A fibroid (myoma) is a benign (non-cancerous) growth that develops from the muscle tissue of the uterus. Fibroids are common in women of reproductive age. There may be one or several, and their size varies from person to person. Most cause no complaints and are noticed during an examination or ultrasound.
What complaints can they cause?
- Long or heavy periods and resulting anemia
- Pelvic pain, a feeling of fullness or pressure in the abdomen
- Frequent urination or constipation
- With fibroids affecting the inside of the uterus, difficulty getting pregnant or miscarriage
Assessment
A gynecological examination and ultrasound are the basic methods for determining the location and size of a fibroid. Detailed imaging with MRI is carried out if needed. A blood count is requested to check for anemia in people with heavy bleeding. Whether a fibroid lies inside the uterine cavity, within the uterine wall or on the outer surface of the uterus affects the choice of treatment.
Treatment options
- Monitoring: fibroids that cause no complaints are often simply monitored with regular check-ups. Fibroids usually shrink after menopause.
- Medication: hormonal or non-hormonal medicines may be used to reduce bleeding and pain. Some medicines can shrink a fibroid temporarily; it may grow again once the medicine is stopped.
- Myomectomy: removal of the fibroids only, preserving the uterus. Depending on the fibroid’s location, it is performed laparoscopically (keyhole), hysteroscopically (through the inside of the uterus) or as open surgery.
- Hysterectomy: removal of the uterus. It is considered for people who do not wish to become pregnant and for whom other options are unsuitable or have not been sufficient. Because the uterus is removed, fibroids do not come back.
For some people, interventional radiology methods based on blocking the uterine arteries (embolization) are also among the options.
Factors that influence the choice of treatment
The severity of the complaints, the features of the fibroid, age, closeness to menopause and the wish for pregnancy are assessed together.
Possible risks of surgery
Surgical options carry risks such as bleeding, infection, injury to nearby organs and adhesions inside the abdomen. During a myomectomy, situations such as unexpected heavy bleeding may rarely make removal of the uterus necessary.
In the laparoscopic method, the fibroid is often cut into small pieces inside the abdomen so that it can be removed. Rarely, tissue thought to be a fibroid contains a previously unknown malignant tumor; in that case, cutting it into pieces can spread the disease inside the abdomen. This risk is discussed before surgery.
Because there is a risk of the uterine wall tearing in pregnancies after a myomectomy, the mode of delivery is planned according to the extent of the operation.