sores can develop on prolapsed myomas, which may become infected, bleed, or both. Prolapsed myomas also can block the flow of urine. (i)

Myomas are more commonly called uterine fibroids, and affect 20 percent of women in their childbearing years. (ii)  The signs and symptoms of uterine fibroids include: (iii)

• Abnormal bleeding
• Pelvic masses
• Pelvic pain
• Infertility
• Pregnancy complications

There are five types of uterine fibroids:

1. The most common are intramural fibroids, which grow in the wall of the uterus.
2. Subserosal fibroids grow in the wall on the outside of the uterus. As they grow larger, they can cause pressure on nearby organs or pain due to their size.
3. Submucosal fibroids grow just beneath the uterine lining and can push into the uterus cavity, leading to heavy bleeding and other more serious complications.
4. Pedunculated fibroids grow on small stalks or stems inside or outside the uterus.
5. Intracavitary fibroids grow into the uterine cavity.

You may develop more than one type of fibroid. Between 70 and 80 percent of women develop a fibroid tumor by the time they reach age 50. (iv)

Diagram of the types of uterine fibroids

The Causes of Uterine Fibroids

Estrogen seems to activate the growth of uterine fibroids. In fact, during the first trimester of pregnancy, about one-third of all fibroids grow larger, but then shrink after birth. (iv) Generally, uterine fibroids shrink after menopause, but hormone therapy after menopause may cause their symptoms to continue.

Other causes of fibroids include: (iii)

• Race: Studies have found that fibroids are more common among African American women.
• Age: A study concluded that white women younger than 35 years of age had faster-growing tumors than white women older than age 45. In addition, waiting to get pregnant until age 30 or older places women at higher risk of developing uterine fibroids.
• Early menstruation: Having your first period at an early age increases the risk of developing fibroids.
• Caffeine and alcohol: A connection between alcohol and caffeine intake and an increased risk of developing uterine fibroids was uncovered in a 2016 study.
• Genetic factors: Researchers found that some specific genetic alterations are linked to fibroid growth.
• General health status: Obesity and high blood pressure also may play a role in fibroid development and growth.
• Diet: A diet rich in red meat appears to increase your chance of developing fibroids.

Treating Uterine Fibroids (Myomas)

Nearly one-third of women with uterine fibroids will seek treatment because of the severity of their symptoms. (iii) Although treatments can range from noninvasive to surgical options, the treatment choice is typically determined by considering a patient’s age—particularly if she is close to the age of menopause—and if the patient wants to have children, ruling out options such as hysterectomies. The treatment approach also depends on the number, size, and location of fibroids. However, most doctors agree that no treatment is needed if there are no symptoms due to uterine fibroids.

If you are experiencing heavy bleeding and don’t want to have a hysterectomy, you have a few options, including:

• Hormonal contraception.
• An intrauterine device.
• Antifibrinolytic
• Nonsteroidal agents.
• If you don’t want to have children, endometrial ablation is another option. During this procedure, the endometrium is destroyed using cold or heat.
• Medications called gonadotropin-releasing hormone agonist (or GnRH agonists) can shrink fibroids, but they grow back once treatment stops.
• Myomectomy, a procedure where a thin tube called an endoscope is passed into the uterus through the cervix. The fibroid is shaved and removed while leaving the uterus intact. It can reduce fibroids, but they may grow back.
• MRI-guided ultrasound surgery uses ultrasound waves to shrink fibroids and reduce heavy bleeding.

Remember, myoma, leiomyoma and uterine fibroids all refer to the same thing – a non-cancerous tumor of the uterus.  Uterine fibroid embolization is a minimally invasive option that blocks the blood supply to fibroids, causing them to shrink and die. This minimally invasive outpatient procedure is uterus sparing and can treat all fibroids during a single procedure, offering less risk of complications and a quicker recovery compared to traditional surgical procedures.

To learn more about myomas and uterine fibroid embolization, download our free fact sheet, A Guide to Understanding Uterine Fibroids, or call 844-UFE-CARE (833-2273) today to schedule an appointment with a vascular specialist.

Sources:
(i) McNeeley, S.G. (2017, December). Cervical Myomas. Retrieved December 11, 2018, from https://www.merckmanuals.com/home/women-s-health-issues/noncancerous-gynecologic-abnormalities/cervical-myomas.
(ii) Healthgrades. (2019, January 5). Myoma (Fibroid). Retrieved January 16, 2019, from https://www.healthgrades.com/conditions/myoma-fibroid.
(iii) Donnez, J., & Dolmans, M. (2016). Uterine fibroid management: From the present to the future. Human Reproduction Update, 22(6), 665-686. doi:10.1093/humupd/dmw023.
(iv) Stöppler, M.C. (2018, February 28). Uterine Fibroids (Benign Tumors of the Uterus) Retrieved July 3, 2018, from https://www.medicinenet.com/uterine_fibroids/article.htm#uterine_fibroids_definition_and_facts.

A. Michael Coppa, MD: OB/GYNs

About 80% of women will have had a fibroid by the time they turn 50. They’re common growths that develop in the uterus, and they’re generally painless. But sometimes fibroids can interfere with fertility and make it more difficult to get pregnant. 

At our comprehensive OB/GYN clinics in Cranston, Providence, and Smithfield, Rhode Island, A. Michael Coppa, MD and our team are here to help you navigate infertility and have a healthy pregnancy. Talk to Dr. Coppa about how fibroids might impact your chances of getting pregnant.

Understanding uterine fibroids

Many women of childbearing age have fibroids. They’re abnormal growths that develop in the uterus, but they’re generally harmless and rarely cause uterine cancer.

Fibroids range in size and in location. Some are very small, while others can be large and distort the uterus. Subserosal fibroids grow outside the uterus, intramural fibroids are located inside the uterine wall, and submucosal fibroids are inside the uterus, or womb.

