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Fibroids

Fibroids

The fibroids are also called fibroids and are benign tumors found in the muscular layer of the uterus. It is a very common type of tumor that affects more than half of the female population, so it is important to have complete information about them. Etiologically, they are related to ovary hormones.

What is a uterine fibroid?

El uterus It has two layers, the outermost is the muscular layer and is responsible for the contractions that expel the fetus during labor. The fibroidsThey are very frequent tumors and can be present in more than 50% of women. They are in a Relationship with the ovary hormones, in such a way that, when the woman reaches the menopause, they tend to be reduced or totally disappear.

Types of existing uterine fibroids

There are different types of fibroids and they are classified according to their location, depending on how close or far they are from the endometrium.

Listed below are the 4 types of fibroids existing:

Submucosal myoma

They are the most internal. The symptoms of submucosal fibroids they are more serious than other types of fibroids such as vaginal bleeding. This is due to its innermost location. The reference surgical technique to remove a submucosal myoma is the surgical hysteroscopy.

Myoma subserous

Is myomas located in the outermost part of the muscular layer. The subserous fibroids They form under the outermost layer of the uterus and grow out of the uterus. They can lead to the so-called pedunculated myoma since when detaching from the uterus it is only attached to it by a fine portion of the tissue.

Symptoms of subserous myoma can be treated with pain reliever, although surgical intervention it is the definitive treatment.

Myomas intramural

They are those that are found in the most central part of the muscular layer of the uterus called myometrium, without reaching the innermost or outermost part. They are the most common type of myoma of all.

The recommended treatment for intramural myoma is surgical.

Transmural fibroids

They are very large and affect the entire muscle layer, from the outermost to the innermost part. The transmural myoma develops in the thickness of the wall of the uterus and can reach a size that distorts the endometrium and the serous surface. It is, together with the previous one, one of the most frequent.

Symptoms of uterine fibroids

The symptoms of fibroids They depend on two factors: size and location, above all. The subserous fibroids (the most external) are usually asymptomatic, However, the submucosal (the most internal ones) usually give mild symptoms: abnormal bleeding (very abundant periods, frequent periods, continuous bleeding among others) and symptoms due to compression of neighboring organs when they are large (pressure in the bladder, in the rectum, pain with the periods or during the cycle, feeling of weight in the lower abdomen, discomfort with relationships, fibroids are usually 50% asymptomatic.

Another symptom that a fibroid can produce is low back pain.

Do fibroids have any side effects on a woman's fertility?

There is great controversy on this question. It is known that myomas submucosal can make it difficult for the embryo to implant or increase the chances of abortion, which is why it is recommended remove them before seeking pregnancy. Regarding the myomas subserous, these do not usually interfere with a woman's fertility. The role of intramural fibroids is more controversial and seems to depend, above all, on their size, although there is no size limit that is related to fertility problems.

Treatment of uterine fibroids

Only fibroids that, even if they have been diagnosed, cause symptoms in the patient, are treated. A woman without symptoms should not be treated even if the fibroids have been located. There are several treatments and their choice by the gynecologist and It depends on many factors, the age of the patient, among which are the symptoms, the desire to get pregnant, or the patient's own preferences.

The different treatment options for uterine fibroids are explained below.

Medical treatment

It is done by gestagens, combined hormonal contraceptives (they are usually very effective in treating bleeding disorders presented by patients); analogs of the releasing factor gonadotropins (They are effective in the treatment of bleeding disorders and are capable of reducing their size; however, they have many side effects and symptoms usually reappear when treatment is stopped, which is why they are usually used as a pre-surgical treatment); selective receptor modulators progesterone (The only one currently on the market is ulipristal acetate. It is very effective in both treating bleeding and reducing the size; it has recently been approved for indefinite use).

Non-invasive treatments

Embolization of the arteries that reach the fibroid (it is done with radiological control through an artery in the leg; very effective for treating intramural fibroids that cause bleeding; if the woman becomes pregnant after its performance, complications of pregnancy are relatively frequent so used as an alternative to hysterectomy); HIFU (it is a technique that allows destroy fibroids using ultrasound; it is very effective in single intramural fibroids not too large, 7 to 8 centimeters in size. Later pregnancy is usually uncomplicated). Radiofrequency (It destroys fibroids using this technique; it is the most recent treatment and there is not much experience with its use yet).

