Uterine fibroids are discovered by chance during routine vaginal examinations. That can prompt questions about the impact of fibroids on a patient’s life, as well as the potential risks and the treatment options.

The answer will depend on the size, location, number of fibroids, severity of symptoms, and your reproductive goals. In most cases, uterine leiomyomata, or fibroids —the abnormal growths in or on the uterus, clinically apparent in up to 25% of women during reproductive years— remain asymptomatic. But there are various types of fibroids, submucosal fibroids, for example, could cause infertility or pregnancy loss. If you expect to become or you are already pregnant and have fibroids, we await you in a friendly and comfortable environment for an ultrasound scan that can confirm that you have fibroids and measure them. if the fibroids are sufficiently large, for a detailed discussion about the baby’s position in the womb.

Types of fibroids

Depending on where they are located, there are four types of fibroids:

  • Intramural Fibroids. The most common type that develops in the muscle wall of the womb.
  • Subserosal Fibroids. They develop in the pelvis and can become very large.
  • Submucosal Fibroids. They considered the most symptomatic, especially when it comes to abnormal uterine bleeding.
  • Pedunculated Fibroids. They grow on a slender stalk that connects them to the uterus and may need to be removed if they twist and cause acute pain.

What symptoms do fibroids cause?

When fibroids are small and the patient is asymptomatic, treatment is not required. After menopause, due to decreased estrogen levels, fibroids shrink. However, if they increase (and during a bimanual gynecological examination, the patient’s uterus is the size of a uterus more than 12 to 14 weeks pregnant, always considering that a uterus enlarged due to fibroids is usually hard), or if the woman has postmenopausal bleeding while not undergoing hormone replacement therapy, then further investigation is required and surgical treatment will likely be necessary. These are the symptoms of uterine fibroids:

  • Heavy or painful periods.
  • Fatigue. It is likely a symptom of anemia and is accompanied by potential shortness of breath, dizziness, or rapid heartbeats. A general blood test is enough to diagnose it.
  • Swelling. As fibroids press on nearby organs in the pelvis and lower abdomen, below the navel, the patient may feel some pressure or swelling.
  • Pelvic pain. Depending on the location of the fibroids, many women experience intense pain in their pelvis, lower back, legs, and even their upper back.
  • Dyspareunia (pain during intercourse, when the fibroid is low in the vagina).
  • Frequent urination, due to pressure on the bladder.
  • Constipation, due to pressure on the rectum, which necessarily limits bowel movements.
  • Fertility problems
  • Lower back pain

Fibroids and Pregnancy

  • High-Risk Pregnancy. The presence of fibroids is considered a high-risk pregnancy factor.
  • This happens because some fibroids increase the risk of miscarriage and bleeding in the first trimester, and possibly also in the second.
  • If they grow rapidly during pregnancy, they can cause pain in the third trimester and potential vitreous degeneration.
  • They may cause bleeding in early pregnancy.
  • And if the fibroids are low, near the cervix, they can obstruct the smooth progression of labor.

Which women are most likely to develop fibroids?

  • Women with a positive family history
  • Women who have not given birth – infertility.
  • Women with a lot of adipose tissue – obesity.
  • Black women

Fibroids, Diet, and Exercise

Poor diet, processed food, pesticides… all of these things burden the body. However, diet as a factor in the development of fibroids appears to play a significant role. Recent research on women who consumed at least two servings of fruits and vegetables daily showed they were 10% less likely to develop fibroids. Women of reproductive age with fibroids should consume fruits and vegetables daily, as well as legumes, soy, fish, whole grains, and oil.

Ways to treat fibroids:

Obviously, the treatment method is linked to the severity of the symptoms, the woman’s age, and her desire to become pregnant or not. Several treatments, such as short-term gonadotropin-releasing hormone agonists (GnRHa), can help shrink fibroids and maintain quality of life.

  • Iron and vitamins are administered to combat anemia.
  • For pain and swelling, simply anti-inflammatories (naproxen, ibuprofen, or Ponstan), which reduce pain during menstruation, or even stronger anti-inflammatories for pressure on adjacent organs.
  • However, the main treatment is hormonal, using birth control pills or an intrauterine device.
  • However, all these treatments can only be applied for a limited time, and furthermore, they are not suitable for women planning to become pregnant…

So, surgical treatment is considered either because the patient’s symptoms are more severe and the fibroids are growing rapidly, or because there is suspicion of potential malignancy, or because after a series of medical examinations, it has been determined that the fibroids are hindering fertility and pregnancy.

In this case, depending on the location, size, and number of fibroids, there are several options:

  • Abdominal myomectomy (open surgery), where the fibroids are removed through an incision in the lower abdomen.
  • Laparoscopic or Robotic Myomectomy (performed with a camera/laparoscope and small incisions in the abdomen to remove subserosal and intramural fibroids up to 7 cm).

Laparoscopy is not only the most modern method but also the least painful and safest, with less blood loss during the procedure and minimal risk of infection, fewer complications, greater effectiveness, and a better cosmetic result for the woman, who usually recovers within two days and consequently leaves the hospital sooner to resume her daily routine within two weeks. Otherwise, with an open myomectomy, it would take at least 4 to 6 weeks for her to get back on her feet.

  • Additionally, there is hysteroscopic myomectomy for the bloodless removal of submucosal fibroids from the uterus, without incisions or hospitalization.

In all the above cases, the uterus is preserved, and the woman can become a mother if she wishes. However, there is a 10-25% chance of the fibroids returning and a possible second surgery.

  • Hysterectomy, the only proven permanent solution for uterine fibroids, ends a patient’s ability to bear children; it is usually performed in case of heavy bleeding. It’s a serious surgery from which the patient needs around 4-6 weeks to recover.
  • Hysterectomy is also recommended for women with a family history of breast or ovarian cancer, and for postmenopausal women, removal of the ovaries.

Histological examination after the complete surgical removal of each underlying fibroma is necessary to rule out any malignancy.

Fibroids and Ensuring Fertility

In the context of reproductive surgery, the complete removal of fibroids with minimal invasion (laparoscopic myomectomy) as a method of treating infertility also serves as a complementary approach to in vitro fertilization (IVF), maximizing the success rates for couples who wish to conceive.