Uterine fibroid (benign growth of the uterus)

Uterine fibroids are benign growths of the uterine tissue. The uterus is roughly the size and shape of a pear and is located between the bladder and rectum, with the pointed end extending into the vagina with the uterine orifice. The uterus consists of a layer of muscle of uniform thickness, covered on the inside by a mucous membrane (called the endometrium) and on the outside by the peritoneum.

Benign lumps (fibroids) can form in the muscle layer and grow from there partly into the abdominal cavity or inside the uterus. Uterine fibroids can occur singly or in larger numbers - if the uterus is heavily interspersed with growths, this is technically known as uterus myomatosus.The benign growths occur mainly between the ages of 35 and 50. Very rarely, women are affected before the age of 25.

In about 20% of all women after the age of 35, a uterine fibroid can be detected. The benign growths are usually not dangerous, but the quality of life can be considerably reduced.

The exact cause of uterine fibroids is not yet known. However, it has been proven that the growth of the growths is strongly influenced by oestrogens (female sex hormones). Since after menopause the oestrogen production of the female body decreases, normally no new fibroids are formed and the already existing ones slowly regress.

The degree of severity of the symptoms depends primarily on the size and location of the fibroids. Some affected women live completely free of symptoms despite the growths.

Typical symptoms of uterine fibroids would be menstrual cramps such as increased and prolonged menstrual bleeding (hypermenorrhoea and metrorrhagia), constipation due to the pressure of the fibroids on the bowel, as well as pain and increased urination due to growths in the direction of the bladder. In rare cases, congestion of the ureter may also be caused.

If a large uterine fibroid puts pressure on the nerve exit sites on the spine, this can also cause back pain or nerve pain in the legs in some women.

During a gynaecological palpation by the gynaecologist , any fibroids can be detected. The uterus is examined through the vagina, the rectum and the abdominal wall, so that an enlargement of the uterus or sometimes the presence of nodules can be felt.

A more accurate method of diagnosing fibroids would be ultrasound examination, which is now often performed directly through the vagina (called vaginal sonography). Hysteroscopy (uterine endoscopy) would be another method of detecting fibroids.

If the growths are putting pressure on the ureter, ultrasound examinations of the kidney and a kidney x-ray are also necessary in some cases.

Since uterine fibroids are benign growths and therefore have only a low potential for degeneration (cancer risk), therapy is not absolutely necessary for fibroids that are symptom-free. However, if symptoms are caused, depending on the size and location of the growths, the following treatment methods are available:

• Surgery: whether the growths are removed surgically through an abdominal incision or directly through the vagina depends mainly on their location. A laparoscopic procedure (slip-hole technique, in which surgical devices are inserted through small incisions in the skin) is also often an option.
  Particularly in women who wish to have children, an isolated removal of the fibroids is advisable. Depending on the location of the fibroids, this can also take the form of a myoma enucleation - in this surgical method, the growth is peeled out of the uterus. If the uterus is very enlarged as a result of the growths or if there is a risk of the fibroids degenerating into cancer due to tissue changes, it may be necessary to perform a hysterectomy.

• Hormone therapy (progestogen therapy): As this often only has a temporary effect and the fibroids therefore grow again after the end of the therapy, treatment with hormones is often used to reduce the size of the growths before surgical removal.
  Under the influence of so-called GnRH analogues (gonadotropin releasing hormone analogues), complete regression of the fibroids can occur. However, the therapy artificially puts the patients into menopause for four to six months, which can lead to the usual complaints such as hot flushes, mood swings, osteoporosis (bone loss) and sleep disorders. If the therapy is stopped, the hormone balance returns to normal and uterine fibroids may develop again.

• Transcatheter embolisation: Percutaneous transcatheter embolisation is a relatively new method of treating fibroids. In a minimally invasive procedure, the blood vessels that supply the growths with nutrients are sclerosed. This cuts off the supply to the fibroids and they regress.

• Ultrasound: This is a very new treatment method in which the fibroid tissue is destroyed in a magnetic resonance tomograph using high-frequency sound waves. During the treatment, the patient lies for about three hours with her abdomen above a sound source from which focused ultrasound is directed at the fibroid. The radiation generates so much heat in the target tissue that it dies and is then broken down by the body's immune system. However, this form of therapy is only possible for uterine fibroids that are conveniently located so that no other organs are harmed during treatment.

If a myoma is diagnosed and is not treated immediately due to minor complaints, it should be checked regularly as part of the gynaecological check-ups. Even if uterine fibroids are benign growths, the following complications can occur, among others:

• a bleeding anaemia, which is caused by spotting and continuous bleeding.
• Problems with conception or during pregnancy.
• In rare cases, tissue changes can occur that lead to the development of malignant tumors.

Uterine fibroids are not necessarily an obstacle to conception - only if they lead to very severe changes in the uterus can fertility be limited as a result.

However, the altered hormone balance during pregnancy can lead to oedema (fluid retention) in the fibroids, causing them to swell and subsequently lead to various problems. These would be, for example, fetal positional anomalies (breech presentation), pain and an early onset of labour. A myoma can also make a natural delivery (vaginal birth) so difficult that a caesarean section (Sectio caesarea) has to be performed.

There are no preventive measures against uterine fibroids, since, according to current knowledge, no defined triggers or causes are known.