Uterine fibroids, benign and silent tumors: this is how they are treated

An often silent disease, it affects one in four women and can be successfully treated thanks to drugs and surgery.

One in four women suffers from it, for a total of almost 3 million people, only in our country.

Yet, women are still poorly informed about uterine fibroids. The symptoms are often underestimated and a precise diagnosis is made late.

What are they?

These are benign tumors that form in the muscle tissue of the uterus. Single or multiple, they can be localized inside the uterine cavity, develop outwards or be intruders into the thickness of the uterine wall.

The dimensions vary from those of the seed of a fruit (a few millimeters), up to the size of a watermelon.

Symptoms often “silent”

In most cases, fibroids do not cause symptoms. However, some patients report the presence of:

• heavy bleeding during the onset of menstruation, which can be so intense that it causes iron deficiency (anaemia) or pain
• feeling of swelling in the pelvic area, i.e. in the area below the stomach
• swelling at the level of the lower abdomen
• frequent need to urinate
• pain during sexual intercourse
• pain in the lower back.

Sometimes intestinal pains may appear, due to the pressure of the fibroid on the intestine.

This is how the diagnosis is made

Uterine fibroids can be diagnosed by a gynecological examination.

In some cases, however, these formations are located in areas that are difficult to observe or are very small in size.

It is therefore advisable to perform a transvaginal ultrasound, or, if suggested by the specialist, a trans-abdominal ultrasound, which will allow to exclude or confirm the diagnosis with certainty.

What are the causes

It is not known with certainty why these formations develop. It is likely that there is a genetic predisposition, but there are also hypotheses that exposure to hormone therapies could influence its appearance.

It has been observed that in the presence of high levels of estrogen and progesterone, for example during pregnancy, fibroids increase in size, while, on the contrary, they seem to reduce during phases of low hormone levels, as occurs during menopause.

Therapy: surgery or medication?

For patients who do not report symptoms it is not necessary to undergo any therapy: it is sufficient to carry out a periodic gynecological examination (every 6-12 months) to check the evolution of fibroids.

If the symptoms are obvious, however, there are three possibilities of treatment:

• Drug therapy
• surgery
• embolization.

Drug therapy

Non-hormonal (antihemorrhagic) drugs or various types of hormones can be used, which:

• They work by reducing menstrual disorders, but are unable to block the growth of fibroids.
• have a temporary effectiveness: in other words, once the treatment is finished, the symptoms reappear
• In some cases they have side effects that prevent prolonged use.

For these reasons, drug therapy is prescribed in special cases:

• women close to menopause, who do not wish to undergo surgery
• to treat any anemia caused by fibroids, pending surgery.

Surgery

There are several surgical procedures, which are chosen based on the characteristics of the fibroids, such as:

• size
• number
• localization.

Depending on these characteristics, the surgeon can advise the patient to undergo a conservative operation, by exporting each individual fibroid, or opt for a hysterectomy, which involves the removal of the entire uterus.

The surgical techniques used are:

• Laparoscopic technique: the doctor works by penetrating the abdominal cavity the optical and surgical instruments through three small incisions, one below the navel and two in the lower abdomen.
• Laparotomic technique: the doctor operates “open abdomen” through an incision in the abdominal wall.
• Vaginal and hysteroscopic techniques: The doctor operates by introducing surgical instruments through the vagina.

Embolization: “cutting food” to fibroids

It is a radiological technique, through which the fibroid is prevented from receiving nourishment through the bloodstream.

In other words, it blocks the artery that carries blood to the fibroid, preventing it from being fed and, therefore, from growing. In this way, there is a progressive reduction in the volume of the fibroids themselves, without having to resort to surgery.

However, embolization cannot be used for all fibroids. During the fibroid resorption phase, in addition, the appearance of pain and blood loss may occur.