It’s possible to have fibroids and not know it, since they don’t always produce symptoms. If you do experience fibroid symptoms, you might notice:

• Heavy or long menstrual periods
• Irregular bleeding between periods
• Lower back pain
• Lower abdominal pain
• Pain during sex

It’s not clear what causes fibroids, but they’re linked to family history. African-American women are more likely to have fibroids than women of other races. Additional risk factors include being overweight, being over age 30, and having been pregnant.

If you’re trying to get pregnant or you’re thinking about having a baby, Dr. Coppa can help you find out if there’s anything that could affect your fertility, from fibroids to endometriosis and more.

How fibroids affect pregnancy

Fibroids are common. Most of the time, they don’t affect your ability to get pregnant. But if you have a lot of fibroids or they’re submucosal fibroids, they may affect fertility. 

Having fibroids doesn’t interfere with ovulation, but submucosal fibroids can make it harder for your uterus to support conception and maintain pregnancy. In some cases, this type of fibroid can cause infertility or pregnancy loss.

Dr. Coppa diagnoses fibroids with a pelvic exam that might include an ultrasound or MRI. Depending on the size and location of your fibroids, he recommends a treatment plan that’s right for you. If you’re pregnant or trying to conceive, it’s important to monitor the fibroids closely.

Having fibroids while pregnant can increase your risk of complications during labor and delivery, including the likelihood that you’ll need a cesarean section. Your risk of placental abruption or preterm delivery might also be higher if you have fibroids.

Whether you’re trying to get pregnant and are concerned about your fertility or you’re pregnant and have fibroids, Dr. Coppa is here to help you have a healthy, full-term baby. Call the location closest to you or request an appointment online today to learn more.

What Is a Subserosal Fibroid?

Did you know that there are different types of uterine fibroids that all grow in different places? Of the four types of fibroids, subserosal fibroids are those that grow on the outside, or outer wall, of the uterus. Here’s what you need to know about the symptoms a subserosal fibroid may cause and how this type of fibroid can be treated.

This diagram shows where each type of fibroid is located in relation to the uterus.
(This image is from Myovant Sciences.)

A subserosal fibroid, or subserosal leiomyoma, is a benign growth on the outer uterine wall. They may be attached directly to the uterus or by a thin stalk, also known as a pedunculated fibroid. Subserosal fibroids don’t typically cause heavy bleeding—a common symptom of most kinds of uterine fibroids—but they can cause severe pelvic pain. This type of fibroid can also put pressure on the surrounding organs.

Every woman’s fibroids experience may differ because of your symptoms and their severity, which depend on:

• The number of fibroids you have
• The size of your fibroids
• Your body and other personal factors

Unlike intramural and submucosal fibroids that grow on the inside of the uterus, subserosal fibroids grow on the outside of the uterus, which means the symptoms tend to be different. The biggest difference is that subserosal fibroids generally seem to impact nearby organs more than the uterus, like the bladder.

Every woman’s fibroids experience may differ because of your symptoms and their severity, which depend on:

• The number of fibroids you have
• The size of your fibroids
• Your body and other personal factors

Unlike intramural and submucosal fibroids that grow on the inside of the uterus, subserosal fibroids grow on the outside of the uterus, which means the symptoms tend to be different. The biggest difference is that subserosal fibroids generally seem to impact nearby organs more than the uterus, like the bladder.

Common symptoms to look out for with a subserosal fibroid include:

• Abdominal pain or cramping
• Bloating or constipation
• Feeling of fullness or heaviness
• Frequent need to urinate
• Lower back pain
• Pain during sex

You may even feel like your clothes are fitting tighter.

The standard treatments for uterine fibroids also apply to subserosal fibroids, such as:

• Medications, including hormonal birth control, Gonadotropin-releasing hormone (GnRH) agonists, tranexamic acid, and nonsteroidal anti-inflammatory drugs (NSAIDs)
• A non-invasive procedure, called MRI-guided focused ultrasound surgery (FUS)
• Minimally-invasive procedures, like uterine artery embolization (UAE), radiofrequency ablation, laparoscopic or robotic myomectomy, hysteroscopic myomectomy, and endometrial ablation
• Surgery, namely a hysterectomy (whether partial or full), but also abdominal myomectomy

How Do They Affect Each Other?

How are fibroids treated before pregnancy to improve fertility?

There different options like hormonal pills, hormonal IUD or surgery to treat fibroids. Since each treatment has its own pros and cons, it is highly advised to explore the impact of all the following options for treatment of uterine fibroids in detail with your doctor before deciding upon the one that is right for you.

Here are the options of the uterine fibroids surgical treatment.

Myomectomy

This is a surgical procedure in which symptom causing fibroids are removed, while keeping the uterus intact. This method has been known to have a low complication rate and is an option for women that would like to get pregnant in the future. Myomectomy is more effective for preserving fertility if compared to UAE

Uterine artery embolization

This minimally invasive procedure is an option for women who want to avoid surgery and are suffering from heavy bleeding due to fibroids. In this procedure, the doctor inserts a slim, flexible tube that injects particle to cut off the blood supply to the fibroids, eventually leading them to starve, shrink and die. However, in some cases, this procedure could lead to fertility complications in the future.

Hysteroscopic myomectomy

This is a procedure during which a submucosal fibroid (type 0, 1 and 2) up to 5 cm. (2 inches) in diameter is removed through the cervix by using an instrument called a resectoscope.

Aside from the details we have already explored on the topic, here are some of the most common questions we get about uterine fibroids, and the answers to each of them:

What do uterine fibroids look like?

Fibroids typically look well-defined, solid masses that are firm and usually round in shape. Smaller sized fibroids may not cause any change in your outward appearance, whereas some large fibroids can distend your midsection and almost make you look pregnant.

What causes fibroids to grow?

While medical research is yet to pinpoint the exact factors that cause fibroids to grow, they have been seen to grow when the reproductive hormone levels – estrogen and progesterone – are high.