Conservative surgical treatment

It consists of the removal of the fibroids using minimally invasive techniques (hysteroscopy, laparoscopy depending on the location) or, by laparotomy (opening the abdomen), when those techniques are not possible (only very rarely: less than 10% of the myomectomies should be done by laparotomy).

The main advantage of these techniques is that they are able to remove tumors with minimal aggression to the patient. Recovery is very fast and presents few risks. Pregnancy can be sought between 3 and 4 months after surgery.

The risk of having to practice a hysterectomy unplanned as a consequence of any of these techniques is practically nil when the surgery is performed by expert surgeons.

Radical surgical treatment

Consists of the total removal of the uterus which, the vast majority of times, can be done through minimally invasive laparoscopy, being necessary to carry out a laparotomy in less than 10% of the occasions.

The main indication of the hysterectomy It is for those women who, having completed their reproductive desire, want to solve their problem in a definitive way avoiding the risk of reappearance of tumors. The removal of the uterus It has no implication for the life of the woman, except the lack of pregnancy capacity (there is no hormonal alteration, there is no increased risk of prolapse, there is no alteration of sexual life, etc.),

Related concepts

Can fibroids be carcinogenic?

No, the uterine fibroids are benign tumors and they never become carcinogenic. When a woman has a sarcoma that is a carcinoma (the malignant equivalent of myoma), it was malignant from the beginning and it never comes from the fact that a benign tumor has turned into a malignant tumor.

What is uterine myomatosis?

La uterine myomatosis is the name given to the production of myomas o leiomyomas in the woman's womb. Uterine myomatosis is considered to be one of the most frequent causes for which patients go to the gynecologist due to the symptoms it produces.

Myomatous uterus

Name used to refer to the organ affected by fibroids, it has a similar meaning to the previous one. The myomatous uterus is the affectation of the uterus by fibroids.

Time off due to myoma operation

The discharge time for a fibroid operation will depend on the surgical technique used. In case of using a minimally invasive surgical technique, the postoperative period will be less than if a laparotomy is performed.

Fibroids and menopause

The myomas may increase in the years of premenopause o perimenopause but when the woman reaches the menopause that fibroids they have a tendency to get smaller or even disappear because they decrease in size by not receiving hormonal stimulation. This occurs as a consequence of the ovary stops producing estrogens, Which is main myoma stimulating hormone.

 It is not usually advisable to remove fibroids in the postmenopause.

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    This entry has 8 comments

    1. Good morning, I have been looking and reading some of your articles in this blog, very interesting, I am very interested in fibroids, and I would like to know or have more information about the medications that can be used such as Orgametril, which I carry using about five years, and it has gone very well but unfortunately I do not know because in Belgium where I live it has not been marketed for several months, and in Spain it seems the same, they have prescribed a Lueva substitute, but in addition to being very expensive , I do not have the same confidence, can you tell me more details about them and because in some countries the commercialization of Orgametril is being discontinued, thank you very much

    2. Hello doctor, good afternoon, I have been reading and I am interested in that 2 years ago they detected me that I have fibroids in the uterus and I have not been able to remove them, only the gynecologist has told me that the uterus must be removed and I do not want to, I am 28 years old and I would like to there is for fibroids

    3. Hello, I wanted to know right now they just gave me my information on Hesterosopia and they diagnosed me with the same submucosal grade of 2 cm, endometrial mucosa atrophy, if type n1 says with degeneration vs Ca GO this is what it says And the minimum analyzed sample whitish fragment of tissue with a mucous appearance of 0,1 maximum dimension total inclusion in a block that is the latter to which it refers
      This is thanks

    4. Hello, I wanted to know right now they just gave me my information on Hesterosopia and they diagnosed me with a submucosal myoma of a grade of 2 cm, endometrial mucosa atrophy, if type n1 says with degeneration vs Ca GO this is what it says And the minimum analyzed sample whitish fragment of tissue with a mucous appearance of 0,1 maximum dimension total inclusion in a block that is the latter to which it refers
      This is thanks

    5. I am 45 years old I do not have children I have a fibroid in the endometrium of 11 cm I tell you anemia they did all the tests the bioxia give it negative I must do sometimes my head hurts

    6. Hi, I have a 17 cm fibroid in the neck of the womb, I bleed a lot and my gynecologist told me that it would be an operation and they would remove the entire uterus, but I would like to know if there is something else so as not to remove the uterus because I want to have a baby. help.Thank you.

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