The symptoms associated with these tumors will depend on the location, size and number of these fibromas.
Uterine fibroids are one of the most common gynecological conditions and reasons for hysterectomy. Approximately 8 out of 10 African-American women and 7 out of 10 Caucasian women will be diagnosed with one or more uterine fibroids. Photo: Shutterstock
Uterine fibroids are one of the most common gynecological conditions and reasons for hysterectomy. Approximately 8 out of 10 African-American women and 7 out of 10 Caucasian women will be diagnosed with one or more uterine fibroids.
fibroids or fibroids They are benign tumors of muscle tissue. They usually develop during a woman’s reproductive years in response to the hormones of the menstrual cycle. The symptoms associated with these tumors will depend on the location, size and number of these fibromas. However, most women with uterine fibroids do not have any associated symptoms or discomfort. Although fibroids are considered benign tumors, there is a risk that they are cancerous in 1 in 1000 cases. The diagnosis of cancer in uterine fibroids is one of the most common following menopause.
These tumors form due to a genetic alteration of the muscle cells of the uterus that causes them to continue multiplying. Although the cause of this change is unknown at this time, it is known that the woman’s genetics and the hormones estrogen and progesterone play an important role in these changes. Given the association between the hormones estrogen and progesterone and the growth of fibroids, it is understandable to see how these develop in reproductive age and decrease in size during menopause. There is no evidence that dietary habits, lifestyles, or low-dose birth control pills have any impact on the growth of these tumors.
Fibroids can be found both in the body of the uterus and in the cervix. These tumors can also be seen connected with a stalk to the uterus itself or to organs near it. Those found in the body of the uterus are classified according to their position:
Subserous: are found on the outer wall of the uterus (55%)
Intramurals: are found in the muscular layers of the uterus (40%)
Submucosos: are found in the uterine cavity (5%)
Among the symptoms that can be observed associated with uterine fibroids are pelvic pain, abnormal uterine bleeding or a feeling of pelvic pressure. Of these symptoms, abnormal uterine bleeding is the most common and the main reason for treatment. Since abnormal bleeding may also be associated with other gynecologic conditions, including uterine cancer, a thorough evaluation, including biopsies, should be performed before definitive treatment is chosen.
Pelvic pain caused by fibroids is usually caused when the fibroid has grown large enough that blood flow is affected, causing the fibroid to begin to degenerate. Uterine fibroids can grow large enough to create symptoms of pelvic or abdominal pressure. These can put pressure on the bladder, causing urinary frequency, on the ureters, causing damage to the kidneys, or on the intestines, causing constipation.
In addition to this, fibroids can be associated with problems of infertility. The effect that fibroids have on fertility will also depend on their location. Submucosal and intramural fibromas usually cause the most problems. Women who do not have fibroids or have had surgery to remove them have been shown to be more successful in getting pregnant following assisted reproductive technologies.
In many cases, uterine fibroids are identified incidentally during pelvic or abdominal surgeries, since most of these patients are asymptomatic. In patients who begin to present symptoms that suggest some gynecological pathology, these tumors can be identified with transvaginal or pelvic sonography. If a fibroid is not found by this evaluation and there is a high suspicion for this diagnosis, a sonohysterography is a method that allows identifying fibroids that protrude or distort the cavity of the uterus. If there is a need to better assess the fibroids and their relationship to nearby organs, an MRI is very helpful in determining treatment options.
The treatment of uterine fibroids will depend on the patient’s symptoms and their effects on nearby organs. If fibroids have been identified, regular exams should be done to see the pattern of growth and detect early symptoms. If the patient desires a pregnancy, this should also be taken into consideration when evaluating treatment options.
The treatments available for these tumors can be surgical with the use of medications. Since the association of estrogen with growth is now known, medications can be used to control its levels. This may provide temporary relief, although it is associated with side effects. Surgical treatment is considered when the symptoms are very marked and always taking into consideration the desire for a future pregnancy. Among the surgical options are:
abdominal myomectomy
The fibroid is removed without removing the uterus (without hysterectomy) through an abdominal incision
laparoscopic myomectomy
Only the fibroma is also removed, but through a small incision in the navel and 5-10?mm incisions to introduce the surgical instruments.
Uterine artery embolization
This procedure is performed by an interventional radiologist who injects small particles into the blood vessels of the uterus. In this way, the irrigation of the fibromas is affected and causes their degeneration. This procedure can cause pain for several days due to degeneration. This treatment is not recommended for women who are interested in future pregnancies.
Hysterectomy
50% of hysterectomies are performed for fibroids. If the patient does not want future pregnancies, a hysterectomy. In this procedure, the uterus with associated fibroids is removed. This surgery, like myomectomy, can be performed abdominally or laparoscopically.
As mentioned above, fibroids are very common in the reproductive age. Although the majority of patients are asymptomatic, if fibromas have been identified incidentally, their growth should be regularly monitored in order to proceed with the appropriate treatment.
