Uterine fibroids are the benign tumors that we will most frequently find in the female reproductive systemalthough there are many occasions in which they go unnoticed, since they rarely cause symptoms and accompany us without posing risks to the health of women of childbearing age.
However, despite being well known in the field of gynecology, there are still many women who come to the consultation with doubts about this pathology.
Fibroids are one structures derived from the muscle tissue of the uterus itself that agglomerates, acquiring a generally rounded shape. We can meet fibroids unique or multiple and? They can vary greatly in their size and location..
Based on its location inside the uterus we can define, broadly speaking, three types fibroids: los subserouswhich grow in the outermost part of the uterus towards the pelvis, the intramural, developed in the thickness of the uterine wall; and finally fibroids submucososwhich are partly or totally inside the uterine cavity.
Why do fibroids occur?
Its appearance and growth depends primarily on the action of hormones feminine on them, so that throughout the reproductive stage of the woman, from the first (exceptionally before) to the last period.
He size of fibroids can be seen increased by various stimuli hormonalsuch as the menstrual cycle or pregnancy. At menopause and after childbirth, with the drop in hormonal levels, these also tend to reduce in size, even disappearing in some cases.
There are a number of factors associated with increased risk of having fibroids, such as ethnicityhe start early of menstruation or the number of children.
It must be remembered that the frequency of appearance of fibroids is 12-25% in patients of childbearing age, but their real prevalence is surely higher, because in many cases they do not produce any symptoms and go unnoticed. Thus, it has been described the presence of fibroids in up to 80% of the uteri analyzed that have been removed for other reasons.
What are the symptoms?
In most cases, its appearance has no effect for the patient, and when they do occur, they do so through two major types of symptoms associated with this pathology so common among women.
First of all, the irregular uterine bleeding It is one of the problems that make women go to consultation and be diagnosed. The closer the fibroid is to the uterine cavity, the longer and more intense the menses will be, although bleeding between periods will rarely occur.
There are other symptoms as well, those of compressionwhich depend on the size of the fibroids and we can notice them as abdominal girth increases caused by compression of the organs neighboring the uterus.
Thus, it can affect the bladder (reflecting increased voiding frequency and decreased urine volume), the recto (constipation or difficulty passing stool), blood vessels the lymphatics (with appearance of leg swelling or varicose veins), and some nerve plexuses (causing pain).
Diagnosis and treatment
When going to a specialist, sometimes it is enough to exploration gynecological and the sonography to detect the presence of these tumors, except in cases of doubt in which the TAC o to resonance magnetic.
As we said, most fibroids do not produce symptoms, and are not a cause for concern. nor do they imply treatment. In these cases it is recommended to reviews periodic to assess the rate of growth of known fibroids and detect new ones.
In the event that fibroids produce heavy menstrual bleedingthere are pharmacological treatments aimed at reducing the amount of bleeding such as Material (non-steroidal anti-inflammatory drugs) antifibrinolíticos and the contraceptives hormonal. There are also some drugs that can even reduce its volume and are used especially when considering future surgery.
In which cases to operate?
Surgical treatment is reserved for fibroids whose symptoms are not adequately controlled with medical treatmentor that have an important volume with compressive symptoms.
Can extract the fibroid, although it is possible that they reproduce again depending on many factors such as their size or the way they are approached. It also can remove The uterusin cases where we do not want to have children in the future or remove the fibroid is too complex.
Sometimes it is also used embolization of the uterine arteries (obstruction of the vessels that supply blood to the uterus) and ablation of fibroids with ultrasoundbut only in selected cases given the limited availability of the techniques.
The most common doubts
1. How are they different from cysts and polyps?
The tumors we are talking about located in muscle tissue or myometriumwhile the cysts and polyps come, respectively, from epithelial tissues and the mucosa that covers the internal cavity of the uterus or the canal of the cervix.
2. Are they related to fertility problems?
They can be, but they are not a common cause of infertility. If we look at the figures, 25% of infertile women have uterine fibroids, but less than 3% present them as the sole cause of sterility. Among the three types that exist, submucosal fibroids, those found in the endometrial cavity, are the ones that could affect fertility the most by causing distortion of the endometrial cavity, obstructing the fallopian tubes or altering implantation, among others. other effects.
3. Can fibroids become malignant?
Yes, but it is very rare. In fact, less than 1 in 1,000 cases have a malignant tumor, called leiomyosarcoma, usually diagnosed in menopausal women, and it has not been shown that this can come from the malignancy of a fibroid.
*Marta Lamarca is a specialist in the Gynecology and Obstetrics service at Hospital Quirónsalud Zaragoza.
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