Uterine fibroids (otherwise known as myomas) are the most commonly occurring medical problem in gynecology. Though they are sometimes completely harmless, they frequently cause very uncomfortable symptoms. Dr Dániel Horányi, our specialist gynecological oncology surgeon, is here to tell you all you need to know about this complex phenomenon.
Uterine fibroids, typically found in the muscle layer of the uterus, are benign tumors that develop from the uterus muscle cells. They can be small (a few millimeters), but can also grow to be very large. Their development is influenced by hormones: they do not usually occur before the first menstruation or after the menopause, while they often change in size during pregnancy.
Fibroids can develop in the following areas:
- Under the muscular uterine wall
- In the myometrium (the middle layer of the uterus)
- Projecting to the side of uterus
- Between the ligaments of the uterus
- Beneath the inner layer of the uterus membrane
- Directly in the cervix
Sometimes these growths can develop without any symptoms or complaints and are only discovered by the doctor during a gynecological examination. However, they can often cause the following uncomfortable symptoms:
- Increased, heavier bleeding during menstruation, potentially resulting in anemia, painful menstruation, recurring miscarriages or infertility
- If the tumor increases in size: urinary and bowel issues
Fibroids and pregnancy
Fibroids can cause a number of problems during pregnancy or during conception:
- The tumor can block the implantation of the ova and therefore prevent conception
- Fibroids can obstruct the development of the fetus, making loss of pregnancy more common in women who have fibroids
- The size of the fibroids can change during pregnancy
- Abnormalities associated with the position, duration and presentation of the fetus are more common
- Larger fibroids during pregnancy can obstruct the birth canal and can necessitate a caesarean birth
This issue can be treated through either medication or surgery, or a combination of the two. The type of treatment depends on the size of the tumor and whether it causes any problems. Small growths that do not cause any symptoms do not usually require treatment: regular check-ups are sufficient. If the tumor is larger, prevents conception or leads to any other issues, then surgery may be required. If the patient wishes to have children, the only surgical option is to have the fibroid removed. If the individual is not planning to have any more children, removal of the uterus from above the cervix may be recommended. During this surgery, the ovaries are also removed in order to prevent ovarian cancer. Both operations can be performed as a laparoscopy (keyhole surgery). Fibroid growths located on the inner surface of the uterus must be removed through a hysteroscopy. Medication can also be administered to shrink the fibroid and moderate bleeding in order to reduce any discomfort.