This usually happens during pregnancy, when the levels of both estrogen and progesterone rise rapidly. Anti-hormone medications have been observed to shrink the size of fibroids, and so has the onset of menopause.

Are uterine fibroids cancerous?

Uterine fibroids are almost always benign growths (non-cancerous) and are rarely ever cancerous (a one in thousand occurrence). Having benign fibroids does not increase your risk of developing a cancerous fibroid or any other cancer of the uterus.

What causes uterine fibroids to grow after menopause?

Since menopause is marked by a dramatic decline in a woman’s estrogen levels, this usually means that any fibroids shrink in size after menopause and stop growing.

However, if you are taking hormone replacement therapy (HRT), then your fibroid-related symptoms and size will persist (since fibroids are stimulated by estrogen). Keep in mind that in the absence of HRT, your fibroids should not be growing in size after menopause. In case you still observe a growth in size, do consult your doctor for an examination.

Conclusion

Despite of their widespread occurrence, there is much research yet to be done to fully understand the causes, prevention and treatment of uterine fibroids.

While most women with fibroids do not face any adverse symptoms or pregnancy complications, there are still cases where the size and location of fibroids can cause fertility and pregnancy issues.

If you are detected with uterine fibroids, it is advised to discuss it at length with your doctor, and decide on whether your case needs treatment, and if yes, which option works best for you, depending on your specific case and any future pregnancy plans.

On the use of MRI-guided tissue ablation at SRI OMM FUS

Focused ultrasound ablation is a method of treating uterine fibroids without surgery.

The FUS-MRI ablation procedure is performed on the Exablate-2100 device (Insightec, Israel). A precisely focused ultrasound beam allows destruction of the myomatous node. The combination of focused ultrasound (FUS) with such a high-precision research method as MRI allows you to achieve a targeted (point) effect on the pathological focus, while eliminating damage to the surrounding healthy tissues.

Therefore, the method of minimally invasive remote tissue ablation by focused ultrasound (FUS) under the control of magnetic resonance imaging (MRI) – FUS-MRI ablation is today often an alternative to the surgical treatment of uterine fibroids.

Indications for FUS-MRI ablation of uterine fibroids (according to the national guidelines for gynecology from 2017):

1. Uterine fibroids, symptomatic or asymptomatic, clinically and instrumentally confirmed.
2. Slow growth of fibroids in dynamics.
3. Unit dimensions 3-9 cm.
4. Uterine bleeding.
5. Pelvic pain syndrome.
6. Dysfunction of adjacent organs (compression of the bladder, rectum) – dysuric disorders, problems with bowel movements, discomfort in the pelvic area.
7. Problems arising during sexual intercourse.
8. Woman’s desire to preserve her organ.

Contraindications for FUS-MRI ablation of uterine fibroids (according to the national guidelines for gynecology from 2017):

1. Malignant formations of the genitals.
2. Acute inflammatory diseases of the pelvic organs.
3. Ovarian tumors.
4. Subserous myomatous nodes on a thin pedicle, cervical nodes.
5. Inability to select safe access (no ultrasonic window).
6. Pregnancy.
7. Severe somatic diseases in the stage of decompensation.
8. Obesity grade 3-4 (weight> 120 kg, waist circumference> 110 cm).
9. Availability of metal and magnetic implants, pacemaker.
10. Rough and extensive scars of the anterior abdominal wall, condition after liposuction in the abdomen, plastic mesh of the anterior abdominal wall, pronounced adhesive process in the pelvic cavity.
11. VMK.
12. The size of the myomatous node <1 cm and> 15 cm.
13. Uterine size> 20 weeks.
14. Fear of confined spaces (claustrophobia).

Attention! The decision on the possibility of carrying out the procedure is made by the doctor of the SRI OMM after examination and personal conversation with the patient.

Contact phone number for consultation and appointment for the procedure

8 (912) 220-14-48, 8 (343) 371-31-21.

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90,000 Uterine fibroids. Part 1

What is uterine fibroids, how often does it occur in women, where nodes can be located, about the diagnosis of the disease, says Alexander Aleksandrovich Makolkin, obstetrician-gynecologist-reproductologist, gynecologist-surgeon.

Good afternoon. My name is Alexander Makolkin, I am a reproductive and gynecologist at the AVA-PETER clinic. Today I would like to tell you about uterine fibroids. This is a fairly common gynecological disease. Myoma is a benign, hormone-dependent tumor that develops, unfortunately, for reasons unknown to us, like any other tumor. The frequency of occurrence is quite high, it is believed that from 25 to 30% of women of reproductive age suffer from this disease.At the same time, in women who suffer from infertility, the incidence of infertility associated with myoma is, according to various sources, somewhere around 5-10%. This is connected with our interest in the fibroid itself, in treatment, in some approaches.

Terminologically, there are some nuances. Myoma is a generic name. There are a number of other names. Fibroids, leiomyomas, and in order not to get confused – it depends on which tissue the fibroid itself develops from. If it is from fibrous tissue, then it is a fibroid, if it is from smooth muscle tissue, then it is a leiomyoma.In fact, this all refers to uterine fibroids.

Uterine fibroids are divided into several types. I want you to understand this classification too, I will simplify it a little, but it will look something like this: uterus, vagina, urethra, bladder, intestine.

If the uterine fibroids deforms the uterine cavity – this is the uterine cavity, here the endometrium – all fibroids that deform the uterine cavity are submucous or submucous fibroids. They are divided into 3 types according to the European classification.Type 0 is pedunculated fibroids. It has a thin base. Type 1 is a fibroid that has less than 50% of the tissue that is found in the wall of the uterus. And type 2 is myoma, which deforms the uterine cavity, but most of the myoma node is located in the wall of the uterus. This is a hysteroscopic classification of fibroids. Also, fibroids can be in the wall of the uterus, the so-called intramural forms. They are located in the wall itself. If such a fibroid grows, then it becomes transmural. It deforms both the uterine cavity and the outer wall of the uterus.Rather complex fibroids.

