Uterine fibroids (myomas) are common benign tumors of the uterus (not cancerous). The structure of uterine muscle is unique and adapted to the organ function. Naturally the fibers are parallel, arranged in a coil-like pattern, permitting the uterus to distend and accommodate the fetus during the pregnancy and contract during delivery. Another very important property is the impressive regeneration and remodeling capability, allowing a 60 grams non-pregnant uterus to reach 1,100 grams in pregnant state and return back to original size postpartum.
Due to unknown circumstances the proliferation of the muscle becomes disorganized and you could imagine a ball of tangled coils as an explanation of fibroid formation. This ball resulted continues to grow under the hormonal stimulation until you reach menopause, so more years of reproductive age you have ahead, higher the likelihood to become bigger. However the rhythm of expansion is unpredictable and it can take many years to enlarge 1 inch or just few months. This is very important in determining the management because like we said in the beginning the fibroids are very common and not all of them require intervention. Furthermore the impact on your body functions is not necessarily proportional with their size.
As a rule of thumb, if the fibroids don’t cause problems, you leave them alone but keep them under surveillance. What kind of problem can they cause? Assuming they are located towards the inner surface of the uterus, you may experience heavy periods with or without bleeding between the periods. If they outgrow their blood supply they may become necrotic and you may have fever, pain and foul-smelling discharge. In some cases they may distort the shape of the uterine cavity making the implantation of the egg impossible and you may have difficulties becoming pregnant or you may experience early pregnancy loses.
If they are located within the thickness of uterine muscle, they may cause pelvic pain only. There are many theories of the origin of pain but imagine a heavier than normal organ attached through ligaments to your skeleton for support. Same ligaments carry the path of some of the nerves that conduct the pelvic pain stimulation to your brain. Continuous stretching of these ligaments may irritate the adjacent nerves signaling your brain the sensation of pain. Obviously same symptom may occur with any location of the fibroids.
Lastly if the myomas are growing towards the outer surface of the uterus, they may compress the organs around keeping in mind the uterus is located between the bladder and the rectum. Subjectively they may cause a urinary urgency sensation or objectively various degrees of constipation.
With such of diversity of symptoms, essentially the treatment should be individualized for the condition targeted. For example if the problem is heavy bleeding leading to anemia and the patient completed childbearing, a hysterectomy is the most logical step. On the contrary if the fibroids are causing infertility and the patient is interested in becoming pregnant, a hysterectomy is out of discussion.
We offer individualized care to address your complaints and we can provide much more information for your particular case. Should you need surgical intervention, we can assist you providing all the options available and help you chose what is best for you. We thoroughly analyze all other associated problems simultaneously in order to resolve everything through one intervention and prevent further unnecessary surgeries. We offer hysteroscopic myomectomy, laparoscopic or open myomectomy, laparoscopic, transvaginal or open hysterectomy with or without removal of the ovaries, with or without concomitant pelvic or vaginal reconstruction, with or without correction of urinary incontinence and the best news is that over 95% of our complex cases are done minimally invasive with 23 hours hospital in stay or same day home discharge.