What Are Fibroids?
Uterine fibroids are benign tumors that develop in the wall of the uterus, in the smooth muscle layer, which is why they are also called leiomyomas. They can be solitary or multiple, ranging in size from a few millimeters to over 10 centimeters, and are found in various locations within the uterus.
This is one of the most common gynecological conditions and is estimated to affect 20 to 40% of women of reproductive age. In most cases, they are discovered incidentally during an annual gynecological ultrasound, as they do not always cause symptoms.
The likelihood of a fibroid developing into a malignant tumor is very low but exists (approximately 0.1–0.8%). Despite their prevalence, fibroids require monitoring by a specialized gynecologist, as some require treatment.
How Fibroids Form
The exact causes of fibroids have not been fully elucidated. There is, however, strong evidence that their development is significantly influenced by female hormones—estrogen and progesterone. This is supported by the fact that they occur mainly in women of reproductive age, grow during pregnancy when hormone levels are high, and shrink or disappear after menopause.
In addition, certain risk factors have been identified that are associated with an increased likelihood of developing fibroids. These include family history, obesity—which increases the risk up to three times the average—and age, with fibroids occurring more frequently in women in their 30s and beyond.
Types of Fibroids
Fibroids are classified based on their location within the uterus. Their location is a key factor in determining both the symptoms they cause and the choice of appropriate treatment.
Intramural Fibroids
They develop within the uterine wall and are the most common type. When they grow large enough, they can cause a feeling of pressure, heavy periods, and enlargement of the uterus.
Submucosal Fibroids
They are located beneath the inner wall of the uterus and, as they grow, protrude into the uterine cavity. This is the type most directly associated with heavy bleeding and fertility issues, as they can prevent embryo implantation.
Subserosal Fibroids
They appear on the outer surface of the uterus. When they grow large enough, they can press on neighboring organs such as the intestines and the bladder, causing symptoms such as frequent urination or constipation.
Cervical Fibroids
They are located in the cervix and are the rarest type. Due to their location, they can cause pain during sexual intercourse and complications during childbirth.
Symptoms
Most women with fibroids have no symptoms, and the condition is often discovered incidentally during a routine annual gynecological exam
Bleeding symptoms
Heavy or prolonged periods are the most common symptom, especially with submucosal fibroids. Bleeding between periods may also occur, as well as fatigue due to anemia caused by increased blood loss.
Pain and Pressure
Chronic pain or a feeling of pressure in the pelvic area, lower back pain, and pain during sexual intercourse are common symptoms, especially with larger fibroids.
Symptoms from adjacent organs
Large fibroids that press on adjacent organs can cause frequent urination, difficulty emptying the bladder, or constipation.
Enlarged uterus
In cases of multiple or large fibroids, the uterus may become significantly enlarged, causing the woman to experience bloating or a feeling of heaviness in the abdomen.
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Treatment of Fibroids
The management of fibroids is individualized and depends on their size, number, and location; the severity of symptoms; the woman’s age; and her reproductive goals. Not all fibroids require treatment.
In cases of small, asymptomatic fibroids, regular monitoring with follow-up ultrasounds is recommended. Since fibroids are hormone-dependent, in women approaching menopause, monitoring is often the most sensible option, as their natural shrinkage is expected.
Medication
Conservative medical treatment aims to reduce symptoms rather than permanently eliminate fibroids. It includes hormonal medications that regulate the menstrual cycle and reduce bleeding, anti-inflammatory drugs for pain relief, as well as GnRH agonists that cause temporary shrinkage of fibroids by reducing estrogen levels.
When Do Fibroids Need to Be Removed?
When medication is ineffective or unsuitable, surgical removal is the most effective solution.
There are two main surgical options depending on each woman’s needs:
Myomectomy involves the removal of fibroids while preserving the uterus and is primarily recommended for women who wish to have children. It is performed laparoscopically, hysteroscopically, or via open surgery, depending on the type and location of the fibroids.
Hysterectomy involves the removal of the uterus and is a definitive solution for women who do not wish to become pregnant in the future and have extensive disease that is resistant to treatment.
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Fibroids, Fertility & Pregnancy
When do they affect fertility?
Submucosal fibroids are the ones most directly linked to infertility, as they can prevent embryo implantation or block the fallopian tubes. Large intramural fibroids can also negatively affect fertility, while submucosal fibroids generally do not significantly affect it.
Fibroids and pregnancy
During pregnancy, fibroids may grow in size due to high hormone levels. In some cases, they may cause complications such as pain, an increased risk of miscarriage, or preterm labor, depending on their location and size. However, the majority of pregnancies with fibroids proceed without complications.
Fibroids and In Vitro Fertilization
The presence of fibroids is carefully evaluated before any in vitro fertilization (IVF) protocol. Depending on their type and location, the gynecologist may recommend their removal before starting the protocol to improve the chances of success.
If you have fibroids and are planning a pregnancy, a personalized evaluation by a specialized gynecologist is the most important step before any attempt to conceive.
Fibroids During Menopause
With the onset of menopause and the decline in estrogen levels, fibroids usually shrink gradually and symptoms subside. In some cases, they may disappear completely.
However, a fibroid that continues to grow after menopause requires immediate investigation, as it is a sign that should not be ignored. Also, women receiving hormone replacement therapy should be aware that it may keep fibroids active.
Menopause does not automatically mean the end of follow-up care. Regular gynecological checkups remain essential.
Frequently Asked Questions (FAQ)
The growth rate of fibroids varies significantly from woman to woman and is unpredictable. Some remain stable in size for years, others grow slowly, and some grow more rapidly, especially during pregnancy. For this reason, regular ultrasound monitoring is essential to track their progression.
Yes, especially after menopause when estrogen levels decline. In women of reproductive age, spontaneous resolution is rare; however, small fibroids may remain stable without causing problems for a long time. The decision to wait or treat is always made in consultation with a gynecologist.
Yes, fibroids can cause menstrual cycle irregularities, including delayed or irregular periods. This is due to the effect of fibroids on hormone levels and the structure of the endometrium. If you notice changes in your cycle, discuss this with your gynecologist.
Fibroids do not rupture in the traditional sense, like a cyst. However, they can undergo degeneration—a process in which the fibroid grows faster than it can be supplied with blood, causing it to die off internally. This can cause sudden and severe pain that requires immediate medical evaluation.
The recovery time depends on the method used. Recovery is fastest (2 to 5 days) following hysteroscopic removal of small submucosal fibroids. With laparoscopic myomectomy, hospitalization usually lasts 24 to 48 hours; with open surgery, hospitalization and recovery take significantly longer (4 to 6 weeks).
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