Gynecology
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Gynecology

Fibroids

What are fibroids?

A woman’s uterus is made of muscle tissue which is called smooth muscle tissue. Fibroids (or myomas) are benign tumors in the uterine walls. They appear frequently in daughters whose mothers also had fibroids. By the age of 50 years, a large number of women (around 40-50%) will develop fibroids, which, depending on the size and location in the womb, they are likely to cause pain, heavy periods or blood between periods. They can also cause painful or frequent urination or constipation due to the pressing phenomena performed in the surrounding organs and the discomfort they create because of space occupation inside the pelvis.

Fibroids can have three types, depending on their location: submucosal, intramural and subserosal. Fibroids vary in size, ranging from a few millimeters to a few centimeters, and can either grow rapidly or remain steady in size. The development of fibroids usually decreases after menopause, because the levels of a woman’s estrogens drop.


Diagnosis of Fibroids

The best method to diagnose fibroids is a transvaginal or abdominal ultrasound. Magnetic Resonance imaging (MRI) is another useful method to diagnose fibroids, primarily for their mapping, where the boundaries are not clear or visible. Sometimes submucosal fibroids are also detected during Salpingography (specific radiological examination of the tubes and intrauterine cavity) or during a diagnostic Hysteroscopy.

Fibroids

 

How do Fibroids affect fertility?

If a fibroid grows near the entrance of the tube, it may cause tube blockage. The size, location and number of fibroids also can affect fertility and in cases of infertile women it is an important factor that should be discussed with the attending physician. Submucosal fibroids hold the major negative factor, entering the uterine cavity, disrupting its architecture, causing bleeding and altering the hormonal and secretory environment in which the embryo is implanted. All these result in difficulties in achieving pregnancy and increased incidence of abortions and / or complications during pregnancy.

 

Treatment of Fibroids

Fibroids can be removed surgically or laparoscopically.The open method (laparotomy) is called myomectomy. The process involves a small abdominal incision where the uterus is opened carefully and the fibroid is removed. Special care is needed to avoid injuring the fallopian tubes or other nearby organs and also caution during surgical suture so as not to form scar tissue.Laparoscopic removal is a process in which two or three small incisions are made on the lower part of the abdomen, to enter the laparoscopic instruments. The following surgical steps are similar to the open surgery, but with considerable advantages such as milder treatments, less traumatic, milder anatomical distortion of the pelvis and of course reduced postoperative pain and faster recovery time. Although various processes have been tried for the treatment of fibroids (e.g. drugs and vaccination), surgical removal remains the first choice especially in large symptomatic fibroids.

 

Do they re-appear even after treatment?

A significant number of women will still present fibroids even after having removed the existing ones. Therefore, after a removal surgery, a frequent medical check is important in case that any new fibroids appear. Limited chance of development or recurrence of fibroids have the women who are in menopause.

 

Is it necessary to remove all fibroids?

Removing fibroids is not always necessary and mainly depends on their size, their number, their location and the symptoms they cause (if and when they do). Moreover, a woman’s age and the degree of infertility are two other crucial factors that should be evaluated by the gynaecologist or the fertility specialist, together with the advantages and possible complications of a surgery.

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