And there are subserous fibroids that deform the outer wall of the uterus without deforming the inner cavity of the uterus. They can also be larger or smaller, located in the wall of the uterus, and can also be on the pedicle.

From this classification, it is clear that fibroids can be completely different in localization, located in different places. A fairly simple location in the wall of the uterus, there can be in the cervix, the so-called cervical nodes or isthmus, since the volume of the cervix is ​​less, any formation is quite critical here.Nodules, if located next to, for example, the bladder, they pressurize it, and this can lead to frequent urge to urinate. If the node is located in the back wall of the uterus, large enough, then it can pressurize the intestine. And this can lead to problems with bowel movements. By analyzing the location of the node, we can assume how it is located, how it should be treated and what prospects for treatment exist.

It is clear that the location of such nodes is not easy to find, it is not easy to understand how they are located.Anamnesis helps us in diagnostics – a conversation with a patient, an examination. Some nodes can be identified by palpation during examination. Of course, ultrasound is the most common minimally invasive non-traumatic diagnostic method (and ultrasound is 2D, 3D, 4D), which allows you to identify the size of the nodes, their location, topic, how they relate to neighboring organs. MRI (magnetic resonance imaging), MRI with construction, computed tomography, in some cases, surgical techniques are used for diagnosis, in particular, laparoscopy or hysteroscopy, because we cannot clearly visualize some nodes.

Date of publication: 08/09/17

Uterine fibroids | TOTALMED

Uterine fibroids

Myoma (fibroids) is a benign hormone-dependent tumor of the uterus. The development of fibroids is slow. One muscle cell, for unknown reasons, begins to divide and creates tumor-like muscle cells that form a node in the uterus.

Myoma is one of the most common benign tumors. In women over 30, it is found in 20-25%.Over 40 years old – 40-50%. After 50 years – 60-70%. There is still no consensus on the reasons for the development of fibroids. Myoma can be located in the thickness of the uterine wall (intramural), in the cavity (submucous) and on the outer surface (subserous). Myoma is almost always combined with adenomyosis (endometriosis of the uterus).

Fibroids are often the cause of:

• profuse prolonged menstruation, which leads to a decrease in hemoglobin, iron and ferritin;
• pulling pains in the lower abdomen of various nature;
• frequent urination;

90,015 constipation;

• infertility and not carrying a pregnancy.

Location, size of nodes, structural features are determined by ultrasound examination with high accuracy. Regularly conducting sound examinations, we observe the growth of nodes, changes in their structure, as well as the effectiveness of treatment. Treatment of uterine fibroids depends on the woman’s age, the size of the nodes, their structure, as well as the woman’s plans for pregnancy.

The main principles of the treatment of fibroids without surgery are the use of hormonal drugs, most often oral contraceptives.Long-term use of them slows down the growth of fibroids, reduces the abundance, soreness of menstruation and in some cases avoids surgery.

Operation for uterine myoma is shown:

• for large node sizes;

90,015 rapid growth;

• changes in internal structure (impaired blood flow, necrosis).

Situations when a node is the cause of profuse and painful periods (a submucous node growing into the uterine cavity).

There are several types of operations for fibroids.

Laporoscopic myomectomy – removal of a node using a laparoscope, which is inserted into the abdominal cavity through small incisions in the anterior abdominal wall.

Benefits of laparoscopic surgery:

• preservation of the uterus;
• fast recovery after surgery;
• opportunity to get pregnant in the future.

Hysteroscopic myoectomy – removal of fibroids growing into the uterine cavity using a hysteroscope.

She may not even suspect that a woman is developing uterine fibroids, since external signs may not appear for a long time. And sometimes myoma is found when it reaches a large size, and you have to resort to complex surgical interventions, up to the removal of the uterus.

Timely access to a gynecologist, regular ultrasound examination allows you to detect fibroids in the early stages, effectively treat and avoid surgery.

90,000 Removal of uterine fibroids without incision – a unique method in Haifu!

The doctor said that you have uterine fibroids and need surgery? Are you afraid of postoperative complications, the risk of infertility and the high likelihood of recurrence?

Yes, the most common methods of removing myoma (conventional or laparoscopic surgery, uterine artery embolization) are dangerous with complications and after their use, the chances of pregnancy are low.

Medicine today makes it possible to remove fibroids in the uterus without making a single incision, and at the same time preserve the uterus and the possibility of carrying a baby.

HIFU (High-Intensity Focused Ultrasound) is a unique method of removing uterine fibroids without incisions and punctures with high-frequency ultrasound.

Why is this technique so interesting to remove uterine fibroids ?! HIFU allows you to perform organ-preserving surgery (remove myoma and save the uterus) without a single incision. Guided high-power ultrasound waves penetrate all layers of the anterior abdominal wall and create powerful coagulation necrosis of the node.Cauterization of the nodes in the uterus takes place without incisions, without pain, without blood loss.

Distinctive features of the method HIFU -ablation uterine fibroids :

• Tumors of any size can be removed almost painlessly and without surgery
• uterus and its functions are fully preserved
• procedure duration is only 2.5 hours
• postoperative period – no more than one day of hospital stay
• A woman who has undergone tumor removal will be able to become a mother and plan a pregnancy already 6 months after the procedure
• the cost of the procedure is comparable to traditional surgical treatment, and the risk of complications and relapses is much lower.

Who is this method recommended for HIFU -ablation uterine fibroids?

• women with a confirmed diagnosis of “ uterine fibroids ”

90,015 women wishing to maintain fertility

90,015 women who do not want to undergo surgery using traditional methods.

HIFU -ablation uterine fibroids is becoming more and more popular among patients and doctors, widely used in the world’s leading clinical centers. HIFU-removal uterine fibroids is carried out on a special apparatus, which is currently installed in Ukraine only in one medical institution – in the Kiev City Clinical Oncological Center. Like any treatment method, non-invasive removal of myoma has its own contraindications, so it is imperative to undergo an initial examination.

