Uterine Fibroids

Dr. Panagiotis Polyzos MD PhD MSc

Obstetrician Gynaecologist
Doctor of Medicine, University of Athens Medical School

Panagiotis Polyzos, Gynaecologist Obstetrician, is active at the Institute of Life - IVF Unit of Iaso Maternity Hospital.

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Uterine Fibroids

What are Uterine Fibroids?

Uterine fibroids are benign tumors (growths) made up of muscle tissue from the uterus, also known as leiomyomas or myomas. They vary in size, shape, and location, and may be found inside the uterine cavity, within the uterine wall, or on its outer surface.

Intramural Uterine Fibroids

Subserosal fibroids develop on the outer surface of the uterus, known as the serosal layer. They can grow quite large and cause the uterus to appear irregularly shaped.

Subserosal Uterine Fibroids

Subserosal fibroids develop on the outer surface of the uterus, known as the serosal layer. They can grow quite large and cause the uterus to appear irregularly shaped.

Submucosal Uterine Fibroids

Submucosal fibroids protrude partially or completely into the uterine cavity, often distorting its shape. They are the least common type, but can cause infertility and abnormal uterine bleeding, which is their primary symptom.

Pedunculated Uterine Fibroids

Subserosal fibroids sometimes develop a thin stalk-like base (peduncle) that supports the fibroid. When this occurs, they are referred to as pedunculated fibroids.

What are the Symptoms of Uterine Fibroids?

Symptoms vary depending on the number, size, and location of the fibroids. Common symptoms include:

  • Menstrual irregularities: Fibroids can cause heavier and longer periods with increased blood loss and more intense abdominal pain.
  • Pain during sexual intercourse: When fibroids are located near the vagina or cervix, they may cause discomfort or pain during intercourse.
  • Infertility or recurrent miscarriages: Fibroids within the endometrium can interfere with implantation of the fertilized egg, leading to reduced fertility or repeated miscarriages.
  • Pregnancy complications: Fibroids are hormone-dependent and tend to grow during pregnancy. They may cause severe pain, preterm labor, and an increased likelihood of cesarean delivery.
  • Malignant transformation: In rare cases (0.1–0.4%), fibroids may become malignant sarcomas. A sudden increase in size is the main warning sign.

How is the correct diagnosis made?

In most cases, fibroids are diagnosed during a routine gynecological examination. A pelvic ultrasound or other imaging methods, such as CT or MRI, can confirm the diagnosis and help differentiate fibroids from other conditions with similar symptoms.

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What is the Appropriate Treatment?

Ο gynecologist will develop a personalized treatment plan based on the patient’s age, reproductive goals, fibroid size, and overall health condition..

Conservative - Medical Treatment

GnRH agonists (e.g., leuprolide) lower estrogen and progesterone levels, which halt menstruation and shrink fibroids.

GnRH antagonists (e.g., ganirelix and cetrorelix) also reduce fibroid size by blocking FSH and LH production.

What should I know about fibroids during pregnancy?

Fibroid size can influence pregnancy outcomes. In about 7 out of 10 cases, the size remains unchanged during pregnancy, but in around 3 out of 10, fibroids may increase in volume.

Fortunately, in most cases, uterine fibroids do not affect pregnancy, and complications are uncommon.

Surgical Treatment & Removal

Hysterectomy

Removal of the uterus is the treatment of choice for symptomatic women of older age who have already completed their family. It can be performed through abdominal, vaginal, or laparoscopic hysterectomy.

Myomectomy

For women who wish to preserve fertility, the fibroids can be surgically removed while retaining the uterus. This can be done through open surgery (abdominal incision), laparoscopy, or hysteroscopy (for submucosal fibroids).

Uterine Artery Embolization (UAE)

Microscopic particles (the size of a grain of sand) are injected into the blood vessels supplying the uterus, cutting off blood flow to the fibroid and causing it to shrink.

MRI-Guided Focused Ultrasound Surgery

High-intensity ultrasound waves are focused on the fibroids through the skin under MRI guidance. Studies show that symptoms significantly improve for up to one year after treatment.

What should I know about fibroids during pregnancy?

Fibroid size can influence pregnancy outcomes. In about 7 out of 10 cases, the size remains unchanged during pregnancy, but in around 3 out of 10, fibroids may increase in volume.

Fortunately, in most cases, uterine fibroids do not affect pregnancy, and complications are uncommon.

Does removal involve complications?

Fibroids are usually removed via laparoscopic or open surgery. In some cases, a total hysterectomy (removal of the uterus) may be performed. Generally, complications are rare, but they can depend on the individual case. For this reason, it’s essential to consult your gynecologist to determine the best approach.

Can fibroid removal be performed at an older age?

In most cases, it is preferable to remove fibroids at a younger age, especially in women who wish to preserve their uterus. Hysterectomy is more suitable for women who have completed childbearing or are not interested in pregnancy, as it is the only way to eliminate the risk of recurrence.

While surgery is often recommended at a younger age, it can still be safely performed later in life when necessary.

What is the cost of treatment? Are prices affordable?

The cost is determined after consultation with your gynecologist and varies depending on the treatment method chosen for each case.

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