Uterine fibroids or leiomyomas are benign tumors that form and grow under the lining of the uterus (hypogonal fibroids), within the muscular wall of the uterus (intramural) and finally in the endometrial cavity (submucosa).
Fibroids can vary in size from very small pea-sized nuclei to large masses larger than 10 centimeters in diameter. As they grow, they can deform both the inside and the outside of the uterus, causing the corresponding symptoms. Sometimes fibroids grow large enough to completely fill the pelvis or abdomen.
A very small percentage of fibroids can hide malignancy, only 1%, which is called sarcoma.
Where are fibroids caused and when are they created?
The exact causes of fibroids have not been identified. However, there are studies that prove that there is a hereditary predisposition. They are common tumors and appear during reproductive age.
Factors that increase the likelihood of formation are a woman’s age (over 30), family history, obesity and race.
Female hormones, estrogen, are involved in their development. The levels of these hormones can increase or decrease during a woman’s life. For example, menopause causes a decrease in estrogen, so fibroids often shrink when a woman enters menopause and grow larger during pregnancy, when hormone levels rise.
With what symptoms do they appear?
A woman with uterine fibroids may experience symptoms such as bleeding between periods, heavy or painful menstrual periods that can lead to heavy blood loss and anemia, a feeling of pressure in the pelvis, and difficulty urinating or defecating due to the pressure symptoms they cause. Rapidly growing fibroids may undergo necrosis and cause acute abdominal pain.
Fibroids and Infertility
Fibroids can cause infertility. However, other more common factors should be investigated first before fibroids are considered the cause of infertility.
However, the location and size of fibroids can affect the possibility of achieving pregnancy, either after attempting natural conception or after IVF, due to the anatomical and functional disturbances they cause to the uterus. Depending on the location and size before the start of each effort they should be removed in order to get the maximum possible results.
Fibroids and Pregnancy
Fibroids are blamed for causing miscarriages in some women as well as premature labor. Depending on their location, there is a risk of miscarriage, premature birth, placental abruption, premature rupture of the membranes. Fibroids located in the lower part of the uterus, increase the possibility of dysproportion at delivery, caesarean section and postpartum bleeding.
Diagnosis of fibroids
The diagnosis of fibroids is made in most cases during the annual gynecological examination or with an ultrasound examination. Also, they can be detected by CT or magnetic resonance imaging of the lower abdomen/pelvis, hysterosalpingography, hysteroscopy, or even laparoscopy, which are performed to check for other diseases of the uterus.
Ultrasound is used to monitor the growth of fibroids over time.
Treatment and treatment of fibroids
Depending on their location, size, number, the symptoms they cause, as well as the age of the woman, it should be decided whether and how they will be removed or if a more conservative approach will be followed.
Fibroids that do not cause symptoms, are small, or occur in a woman approaching menopause often require no treatment but ultrasound monitoring.
Certain signs and symptoms may signal the need for treatment:
• Heavy or painful menstrual periods that cause anemia or that interfere with your normal activities
• Bleeding between periods
• Uncertainty whether the growth is a fibroid or another type of tumor
• Rapid growth of fibroid
• Infertility
• Pelvic pain
Their treatment is usually surgical. There are also alternative treatments for fibroids, such as medication, which aims to temporarily improve symptoms and treat anemia before surgery. Less common treatments are the destruction of the fibroid with therapeutic ultrasound or embolization.
Surgical treatment
The treatment of fibroids is mainly their surgical removal. Modern treatment is largely done through minimally invasive surgery that includes endoscopic procedures. They are applied for both diagnostic and therapeutic purposes and include Hysteroscopy, Laparoscopy, but also the most advanced surgical method of robotic surgery.
Endoscopic surgery in experienced hands is a revolutionary method.
With the use of special micro-tools through 1 cm incisions, fibroids are removed and patients leave the hospital the same or the next day, with an immediate return to everyday life, and at the same time blood loss, risk of infection, post-operative pain are reduced by combining maximum efficiency with the best aesthetic result.
Robotics is the advanced form of endoscopic surgery offering additional advantages:
• 3D vision of surgical field
• 7 degrees of freedom of movement
• Two-handed operation
• Motion accuracy of tenths of a millimeter
• Greater comfort of the surgeon during the operation (ergonomics)
Fibroid removal is an operation that requires special expertise and surgical skill, especially in women who are of reproductive age, in order to ensure good healing and functionality of the uterus, enabling them to have children in the future without complications.
Reproductive surgery is a specialized branch of gynecology, which finds application in the surgical restoration of pathological conditions of the female reproductive system in women who wish to have children in the future, combining at the same time the well-known advantages of endoscopic surgery.
Written by:
Vasilios Kapetanakis
Obstetrician gynecologist
Director of Endoscopic Female Reproductive Surgery HYGEIA
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