Uterine fibroma: a sketch of the most common benign female tumour

By Cristiano Antonino On May 30, 2023

One in four women, between the ages of 30 and 60, develops uterine fibroma, a benign tumour that sometimes shows no signs of itself, while others may manifest itself with anaemia due to heavy bleeding, pelvic pain and infertility

It is always essential not to underestimate the problem and to pay attention to the first alarm bells, such as abnormal uterine bleeding, frequent or abnormally heavy menstrual cycles, and volumetric increases in the abdomen.

WHAT ARE UTERINE FIBROMA?

Uterine fibroids (or myomas) originate from the muscular tissue of the uterus and represent the most frequent benign female neoplasm, especially during fertile age.

In particular cases, if neglected and growing, fibroids can significantly impair the patient’s quality of life, which is why it is important not to postpone gynaecological check-ups, which, unless otherwise indicated by the specialist, should be annual.

UTERINE FIBROMA, SYMPTOMS

While in many cases uterine fibroids are not accompanied by discomfort, in others they can cause significant discomfort.

Submucosal fibroids are the most troublesome, causing very heavy menstruation and metrorrhagia (heavy bleeding not due to menstruation).

They can also cause pelvic pain, leading to a worsening of the sufferer’s quality of life and can affect fertility.

In fact, the presence of a fibroid alters the regular anatomy and function of the uterus.

DIAGNOSIS

The diagnosis of uterine fibroma is made through a specialist gynaecological examination combined with transvaginal and (if necessary) transabdominal ultrasound.

When fibroids occur silently or asymptomatically, they may be detected by chance during a gynaecological check-up.

TREATMENTS FOR UTERINE FIBROMA

Fibroids are often asymptomatic: in these cases, treatment is based on periodic monitoring – by gynaecological examination and ultrasound – to check for any changes in their volume and position.

When, on the other hand, fibroids are symptomatic, drug therapies, surgery or embolisation surgery can be used.

Pharmacological therapy is based on the use of the estro/progestin contraceptive pill, natural progesterone, progestin drugs or injections with ‘GnRH analogues’ (gonadotropin-releasing hormone).

Recently, new drugs have also been introduced that combine GnRH antagonists with oestrogen.

The drugs used are effective on menstrual disorders, but they are often not able to stop the growth of fibroids, which is why most of the time they have temporary effectiveness (i.e. the symptoms reappear once the treatment is over).

Furthermore, pharmacological treatment is only used in specific cases: for example, to treat anaemia caused by fibroids or as a preparatory therapy for surgery.

Uterine fibroma surgical therapy is aimed at removing

Depending on the type, size and number of fibroids, different surgical techniques can be employed.

With laparoscopy, the surgical and optical instruments to perform the operation are inserted into the abdominal cavity through small incisions.

In the case of traditional surgery, the operation is performed through a larger incision in the abdominal wall (laparotomy).

With hysteroscopy, on the other hand, the operation is performed by introducing the surgical instruments into the uterine cavity, through the vagina.

This technique allows the removal of a particular type of fibroids, those with endocavitary development.

Depending on the case, the evolution, the age of the patient, the desire for motherhood and the patient’s preference, the surgical choices vary from more conservative operations to the possible or necessary removal of the uterus.

Embolisation is an interventional radiological technique whereby the artery ‘feeding’ the fibroid is identified and occluded, thus depriving the fibroid of the blood supply from which it draws nourishment to grow.

The manoeuvre thus entails a progressive reduction in the volume of the fibroid itself without the need for surgery.

However, this procedure is not feasible for all myomas and often creates pain and blood loss during the resorption phase of the fibroid.