Uterine fibroids, also known as leiomyomas or myomas, are benign, non-cancerous growths that develop in or around the uterus. They are very common during the reproductive years and, in many cases, cause no symptoms and are discovered during a routine gynecological examination.
Depending on their size, number and location, uterine fibroids may cause heavy menstrual bleeding, pelvic pressure or pain and, in certain cases, may affect fertility. Not every fibroid requires treatment. The appropriate approach depends on the woman’s symptoms, reproductive plans and the characteristics of the fibroids, with treatment ranging from regular monitoring to hysteroscopic or laparoscopic removal when medically indicated.
What Are Uterine Fibroids?
Uterine fibroids are benign growths that develop from the muscle and connective tissue of the uterus. They may appear as a single fibroid or as multiple growths and can vary considerably in size, from very small nodules to larger masses that may alter the shape of the uterus.
The exact cause of fibroids is not fully understood. However, hormones such as estrogen and progesterone, genetic factors and other biological mechanisms are believed to contribute to their development and growth.
Fibroids are classified according to their location within the uterus:
Types of Uterine Fibroids
Intramural fibroids develop within the muscular wall of the uterus and are among the most common types.
Submucosal fibroids grow toward the inner uterine cavity. Even relatively small submucosal fibroids may be clinically important because they can affect the shape of the uterine cavity and, in some cases, fertility.
Subserosal fibroids grow toward the outer surface of the uterus and may cause pressure symptoms when they become large.
Pedunculated fibroids are attached to the uterus by a narrow stalk and may develop either inside or outside the uterine cavity.
The location, size and number of fibroids are important factors when assessing their possible symptoms, their effect on fertility and whether treatment is required.
Uterine Fibroid Symptoms and Diagnosis
Many women with uterine fibroids have no symptoms and may only discover them during a routine gynecological examination or ultrasound. When symptoms do occur, they depend mainly on the size, number and location of the fibroids.
The most common symptoms include:
- Heavy or prolonged menstrual bleeding
- Pelvic pain, pressure or a feeling of heaviness
- Menstrual cramps
- Frequent urination, particularly when a fibroid presses on the bladder
- Lower abdominal or back discomfort
- Anemia as a result of heavy menstrual bleeding
- Fertility problems in selected cases
The diagnosis of uterine fibroids is usually based on a gynecological examination and pelvic or transvaginal ultrasound. Ultrasound helps determine the number, size and location of the fibroids and whether they affect the uterine cavity.
In selected cases, additional examinations such as hysteroscopy or magnetic resonance imaging (MRI) may be recommended to provide more detailed information and assist in treatment planning.
Can Fibroids Affect Fertility?
Uterine fibroids do not always affect fertility. Many women with fibroids conceive naturally and have uncomplicated pregnancies. However, in certain cases, the size and especially the location of a fibroid may interfere with conception or implantation.
Submucosal fibroids are more likely to affect fertility because they grow toward the uterine cavity and may alter its shape. Depending on their position, they can interfere with embryo implantation or, less commonly, affect the passage through the fallopian tubes.
Large intramural fibroids may also be clinically significant when they distort the uterine cavity, while subserosal fibroids generally have a smaller impact on fertility unless they are very large or cause other problems.
For this reason, the presence of a fibroid alone does not automatically mean that it must be removed. The decision depends on factors such as its size, location, symptoms, previous fertility history and whether the woman is planning natural conception or assisted reproduction.
Fibroids and IVF
Before IVF treatment, fibroids are carefully assessed to determine whether they may reduce the chances of successful embryo implantation.
Fibroids that significantly distort the uterine cavity, particularly submucosal fibroids, may need to be removed before embryo transfer. In contrast, small fibroids that do not affect the uterine cavity may not require treatment.
The decision is individualized, with the aim of improving the uterine environment while avoiding unnecessary surgical intervention.
Treatment for Uterine Fibroids
Treatment for uterine fibroids depends on several factors, including the size, number and location of the fibroids, the severity of symptoms, the woman’s age and whether she wishes to preserve her fertility.
Not all fibroids require treatment. Small or asymptomatic fibroids may simply be monitored with regular gynecological examinations and ultrasound. When fibroids cause significant bleeding, pain, pressure symptoms or fertility problems, treatment may be recommended.
The most appropriate approach is selected individually and may include medical treatment or surgical removal, depending on the clinical situation.
Hysteroscopic Myomectomy
Hysteroscopic myomectomy is commonly used for submucosal fibroids that protrude into the uterine cavity.
During the procedure, a hysteroscope is inserted through the cervix, allowing the surgeon to visualize and remove the fibroid without making abdominal incisions. This technique may be particularly important in women whose fibroids distort the uterine cavity or may be affecting fertility.
Laparoscopic Myomectomy
Laparoscopic myomectomy may be recommended for selected intramural or subserosal fibroids.
The procedure is performed through small abdominal incisions using a laparoscope and specialized surgical instruments. The fibroids are removed while preserving the uterus, making this approach particularly relevant for women who wish to maintain their reproductive potential.
The suitability of laparoscopic surgery depends on factors such as the size, number and exact location of the fibroids.
When Is Hysterectomy Considered?
A hysterectomy involves the removal of the uterus and provides a definitive treatment for uterine fibroids.
It may be considered in selected cases when symptoms are severe, other treatment options are not appropriate or effective, and the woman does not wish to become pregnant in the future.
Because hysterectomy permanently eliminates the possibility of carrying a pregnancy, the decision should always be made after careful discussion with the treating gynecologist.
Uterine Fibroids and Fertility Treatment
The management of uterine fibroids should always be individualized, especially when fertility is a concern. Dr. Panagiotis Kaliantzis evaluates each case according to the size, number and location of the fibroids, the presence of symptoms and the woman’s reproductive plans.
A detailed assessment may include gynecological examination, transvaginal ultrasound and, when indicated, hysteroscopy or further imaging. The aim is to determine whether the fibroids are likely to affect the uterine cavity, implantation or future pregnancy and whether treatment is necessary.
When surgical treatment is required, minimally invasive techniques such as hysteroscopic or laparoscopic myomectomy may be considered, depending on the characteristics of the fibroids. Whenever appropriate, the treatment plan focuses on preserving the uterus and supporting the woman’s future fertility.
Patients can also view examples of hysteroscopic removal of a submucosal fibroid and laparoscopic removal of a subserosal fibroid to better understand how these procedures are performed.
Frequently Asked Questions About Uterine Fibroids
Are uterine fibroids cancerous?
Uterine fibroids are benign, non-cancerous growths of the uterus. In the vast majority of cases, they do not become cancerous.
Can fibroids cause infertility?
Fibroids can affect fertility in certain cases, particularly when they distort the uterine cavity. Submucosal fibroids are more likely to interfere with implantation, while the impact of intramural fibroids depends largely on their size and location.
Which type of fibroid affects fertility the most?
Submucosal fibroids generally have the greatest potential to affect fertility because they grow toward the uterine cavity and may alter the area where an embryo needs to implant.
Do all fibroids need to be removed?
No. Many fibroids do not cause symptoms and do not require treatment. Removal is usually considered when fibroids cause significant symptoms, distort the uterine cavity, affect fertility or create other clinical concerns.
Can I get pregnant after fibroid removal?
Many women can conceive after myomectomy. The chances of pregnancy depend on several factors, including age, overall fertility, the number and location of the fibroids and the type of surgery performed.
Can fibroids come back after myomectomy?
Yes. Myomectomy removes existing fibroids but does not prevent new fibroids from developing in the future. Regular gynecological follow-up may therefore be recommended, particularly in women with a history of multiple fibroids.
