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Fibroids are one of the most common conditions in women, affecting about one in four women at some point in their lives. These are benign masses that originate from uterine tissue and extend beyond the shape of the uterus.
Genetic predisposition plays a significant role in the development of fibroids, and many patients have multiple fibroids. Since estrogen causes fibroids to grow, they often enlarge during reproductive years and pregnancy.
Fibroids vary in location within the uterus; they can grow towards the uterine lining or be embedded in the uterine muscle. Additionally, fibroids can extend outward from the uterus or develop with a stalk, and fibroids near the ovaries can also occur.
Though the exact cause is still unknown, fibroids can lead to pregnancy losses and reproductive issues. Factors like age, ethnicity, not having given birth, and obesity increase the risk, while multiple childbirths reduce it.
Pathological examinations of the uterus show that 77% of women have one or more fibroids, causing issues in 60% of women of reproductive age.
Fibroids are very common and are the most frequent benign tumors in the uterus. Approximately one in ten women has non-harmful small fibroids, most common among women aged 35-40.
Most fibroids are asymptomatic and may not cause any issues. However, irregular bleeding is the most common symptom associated with fibroids.
Additionally, fibroids may cause pain and pressure in the lower abdomen, similar to pregnancy. This can reduce bladder capacity, leading to frequent urination.
Irregular bleeding associated with fibroids may also cause iron deficiency anemia in women, leading to symptoms like fatigue, weakness, and shortness of breath.
As fibroids are prevalent among women, they can have a negative impact on conception. The type of fibroid also affects the likelihood of preventing pregnancy.
The most common types are intramural, submucosal, and subserosal fibroids. Submucosal fibroids, which are located near or within the endometrium of the uterus, have been shown in many studies to make pregnancy more difficult and may need removal to increase pregnancy chances.
Intramural fibroids, located within the uterine wall, may affect pregnancy if they are 4 cm or larger, in which case removal is recommended.
Large fibroids can affect uterine contractions, disrupt blood flow to the uterus, impact fetal development, and cause premature labor in advanced pregnancy stages. Fibroids near the fallopian tubes can also block passage, affecting fertility. However, subserosal fibroids outside the uterus are not shown to impact pregnancy negatively.
The need for fibroid removal depends on the symptoms and consequences. If a fibroid is 5 cm or larger, keeps growing, and impacts quality of life, it requires treatment.
Surgery is the primary treatment for fibroids. While some medications are used pre-operatively to shrink large fibroids, they do not replace surgery.
Not all fibroids need surgery. Fibroids that cause symptoms or issues should be surgically treated. For instance, fibroids causing bleeding, excessive uterine growth, or pressure on the bladder and rectum may need removal. Sometimes, fibroids twist around their stalk, causing pain and requiring urgent surgery.
Large fibroids forming masses in the abdomen or those causing bleeding inside the uterus are also surgically removed.
Surgery is necessary when fibroids cause discomfort, continue growing, cause pressure, lead to heavy bleeding, or affect pregnancy and risk miscarriage. The procedure is done via open surgery, laparoscopy, or hysteroscopy. Hysteroscopy is used for fibroids growing towards the uterine lining, allowing removal through the vagina.
Today, most large centers perform fibroid surgeries via laparoscopy. With this method, fibroids are removed through the navel without opening the abdomen.
Even large or numerous fibroids can now be removed with closed methods due to advances in experience and technical resources.
If the patient is in or near menopause, removing the entire uterus may be considered, while younger patients who wish to retain fertility can have only the fibroid(s) removed.
Fibroid surgeries can be performed laparoscopically or through open surgery. Laparoscopic surgery has significant advantages over open surgery.
The main advantage is minimal blood loss. Hospitalization time is brief, and post-operative pain is minimal.
Due to these benefits, laparoscopic surgery offers high comfort to patients, allowing them to return to daily life within days.
However, for large or numerous fibroids, open surgery may be preferred to shorten operation time.
Non-surgical treatments are available for fibroids, including high-intensity focused ultrasound guided by magnetic resonance (MR-HIFU). This method, which requires no anesthesia or surgery, has shown success in many patients.
Acoustic treatment heats fibroids to 70-80 degrees using sound waves, shrinking them. Approximately 30% of cases are suitable for this method.
Another option is embolization, blocking fibroid blood vessels, considered for some cases.
Generally, fibroids are not considered cancerous, though about one in a thousand cases may develop into cancer.
Rapidly growing fibroids or those that continue growing after menopause warrant further investigation and may require surgery as a precaution.
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