Uterine fibroids are the most common tumor in women. Seventy percent of women over the age of 50 have at least one fibroid, and they are caused by the growth of uterine smooth muscle cells.
The reason why uterine fibroids appear is unknown, although there is evidence that estrogens and progesterone are related to tumor growth. It is rare to find them before menarche, and fibroids usually decrease after menopause.
Most fibroids are asymptomatic, and those that interfere with normal quality of life should be treated. The clinical symptomatology depends on the size, location and number. Depending on this, it may result in symptomatology due to compression, alterations in menstrual or intermenstrual bleeding, or affect fertility.
Treatment of fibroids
Treatments can be medical or surgical. Medical treatments are mainly based on estrogen reduction. In general, patients show a transitory improvement of the symptomatology, although it usually returns after the end of the treatment, sometimes they can solve the problems and avoid surgical treatment.
Radiological techniques, myoma embolization and ultrasound-guided destruction with radiofrequency are other options available.
On the other hand, when surgical treatment must be performed, we have different techniques, which will depend on the characteristics of the myoma, the patient and the surgeon’s experience. Whenever possible, minimally invasive surgery (laparoscopy, hysteroscopy) will be performed. When it is necessary or desired to preserve the uterus, myomectomy (which is a removal of the myoma or myomas only) will be performed, and in other cases hysterectomy (removal of the uterus) will be required.
Surgical technique depending on the case and the surgeon’s experience
1. Hysteroscopy: Indicated in submucosal and intracavitary lesions.
2. Laparoscopy or laparotomy: subserosal and intramural myomas, myomectomy or hysterectomy (total or subtotal).
3. Vaginal route: total hysterectomy and some cases of myomectomy.
The laparoscopic and vaginal routes allow a shorter hospital stay and an early recovery.
We must not forget that, although most myomas are benign, a small percentage can be malignant (leiomyosarcomas), this should be assessed when indicating the surgical technique.