Large fibroids can cause symptoms

Fibroids (growths of the uterine muscles)

Fibroids are nodular new muscle formations in the uterine muscles. They are usually benign tumors of the uterus. Very rarely, fibroids can degenerate and form malignant tumors.

How do fibroids develop?

From the age of 35, every third woman carries myoma. The growth of these muscle nodes in the uterus is stimulated by the female sex hormones, especially estrogens, which are repeatedly formed in the monthly cycle. After the menstrual period has ceased (= menopause or menopause), this estrogen-dependent tumor recedes in size, since the stimulating hormone production also declines with the discontinuation of the monthly cycle.

The growth of the fibroids is linked to the function of the ovaries. There are no uterine fibroids in children and no new fibroid growth after menopause.

What symptoms do fibroids cause? 

Fibroids can exist without any symptoms and go unnoticed. But they can also cause severe symptoms in some cases.

Most frequently, patients suffer from bleeding disorders and "menstrual pain." Impairment of fertility or the occurrence of ureteral or kidney congestion are rare.
Whether or not a fibroid causes symptoms depends on both its size and the location of its growth. Most fibroids grow directly in the muscles of the uterus (intramural); 40% are in the outer layer of the uterine muscles. Other locations are less common. Small fibroids near the lining of the uterus can cause severe symptoms such as increased or painful menstrual bleeding. In contrast, large fibroids close to the peritoneum with a diameter of up to 10 or 12 cm often do not give rise to any complaints.

The following symptoms can indicate the presence of fibroids:

  • Infertility or recurring miscarriages
  • Bleeding disorders, menstrual pain (= dysmenorrhea), increased menstruation
  • Abdominal discomfort, frequent urination, ureteral congestion / kidney congestion

How are fibroids diagnosed?

Large fibroids can be felt by the gynecologist during the examination and are often secondary findings if the patient has no symptoms. The best diagnostic procedure is to use ultrasound scans of the uterus to determine the location, number, and size of the fibroids. Myomas can be detected almost everywhere based on their typical image. In exceptional cases, computed tomography or magnetic resonance imaging is necessary for clarification. For the final clarification, a laparoscopy is required for the rare myomas near the peritoneum (laparoscopy) and for myomas near the mucous membrane, which are associated with increased and prolonged menstrual bleeding, a hysteroscopy. Anesthesia is necessary for the latter two examinations.

What complications can fibroids cause?

Fibroids can remain symptom-free for a long time and become larger in the interval, but they can also soften due to the increased growth in size. The reason for the softening is an insufficient blood flow, which leads to an undersupply of the muscle node, whereby the muscle tissue slowly perishes and possibly even disintegrates. Each muscle knot is examined in the tissue (microscopically). The malignant degeneration of fibroids is rare and occurs in less than 1% of cases. It is observed almost exclusively in postmenopausal women (after the menopause).

How are fibroids treated?

The classic treatment method for women who have completed family planning is removal of the uterus (hysterectomy). Alternative methods by means of hormone treatment (gonadotropin releasing hormone analogues, GnRH) are only temporary and after discontinuation of the drug, the myomas recur.
If there is a desire to have children, and increasingly also in women who wish to preserve the uterus, the fibroids can be removed or peeled out of the uterine muscles (myomectomy). In the case of fibroids within the muscles or fibroids close to the peritoneum, this is done on the one hand by the conventional abdominal incision method; on the other hand, laparoscopy (laparoscopy) is used more and more often, whereby myomas up to a size of 15 cm can be removed. Fibroids near the mucous membrane must be removed by means of an uterine specimen.

Women who wish to have children should know that the scar in the uterine wall that occurs after myoma enucleation is exposed to an increased risk of rupture during a future pregnancy. Therefore, a close inspection by the gynecologist is necessary, especially in the second half of pregnancy, in order to identify the possible complication of a tearing of the scar at an early stage.

As a patient, what should I do if I have fibroids?

If muscle nodes are present, the growth of the muscle nodes should be checked regularly by means of ultrasound in addition to the gynecological examination. Depending on the existing symptoms, further therapy should be carried out in consultation with your gynecologist.

 

Read more about the diagnosis and treatment of fibroids.

 

Removal of the uterus or hysterectomy is one of the most common gynecological operations. Around every third woman in the Federal Republic of Germany will be affected by it in the course of her life.

Widespread changes in the uterus often make such an operation necessary. "Fibroids that cause symptoms, bleeding disorders or painful endometriosis, sagging or cancerous changes are part of it," says Prof. Dr. Run tree. "For women for whom this step is necessary and sensible, we can now offer much gentler surgical methods with new minimally invasive procedures."