16 Septmber 2025, Tuesday

LEIOMYOMA

 

Uterine fibroid is a benign tumor composed of smooth muscle cells of the uterine body or cervix. It is non-malignant and rarely undergoes sarcomatous transformation.

 

Etiology and Risk Factors

• Genetic predisposition
• Early menarche, late menopause
• Obesity, metabolic disorders
• Nulliparity
• Estrogen stimulation
• Chronic stress
• Endocrine disorders (e.g., thyroid disease)

Fibroids are monoclonal tumors (originating from a single mutated cell), commonly associated with MED12 gene mutations and impaired angiogenesis. 

 

Classification (FIGO)

 

Submucosal (types 0–2)

• Type 0 — entirely within the endometrial cavity
• Type 1 — <50% intramural
• Type 2 — >50% intramural

Intramural / Interstitial (types 3–4)

• Type 3 — contacts endometrium, 100% intramural
• Type 4 — fully intramural

Subserosal (types 5–7)

• Type 5 — >50% intramural
• Type 6 — <50% intramural
• Type 7 — subserosal with a stalk

Type 8 — other locations unrelated to myometrium (e.g., cervical, round ligament, broad ligament)

 

Main Symptoms

• Asymptomatic course — in most women, fibroids are asymptomatic, usually found incidentally by ultrasound

• Menstrual cycle disorders, more often heavy, prolonged menstruation

• Intermenstrual bloody discharge

• Lower abdominal pain

• Pain during sexual intercourse

• Dysfunction of neighboring organs:
  o Pressure on the bladder → frequent urination
  o Pressure on the intestines → constipation

• Infertility, pregnancy loss

 

Diagnosis

Uterine fibroid usually does not cause difficulties in diagnosis:

• The doctor may suspect the presence of nodes during a gynecological exam
• Ultrasound examination (US) — gold standard of diagnosis. Transvaginal or transabdominal probe is used
• Hysteroscopy — to diagnose submucosal nodes
• MRI — in complex cases and for surgical preparation 

 

Treatment

Treatment is selected individually during a consultation with an obstetrician-gynecologist. It depends on:

• Location and size of the nodes
• Presence of symptoms
• Age of the patient
• Reproductive plans

Conservative:

• Observation
• Medication treatment

Surgical:

• Myomectomy — organ-preserving operation
• Hysterectomy — removal of the uterus
• UAE (uterine artery embolization)
• FUS-ablation

 

Complications and Prevention

Complications:

• Anemia
• Dysfunction of neighboring organs
• Reproductive difficulties
• Torsion of the subserosal node pedicle
• Necrosis of the myomatous node

Prevention:

• Regular pelvic ultrasound
• Hormonal background monitoring
• Body weight control

 

Fibroid and Pregnancy

A fibroid does not always cause complications during pregnancy. Everything depends on the size and location of the nodes. Submucosal fibroids may interfere with embryo implantation and reduce conception chances. With small intramural or subserosal nodes, pregnancy often occurs spontaneously. Myomatous nodes may increase the risk of: miscarriage, preterm birth.
With regular medical follow-up, most women successfully carry a pregnancy.

 

When to See a Doctor

• Heavy or irregular menstruation
• Lower abdominal pain
• Conception difficulties
• Abdominal enlargement
• Diagnosed fibroid — to clarify treatment tactics