1.1 About uterine fibroid
Uterine fibroids, commonly known as “leiomyomas” or “uterine fibroid tumors,” are benign tumors that develop in the smooth muscle layer of the uterus. They occur when the smooth muscle cells in the uterine wall experience excessive stimulation from estrogen, leading to overgrowth and the formation of benign tumors. Uterine fibroids are a common gynecological condition and are frequently found in middle-aged women. It is estimated that around 20% of women over the age of 35 have uterine fibroids.
1.2 Cause of uterine fibroid
The exact cause of uterine fibroids is unknown, but research has shown a correlation between the development of uterine fibroids and the secretion of the female hormone estrogen. Therefore, any situation that increases estrogen levels in the body may be associated with the formation of uterine fibroids. These situations include:
- Taking estrogen-containing medications such as birth control pills.
- Obesity.
- Dietary factors.
Additionally, there is a genetic component to uterine fibroids. If a mother has uterine fibroids, her daughter is three times more likely to develop them compared to the general population.
1.3 Symptoms of uterine fibroid
About half of uterine fibroid cases are asymptomatic, and many women discover them incidentally during routine physical examinations, gynecological check-ups, or ultrasound scans.
Other possible symptoms include:
- Excessive menstrual bleeding, which can lead to iron deficiency anemia. This may cause symptoms such as fatigue, dizziness, and shortness of breath.
- Lower abdominal pain and back pain.
- Menstrual pain.
- Frequent urination, bloating, and constipation: If the size of the uterine fibroids is large, it may exert pressure on surrounding organs such as the bladder and rectum, resulting in symptoms like frequent urination, bloating, and constipation.
In general, uterine fibroids grow slowly, and the vast majority of them are benign. Medical literature reports that the chance of uterine fibroids transforming into malignant tumors (cancerous) is less than 0.5%.
1.4 Classification of uterine fibroid
Uterine fibroids can be classified into three main types based on their location:
- Submucosal fibroids: These fibroids primarily grow within the inner lining of the uterus (submucosal layer). They can cause symptoms such as excessive menstrual bleeding and even anemia.
- Intramural fibroids: These fibroids grow within the muscular wall of the uterus (myometrium). They generally do not cause significant symptoms.
- Subserosal fibroids: These fibroids mainly grow on the outer surface of the uterus (serosa). If the size of the fibroids becomes large, they may exert pressure on surrounding organs such as the bladder and rectum, leading to symptoms like frequent urination and constipation.
It’s important to note that a fibroid can have a combination of these characteristics, and its symptoms can vary depending on its size, location, and individual factors.
1.5 How to diagnose uterine fibroid?
The doctor will first inquire about the patient’s medical history and understand their symptoms. Then they will perform a clinical gynecological examination, which includes a vaginal and pelvic examination. In cases where the uterine fibroid is of a significant size, the doctor may be able to palpate it through abdominal palpation.
Afterward, the doctor will conduct an ultrasound scan. The ultrasound scan can be performed either trans-abdominally (through the abdomen) or trans-vaginally (through the vagina). Trans-vaginal ultrasound, being closer to the uterus during the examination, can detect uterine fibroids as small as 0.5 centimeters and also assess the condition of the ovaries. In some cases where the fibroids are located in more concealed areas, the doctor may need to inject saline solution into the patient’s uterine cavity via a catheter to enhance the sensitivity of the ultrasound scan. The ultrasound scan provides information about the size, location, and relationship of the uterine fibroids with surrounding organs, which helps the doctor develop a treatment plan and rule out other uterine conditions.
Sometimes, if the diagnosis cannot be confirmed through ultrasound scanning, the doctor may recommend magnetic resonance imaging (MRI) for more accurate imaging.
1.6 Treatment of uterine fibroid
Regular Observation
If the uterine fibroids are small in size and do not cause clinical symptoms, the patient may not necessarily require surgical treatment. They can choose regular monitoring, which involves tracking the size of the uterine fibroids through ultrasound scans. Additionally, since uterine fibroids are related to the secretion of estrogen, most fibroids tend to shrink after menopause, so conservative management is often an option.
Medical Treatment
Currently, there are no medications available that can make uterine fibroids disappear or shrink. The purpose of medical treatment mainly focuses on managing the complications caused by uterine fibroids.
To address excessive menstrual bleeding caused by uterine fibroids, the doctor may prescribe hemostatic medications such as tranexamic acid or hormone medications like danazol to regulate the menstrual cycle and reduce blood loss.
To alleviate lower abdominal pain caused by uterine fibroids, the doctor may prescribe pain relievers and anti-inflammatory drugs (NSAIDs) to relieve symptoms.
Surgical Treatment
If the patient experiences the following conditions, the doctor may recommend surgical intervention:
- Excessive menstrual bleeding caused by uterine fibroids, resulting in anemia that cannot be managed with medication.
- Uterine fibroids compressing surrounding organs such as the bladder or rectum, causing severe urinary or bowel problems.
- Rapid growth of uterine fibroids, raising suspicion of possible malignancy.
- Uterine fibroids leading to infertility or miscarriage.
Myomectomy
Myomectomy is a surgical procedure in which the doctor removes only the uterine fibroids while preserving the uterus. This procedure is suitable for patients who plan to conceive in the future. It is recommended to wait at least three to six months after the surgery before attempting pregnancy. However, this procedure does not guarantee complete improvement of symptoms, and the recurrence rate after surgery is approximately 15% to 27%. If the uterine fibroids are located inside the uterine cavity, a hysteroscope may be used to assist in the myomectomy procedure.
Hysterectomy
For patients who have reached menopause, have a large number of uterine fibroids, or do not plan to conceive, a hysterectomy may be performed. This surgical procedure involves the complete removal of the uterus, eliminating the possibility of uterine fibroid recurrence.
High-Intensity Focused Ultrasound (HIFU) / HIFU Knife
HIFU utilizes low-energy ultrasound waves that are focused from outside the body to the inside, concentrating the energy into the uterine fibroids. This causes thermal ablation of the fibroids, leading to coagulative necrosis of the fibroid cells and subsequent elimination of the fibroids. The advantages of HIFU include no skin wounds or scars and a short surgical procedure, making it suitable for most uterine fibroid cases. However, since the fibroid tissue cannot be obtained for histological examination during the procedure, HIFU is not appropriate for cases where malignancy is suspected.