At MC “MedLena” primary consultation, preoperative examination and registration for HIFU-removal uterine fibroids are carried out.

Sign up for a consultation and find out how to remove myoma without incision and puncture!

Medical Center Axon

Uterine fibroids (also fibroids, leiomyomas) is a benign tumor that occurs in the muscle layer of the uterus – the myometrium. Myoma is a tangle of smooth muscle fibers randomly intertwining with each other and is found in the form of a rounded knot. Fibroid nodes can reach large sizes and weights of several kilograms. So, the largest knot, which is mentioned in the world literature, weighed 63 kg.Most knots have diameters ranging from a few millimeters to several centimeters.

Development Mechanism

Each fibroid node results from abnormal division of one smooth muscle cell, and therefore all cells in the node are identical. Uterine fibroids are considered a hormone-dependent tumor. This is evidenced by the following factors:

detection of sex hormone receptors in tumors,

the appearance of fibroids at reproductive age, when the level of estrogen is high,

tumor regression after menopause, when estrogen levels reach a minimum,

The appearance of fibroids in some postmenopausal women while taking estrogen drugs.

Prevalence

Uterine fibroids is the most common tumor in women. According to various estimates, it occurs in every second to fourth woman during the reproductive period, mainly after 30 years.

Classification

According to the number of nodes, single and multiple myomas are distinguished. According to the location of the nodes in the uterus, submucosal (submucous), intermuscular (interstitial, intramural), subperitoneal (subserous), interconnective (intraligamentary) and cervical myoma are distinguished.Most often (95%) there is an intermuscular myoma with the location of the node (s) in the region of the fundus and body of the uterus. Submucosal nodes are relatively rare, sometimes they have a thin stem and can descend from the uterus into the cervix or vagina; in this case, they speak of a “nascent” fibroid node. The subperitoneal node can also have a base with a smaller diameter than the node itself; in this case, the term “peduncle” is used. In the course of myoma, it is symptomatic and asymptomatic. Asymptomatic course is more typical for small single or multiple fibroids with intermuscular and subperitoneal location.

Symptoms

The most typical symptoms of uterine fibroids are menstrual bleeding (menorrhagia), pressure and pain in the lower abdomen. Menorrhagias are more common in submucosal fibroids. With the growth of fibroids, menstruation gradually becomes more abundant and prolonged, often leading to the development of anemia (anemia). A feeling of heaviness or pressure in the lower abdomen is more typical for intermuscular and subperitoneal fibroids, especially with large nodes. Pain usually occurs during menstruation and is cramping, but can be constant.The pain can also have a sudden cutting character, which is noted with a very rare complication – torsion of the legs of the subperitoneal node. More rare symptoms of uterine fibroids include infertility and dysfunction of neighboring organs: the bladder and rectum.

Diagnosis

For the diagnosis of uterine fibroids, the most informative method is ultrasound, in which fibroids are found in the form of rounded foci of reduced echogenicity (having a less dense structure than the myometrium).In some cases, magnetic resonance imaging is used to differentiate between uterine fibroids and ovarian tumors.

Treatment

Of all cases of uterine fibroids, only 10-20% need treatment, in the rest of the cases, a wait-and-see method is used, which is justified in case of slowly growing asymptomatic fibroids.

Drug therapy

Surgical treatment

Until recently, hysterectomy (removal of the uterus) was the only treatment for symptomatic fibroids.Currently, hysterectomy is used less and less, giving way to more modern, less traumatic and highly effective methods. Of the endoscopic methods, laparoscopy is used to remove the subperitoneal nodes of fibroids, and hysteroscopy is used to remove the submucosal nodes.

Embolization of the uterine arteries

A modern method of treating uterine fibroids, the principle of which is to stop blood flow through the uterine arteries and replace fibroid nodes with connective tissue. The method consists in passing a catheter through the femoral artery into the uterine artery and blocking blood flow in it using an embolization material.The procedure is performed in the X-ray operating room, refers to minimally invasive interventions and does not require anesthesia. Hospitalization for one day is usually required. Currently, embolization is increasingly used to treat uterine fibroids.

FUS-ablation of myoma

A method of treating fibroids based on heating the tissues of the nodes with high-intensity focused ultrasound, after which the nodes become necrosis. Ultrasound is performed through the anterior abdominal wall.The procedure does not require the introduction of instruments into the body cavity, pain relief and hospitalization, but it is not possible in all cases. The long-term effectiveness of FUS ablation remains a controversial issue; there is evidence of recurrence of uterine fibroids in a significant number of patients.

Other treatments

Herbal extracts and homeopathic medicines are used for the treatment of fibroids, but their effectiveness has not been proven.

Uterine fibroids (also fibroids, leiomyomas) is a benign tumor that occurs in the muscle layer of the uterus – the myometrium.Myoma is a tangle of smooth muscle fibers randomly intertwining with each other and is found in the form of a rounded knot. Fibroid nodes can reach large sizes and weights of several kilograms. So, the largest knot, which is mentioned in the world literature, weighed 63 kg. Most knots have diameters ranging from a few millimeters to several centimeters.

Development mechanism

Each fibroid node results from abnormal division of one smooth muscle cell, and therefore all cells in the node are identical.Uterine fibroids are considered a hormone-dependent tumor. This is evidenced by the following factors:

• detection of sex hormone receptors in tumors,
• The appearance of fibroids in reproductive age, when the level of estrogen is high,
• tumor regression after menopause, when estrogen levels reach a minimum,
• The appearance of fibroids in some postmenopausal women while taking estrogen drugs.

Prevalence

Uterine fibroids is the most common tumor in women.According to various estimates, it occurs in every second to fourth woman during the reproductive period, mainly after 30 years.

