Uterine Fibroids

What it is

Fibroids are common benign uterine tumors that, in many cases, cause no symptoms. When symptomatic, they can cause heavy or prolonged menstrual bleeding, anemia, cramping, a sensation of heaviness or pressure in the lower abdomen and, in some cases, difficulty becoming pregnant. Treatment depends on the size, location, and symptoms, as well as age and the desire for pregnancy: it can range from periodic monitoring with ultrasound to medications to control bleeding and pain. When indicated, procedures such as surgical hysteroscopy or other surgeries may be considered.

Most common symptoms

• Heavy or prolonged periods, with clots
• Anemia, fatigue and weakness
• Cramping and pelvic pain
• A feeling of heaviness or pressure in the lower abdomen
• Frequent urge to urinate or constipation
• Increased abdominal volume
• Difficulty becoming pregnant or pregnancy loss

Causes and risk factors

• Action of the hormones estrogen and progesterone on the uterus
• Family history of fibroids
• Reproductive age, most common between ages 30 and 50
• Early first period and never having been pregnant
• Obesity and high blood pressure
• Genetic and ethnic factors

How it is diagnosed

Diagnosis usually starts with symptoms and the gynecological exam, in which the uterus may appear enlarged or irregular. Transvaginal ultrasound is the main test: it shows the number, size and location of the fibroids, information that is essential for defining treatment. In very enlarged uteruses or when planning surgery, MRI may be ordered. When a fibroid projects into the uterine cavity, diagnostic hysteroscopy confirms its location. A complete blood count assesses for anemia.

How we treat it at Femi Saúde

Fibroids without symptoms are generally just monitored with periodic ultrasound. When there is bleeding or pain, the Femi Saúde gynecology team may recommend anti-inflammatory drugs, medications that reduce flow, hormonal contraceptives, progestins or the hormonal IUD, along with iron replacement for anemia. In selected cases, medications that temporarily shrink the fibroids are used before surgery. Fibroids inside the uterine cavity can be removed by surgical hysteroscopy; others, by myomectomy via laparoscopy or open surgery, preserving the uterus. Hysterectomy is an option for those who no longer wish to become pregnant. The plan is individualized according to age, symptoms and desire for pregnancy.

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