Fibroids (also called leiomyomas) are the most common benign tumors of the uterus.
In a percentage less than 1% they can develop into malignancy.
They appear more in young women of reproductive age, while after menopause it has been observed that they regress, i.e. decrease in size.
The range of their dimensions varies, from very few centimeters to fibroids that occupy the entire peritoneal cavity.
There are different types of fibroids depending on where they develop.
Thus we have the hypogonias that are on the outer surface of the uterus, the intramural and the submucosas, which project into the endometrial cavity.
A submucosal pedunculated fibroid may project from the cervix (fibular fibroid).
The causes that cause them are unknown.
Hereditary predisposition is believed to play a role.
Many studies also demonstrate their hormonal, estrogenic dependence.
That is why they appear in people of reproductive age, increase in size during pregnancy and shrink during menopause.
Their clinical symptoms are various.
The main ones are menorrhoea and uterine bleeding, women notice vaginal bleeding outside the days of their cycle.
If the blood loss is large or the episodes are frequent, these women may experience anemia.
Another main feature is chronic abdominal pain and a feeling of heaviness in the lower abdomen.
This pain can manifest itself as dysmenorrhoea (pain on the days of the period), or as dyspareunia (pain during sexual intercourse).
Other times the pain can be excruciating, this is when the fibroid becomes inflamed or degenerates.
Depending on its position and its size, it can cause dysuric problems, in case of pressure on the urinary bladder, constipation, if it presses on the large intestine, but also vascular problems when it presses on the pelvic vessels.
Of course, it must be mentioned that a large percentage of women do not show any symptoms.
Fibroids can also play a role in a woman's fertility by reducing it.
This happens when they push the fallopian tubes externally or when they project into the endometrial cavity.
In a percentage of about 10% they are responsible for regular abortions.
Their diagnosis is made by the clinical symptomatology of the woman combined with the physical examination, i.e. palpation of the abdomen and bimanual gynecological examination. Gynecological ultrasound has a great diagnostic approach.
The treatment of fibroids varies depending on the location, type, size of the fibroid, symptoms and the age of the woman.
Their removal based on the above criteria can be done laparotomy, laparoscopic or hysteroscopic.
There is no medication to completely remove them. GnRH analogs are often administered preoperatively in order to reduce size.
PS Nowadays, and by our unit, the laparoscopic removal of fibroids of any size and number is mainly applied, with very few exceptions
Ioannis Kalogirou OBG