Classification

By the number of nodes, are distinguished single and multiple myoma . According to the location of the nodes in the uterus, submucosal (submucous), intermuscular (interstitial, intramural), subperitoneal (subserous), interconnective (intraligamentary) and cervical myoma are distinguished. Most often (95%) there is an intermuscular myoma with the location of the node (s) in the region of the fundus and body of the uterus.Submucosal nodes are relatively rare, sometimes they have a thin stem and can descend from the uterus into the cervix or vagina; in this case, they speak of a “nascent” fibroid node. The subperitoneal node can also have a base with a smaller diameter than the node itself; in this case, the term “peduncle” is used. In the course of myoma, it is symptomatic and asymptomatic. Asymptomatic course is more typical for small single or multiple fibroids with intermuscular and subperitoneal location.

Symptoms

The most typical symptoms of uterine fibroids are menstrual bleeding (menorrhagia), pressure and pain in the lower abdomen. Menorrhagias are more common in submucosal fibroids. With the growth of fibroids, menstruation gradually becomes more abundant and prolonged, often leading to the development of anemia (anemia). A feeling of heaviness or pressure in the lower abdomen is more typical for intermuscular and subperitoneal fibroids, especially with large nodes. Pain usually occurs during menstruation and is cramping, but can be constant.The pain can also have a sudden cutting character, which is noted with a very rare complication – torsion of the legs of the subperitoneal node. More rare symptoms of uterine fibroids include infertility and dysfunction of neighboring organs: the bladder and rectum.

Diagnosis

For the diagnosis of uterine fibroids, the most informative method is ultrasound, in which fibroids are found in the form of rounded foci of reduced echogenicity (having a less dense structure than the myometrium).In some cases, magnetic resonance imaging is used to differentiate between uterine fibroids and ovarian tumors.

Treatment of uterine fibroids

Of all cases of uterine fibroids, only 10-20% need treatment, in the rest of the cases, a wait-and-see method is used, which is justified in case of slowly growing asymptomatic fibroids.

Drug therapy

Surgical treatment

Until recently, hysterectomy (removal of the uterus) was the only treatment for symptomatic fibroids.Currently, hysterectomy is used less and less, giving way to more modern, less traumatic and highly effective methods. Of the endoscopic methods, laparoscopy is used to remove the subperitoneal nodes of fibroids, and hysteroscopy is used to remove the submucosal nodes.

Embolization of the uterine arteries

A modern method of treating uterine fibroids, the principle of which is to stop blood flow through the uterine arteries and replace fibroid nodes with connective tissue. The method consists in passing a catheter through the femoral artery into the uterine artery and blocking blood flow in it using an embolization material.The procedure is performed in the X-ray operating room, refers to minimally invasive interventions and does not require anesthesia. Hospitalization for one day is usually required. Currently, embolization is increasingly used to treat uterine fibroids.

FUS-ablation of fibroids

A method of treating fibroids, based on heating the tissues of the nodes with high-intensity focused ultrasound, after which the nodes become necrosis. Ultrasound is performed through the anterior abdominal wall.The procedure does not require the introduction of instruments into the body cavity, pain relief and hospitalization, but it is not possible in all cases. The long-term effectiveness of FUS ablation remains a controversial issue; there is evidence of recurrence of uterine fibroids in a significant number of patients.

Other treatments

Herbal extracts and homeopathic medicines are used for the treatment of fibroids, but their effectiveness has not been proven.

Prices for treatment and removal of uterine fibroids in the Danae clinic

Myoma is a benign dyshormonal tumor that forms in the muscle layer of blood vessels.This pathology is one of the most common in the female reproductive system. According to statistics, it occurs in 20% of cases in patients aged 30-35 years, and in 60% – over the age of 40 years.

The causes of the onset of the tumor are still not fully understood, but most often its appearance is associated with hormonal imbalance and impaired progesterone metabolism. Despite its benign nature, it poses a serious threat to health, as it often leads to complications.One of the possible risks is the development of infertility. For this reason, pathology requires compulsory treatment and prevention.

Treatment cost

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Appointment to a doctor

Symptoms

Very often, a tumor is discovered by chance, during a routine gynecological examination.The fact is that sometimes it does not have pronounced symptoms, and many patients do not attach importance to a slight malaise or a change in the menstrual cycle.

Most often, symptoms appear with a prolonged course of the disease and an increase in fibroids in size.

A woman has the following:

• The appearance of intermenstrual bleeding.
• Long and heavy menses.
• General weakness and fatigue due to large blood loss.
• Drawing or aching pains in the lower abdomen.
• Increased urination or constipation due to organ constriction syndrome.
• Problems with conception.
• Increase in the volume of the abdomen without weight gain.

Classification of fibroids

Myomatous nodes are classified depending on the size and timing of development (as in pregnancy):

• small – up to 5-6 weeks;
• average – 7-11 weeks;
• large – over 12 weeks.

Taking into account the characteristics of growth, the following are distinguished: false, increasing with impaired blood circulation (necrosis) and true (proliferation of muscle tissue).There are several types of tumor and depending on its location:

• Interstitial type. It develops in the thickness of the myometrium.
• Subserous type. The node is located under the subserous membrane of the organ and grows towards the abdominal cavity.
• Cervical type. Located on the cervix.
• Submucous (submucous) type. The tumor develops in the uterine cavity, under the mucous membrane.

Also, a separate classification of tumors is based on their histological structure:

• Fibroids (includes only muscle tissue).
• Fibroids (contain connective tissue).
• Fibroids (composed of muscle and connective tissue).

Diagnostics

Before the tumor is removed, differential diagnostics are performed to exclude uterine cancer and ovarian neoplasms. Most often, the doctor can determine the presence of a node during a gynecological examination. On palpation, the presence of a dense formation with high mobility is determined. After examination, the gynecologist prescribes a number of additional diagnostic procedures:

• Ultrasound of the pelvic organs.Helps to determine the location and size of the tumor, as well as associated pathologies of the uterus (hyperplasia, endometrial polyps, etc.).
• Diagnostic curettage. It is indicated for any identified fibroids to establish concomitant endometrial diseases.
• Hysteroscopy. Examination of the uterine cavity and cervical canal with a special device that allows tissue biopsy.
• Laparoscopy. A technique used to detect hemorrhage or necrosis of myomatous nodes.

