- ATHENS OFFICE MED4WOMAN ATHENS
- VOLOS OFFICE MED4WOMAN VOLOS
Obstetrician-Gynecologist
PhD, University of Athens Medical School
Obstetrician-gynecologist Panagiotis Polyzos practices at the Institute of Life, the IVF Unit of IASO Maternity Hospital.
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.
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 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 fibroids project fully or partly into the uterine cavity and distort it. Submucosal fibroids can cause infertility, while their main symptom is abnormal uterine bleeding. They are the least common compared with the other types of 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.
Symptoms vary depending on the number, size, and location of the fibroids. Common symptoms include:
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.
The gynecologist will develop a personalized treatment plan based on the patient’s age, reproductive goals, fibroid size, and overall health.
Gonadotropin-releasing hormone (GnRH) agonists, such as leuprolide, lower the levels of estrogen and progesterone. This will gradually stop menstruation and shrink the fibroids.
Oral GnRH antagonists, such as relugolix (combined with a low dose of hormones), reduce bleeding and symptoms. They work by stopping the production of follicle-stimulating hormone (FSH) and luteinizing hormone (LH).
Most uterine fibroids do not prevent conception or a normal pregnancy. The ones that cause problems are mainly submucosal fibroids, which distort the uterine cavity and make implantation harder, and very large or multiple fibroids. In these cases, removal is discussed before trying for a baby, often by hysteroscopy or laparoscopy.
To learn what changes when you get pregnant with fibroids, the risks and delivery, read the guide on fibroids in pregnancy.
The hysterectomy (removal of the uterus) option is for older women with symptoms who have already had children. An abdominal, vaginal or laparoscopic hysterectomy can be performed.
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).
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.
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.
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.
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.
The cost is determined after consultation with your gynecologist and varies depending on the treatment method chosen for each case.
When fibroids are multiple and the woman does not want another pregnancy, one of the permanent solutions is a laparoscopic total hysterectomy.
Fibroids are the most common benign tumor of the female reproductive system. In large ultrasound studies, up to seven in ten women have at least one fibroid by the age of 50. Most of them do not know it, because they have no symptoms.
The exact cause is not fully known. We know that each fibroid starts from a single smooth muscle cell of the uterus that acquires a genetic change (most often in the MED12 gene) and begins to multiply. Estrogen and progesterone act as “fuel” for its growth.
Pregnancies, on the other hand, seem to slightly reduce the risk. None of the above means you will definitely develop fibroids. It simply shows which women benefit from a regular gynecological ultrasound.
Large intramural and subserosal fibroids often do not affect periods at all. They do cause discomfort, however, because they take up space in the pelvis and press on nearby organs.
Many women put these symptoms down to age or irritable bowel. If they occur together with heavy periods or bloating in the lower abdomen, a simple ultrasound gives a quick answer.
Heavy bleeding is the most common problem that brings a woman with fibroids to the gynecologist. Over time, the blood loss drains the body's iron stores.
Fatigue that does not go away with rest, shortness of breath on the stairs, a racing heart, paleness, headache, hair loss and brittle nails. A complete blood count and a ferritin test show how much your body has been affected.
Anemia is treated alongside the fibroids, with oral iron or, when a quick recovery is needed, intravenous iron. If surgery is planned, correcting the anemia beforehand reduces the risk of a transfusion.
Not every woman needs injections or surgery. Often the goal is simply to reduce bleeding and pain, so that you can manage comfortably until menopause or a planned pregnancy.
Ulipristal 5 mg, which was used for fibroids in the past, is now restricted by the European Medicines Agency because of rare but serious liver injury. No medication makes fibroids “disappear” permanently. Once it is stopped, symptoms usually return.
A small fibroid that causes no symptoms and does not affect the uterine cavity is usually just monitored. This approach does not mean neglect, but active surveillance.
In follow-up studies, the growth rate varies greatly from woman to woman, and even between fibroids in the same uterus. Some grow slowly, others stay stable for years and some shrink on their own.
Heavy periods and pelvic pain are not always due to fibroids. Two conditions often coexist, and that changes the treatment.
When a lesion inside the cavity is suspected, hysteroscopy allows immediate visual confirmation and, often, removal in the same session.
The time it takes to return to daily life depends mainly on the technique and on how deep in the wall the fibroid was.
If the uterine wall needed extensive suturing, waiting a few months before trying to conceive again is usually recommended. The guide on fibroids in pregnancy explains in detail what changes when you are already pregnant.
Most fibroids progress slowly and mildly. But some situations should not wait for your next scheduled appointment.
In these cases, contact your gynecologist the same day or go to an on-call hospital.
Fibroids are benign tumors. Malignancy (sarcoma) is extremely rare.
No. Those that cause no symptoms and do not affect fertility are simply monitored with ultrasound.
Mainly submucosal fibroids, which distort the uterine cavity. The others usually do not affect conception.
Yes, in most women they shrink, because estrogen levels drop.
New fibroids can appear, especially in younger women with multiple fibroids.
There is no fixed rate. In follow-up studies, the average growth was small, but with huge differences: some fibroids stay stable for years, others grow faster and some shrink on their own. That’s why a follow-up ultrasound is the only reliable way to know what is happening in your case.
Large fibroids can enlarge the lower abdomen and cause a feeling of bloating or heaviness in the pelvis. Body weight increases very little, unless the uterus is very large. If your waist is getting wider without any change in your diet, a gynecological checkup is worthwhile.
In most cases, yes. Modern low-dose contraceptives do not seem to make fibroids grow and often reduce bleeding. Menopausal hormone therapy may cause slight growth in some women, so ultrasound monitoring is needed. The choice is always made on an individual basis.
A balanced diet with vegetables, fruit and less red meat, maintaining a healthy weight and correcting vitamin D deficiency are linked to a lower risk in observational studies. However, no diet or supplement makes existing fibroids disappear. Do not delay treatment by relying on supplements alone.