Treatment methods

There are two treatment options for benign tumors – conservative and operative. The choice of a particular technique depends on the size of the detected node, signs of its growth, concomitant diseases and the desire to preserve the reproductive function of the body.

Drug therapy

This is a conservative treatment that is carried out with hormonal drugs. The goal is to delay surgery until menopause, during which the fibroids often regress.

Depending on the available indications, the gynecologist may prescribe one of the groups of antigestagen drugs. The duration of treatment is on average 6-8 months. During this period, constant monitoring by the gynecologist will be required, since it is important to make sure that the drugs have the necessary therapeutic effect.

Surgical treatment

In some cases, surgical removal of uterine fibroids will be required. It is indicated for patients in the following cases:

• Large size of myoma nodes (more than 12 weeks).
• Accelerated tumor growth.
• Constant bleeding.
• Submucous type of myoma.
• Presence of ovarian tumors or adenomyosis.

Surgical treatment can be performed in different ways. In our clinic, myomectomy (enucleation of myomatous nodes) is most often performed with the preservation of the uterus. For such a procedure, equipment with video endoscopic technologies is used, which makes the treatment less traumatic and safe. In addition, such an operation allows you to preserve reproductive function.

In case of recurrence of pathology and serious growth of nodes, a more radical method can be used – hysterectomy (complete removal of the uterus or its amputation while preserving the cervix and stump).

Prevention

Fibroids are a fairly common problem, but fortunately there are several steps you can take to prevent it. The following is recommended:

• Healthy lifestyle.
• A balanced diet, adequate sleep and regular physical activity are a great way to maintain women’s health for a long time.
• Weight control. Obesity is one of the risk factors for the development of fibroids – the risk of pathology increases by about 20% for every 10 kg of excess weight.
• Harmonious intimate life. Regular sex life with a regular partner prevents the development of tumor pathologies.
• Regular visits to the gynecologist. At least once a year, or better – once every six months, you will need to be examined by such a specialist. This will allow to identify pathology in the early stages and avoid surgical intervention.

If you have any questions about the treatment of pathology or want to learn more about treatment and prevention, then our doctors will certainly provide additional information.

Appointment

You can sign up for the treatment of uterine fibroids at any branch of the Danae Medical Center in St. Petersburg. The gynecologist accepts in clinics in the Vyborgsky district near the metro station “pr. Education “,” Ozerki “and Kirovsky district near the metro station” Leninsky Prospekt “.

To make an appointment, you can call the indicated phone numbers or use the form on the website.

Reception is conducted:

90,000 in which cases an operation is needed?

What is fibroids?

Myoma has many names – fibroids, leiomyomas or uterine fibroids, and is the most common pelvic tumor in women. Although myoma is a 100% benign tumor , it can be very troublesome if not treated properly.

The uterus consists of several layers.The thickest of the uterus, which – consists exclusively of muscle tissue, and is called “myometrium” . It is about him that we are talking in the context of fibroids – the tumor begins to develop from the muscles of the uterus. The muscular layer is the middle between the mucous membrane, “growing” inward, into the uterine cavity – the endometrium and the outer – growing “outward”, towards the bladder and colon.

Why does myoma appear?

A typical situation for any tumor – no one can say for sure why myoma appeared.In the same way, it is impossible to explain why in one woman a centimeter tumor is asymptomatic in the uterus all her life, and in the second it grows so much in six months that it necessitates an operation. Most often this is associated with a genetic predisposition, with external factors such as stress, alcohol and nicotine.

Although it is impossible to name the reasons for the appearance of the problem, the fact remains that fibroids are hormone-dependent tumor . It is estrogens and progesterones that affect the growth of neoplasms.Therefore, most often fibroids are a problem for women of reproductive age – a period when hormones are actively and successfully produced. This also explains the hormone replacement therapy – for example, after menopause, can provoke the growth of a long “silent” small fibroids.

What are the symptoms?

Before describing the symptoms, (first you need to understand how different fibroids can be.

If the myoma grows towards the uterine cavity, then it is called “submucous” or “submucous” .It is these formations that most often cause symptoms: severe menstrual pain and heavy bleeding , and as a result – anemia, weakness. If the myoma is large, it “occupies” the territory where the embryo potentially wants to attach, deforms the endometrium: submucous fibroids can cause infertility, problems with carrying a pregnancy . An important symptomatic difference between polyps and myomas: in the case of the former, the patient complains of spotting bleeding, and in the case of submucous fibroids, heavy menstrual bleeding.

Another variant of myoma – the one that grows “outward” – subserous . From the symptoms – a feeling of pressure, a constantly full bladder, frequent urge to use the toilet, constipation, chronic aching pelvic or even low back pain. If the fibroid is small, then there may be no symptoms.

There is another type of fibroids that develop in the muscular layer of the uterus – intramural . Such a node can also bleed and cause miscarriage or infertility.But, as a rule, this education does not cause complaints and does not interfere with life. This type is most common.

There are also myoma “on the leg”. There is a danger that the leg will twist – the blood supply to the fibroid will stop, fibroid cells will begin to die off, which can cause intolerable pain. This is a direct indication for an urgent operation! With a different arrangement of the fibroid it can be “squeezed” outward, directly into the cervical cavity or even into the vagina – then they talk about the so-called “nascent myoma” .This situation is also very painful: the neck opens, later bloody discharge from the genital tract appears.

How is fibroid diagnosed?

If the fibroid is large, then it can be “felt”, palpated during a gynecological examination. But, in the case, for example, with a submucous node growing inward, alas – this is impossible. That is why is the gold standard for diagnosing fibroids – ultrasonography.

On ultrasound, the myoma looks like this: dark, the edges are very clearly visible, the shape is round, has a light shadow, called the “comet’s tail”.How the patient will be treated depends on the result of the ultrasound. It is necessary to understand the size of the tumor, where and how deep in the tissues of the uterus it is located.

Sonohysterography can be done to make the picture clearer – this will help distinguish a fibroid from, for example, a polyp (see the article “Polyps”).

With an accuracy of 90-95%, you can see suspicious fibroids on ultrasound. For example, the one that itself began to “die off” – the tissues disintegrate, cavities with liquid appear inside, the contour changes.In this case, it is vital to make sure that it is not a malignant tumor. Therefore, after an ultrasound scan, the patient is sent to the magnetic resonance imaging test for fidelity.

It makes no sense to take aspirate – that is, fluid from the uterine cavity for analysis – . With this analysis, the myometrium cannot be checked.

How to treat fibroids?

L Fibroid treatment is necessary only if there are symptoms or fibroids that are too large , if not, it is necessary to do an ultrasound every six months to control the size of the fibroid.A small fibroid does not interfere with either pregnancy or bearing a fetus.

There are several therapy options. The first is hormonal treatment. Works partially. Myoma grows under the influence of hormones, and if the drug blocks their production or the effect on the tumor, then this is a way to shrink it, weaken its circulation and relieve the patient of symptomatic bleeding. It is this action of hormonal drugs that is often used before surgery to make it easier to remove the tumor, but, alas, drugs only work in 35-40 percent of cases.It happens that the tumor does not react to drugs at all, or it may even begin to grow.

Today, there are two types of drugs that are used to treat fibroids. The first ( analogue of gonadotropin- releasing hormones, for example, buserilin acetate acts at the level of the brain and radically changes the hormonal background . The drug causes artificial menopause with all the ensuing consequences – osteoporosis, hot flashes, overweight, and so on.Therefore, no more than 2-3 courses of the drug are recommended before the operation.

Second – ulipristal acetate – a newer and less aggressive drug, acts exclusively on fibroids, hormones calmly continue to affect the body, and no symptoms of menopause are observed. It is this drug that experts prescribe today. The medicine can be taken in courses.

However, the medication has contraindications. Firstly, according to the new recommendations, it cannot be prescribed to patients with liver problems: before discharging it, it is imperative to take liver tests . And secondly, do not forget that the second medicine relieves the patient from symptoms exactly as long as she takes the drug, and after its cancellation, the myoma will again safely increase in size and again become the cause of complaints.

Another point: if an operation is necessary, then the first group of medicines is more suitable, because ulipristal acetate softens the fibroids too much, complicating the surgical intervention.

Sometimes doctors suggest an intrauterine hormonal device as a treatment.Yes, it can reduce symptoms, but bleeding and pain may return over time. The spiral acts more on the endometrium than on the fibroids.

Main method of treatment – operation

If the patient is close to menopause and does not plan a pregnancy, and the myoma is large enough, or if there are several of them, in these cases it is suggested to remove the entire uterus. Doctors say that for a woman of reproductive age who does not want to have children anymore, only the ovaries are important (for the production of hormones and the maintenance of normal hormonal levels).They, if there is no pathology, are left, but the correct removal of the uterus will not affect health in any way.

The second option – to remove only fibroids – is usually the preferred method for those planning a pregnancy. And here is the main question in the type of operation:

• Hysteroresectoscopy , when, under the visual control of the camera, the fibroid is removed from the inside of the uterine cavity, without incisions in the abdomen (read more in the article “Polyps”). The doctor will most likely choose this method if the myoma is submucous, small (say, up to 2-3 cm).

• Laparoscopy, in which, under general anesthesia, 3-4 incisions are made in the patient’s abdomen, no more than 10 mm in diameter, through which a camera and instruments are inserted into the cavity;

• Laparotomy – open surgery with an incision in the anterior abdominal wall. This method is best if the fibroid is really large (more than 6-7 cm) or is located in an “unfortunate”, poorly visualized place.

Which of the three methods the gynecologist will choose – the question of the location of the fibroid, its size and, of course, the doctor’s practice in one method or another – the most important part of the operation is suture in order to successfully restore the integrity of the uterus.

Another method of treatment is uterine artery embolization . The bottom line is that the blood flow of the fibroid is blocked by a special substance that is launched into the uterine artery through a thin catheter inserted through the groin. This is a minimally invasive procedure that does not require general anesthesia and is not performed by gynecologists, but by invasive radiologists. When the nutrition of the fibroid is blocked, it begins to die off by itself. But, if the myoma is large, then such a “half-dead” tumor can become infected and cause severe pain.Moreover, embolization is currently not recommended for women planning a pregnancy.

What to expect after treatment?

If fibroids are treated only with medications, you need to understand that this is a temporary therapy, and as soon as the patient stops taking medications, the fibroids will grow again and will again give symptoms .

In the case of surgical treatment, there is a fundamental difference for women planning a pregnancy. After hysteroresectoscopy, you can become pregnant in the next cycle . And with laparoscopy and laparotomy , if the myoma was in the muscle, if you had to make incisions in the uterus, then you need to wait at least six months (for a scar to form), and is better for 12 months , so that the scar is covered with elastic tissues, which are necessary for pregnancy. If the myoma was pedunculated or subserous, growing towards the organs, you can become pregnant already in the next cycle after the operation.

It should be borne in mind that if there were multiple fibroids, if there was a large incision on the uterus, then this may be an indication for caesarean section to avoid rupture of the uterus from tension during childbirth.But here everything is very individual – such questions are taken by the obstetrician-gynecologist based on the description of the operation performed.

The most important thing is one way or another, but it is possible and even necessary to get rid of the unpleasant symptoms of fibroids. The doctor will select the treatment tactics individually, based on the indications of each patient.

To make an appointment with Dr. Anton Babushkin, call (+371) 67333322, (+371) 67579208

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