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Uterine fibrous tumors
Last reviewed: 04.07.2025
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Fibrous tumors of the uterus are benign tumors of smooth muscle origin. Fibrous tumors are often the cause of abnormal uterine bleeding (menorrhagia, menometrorrhagia), pelvic pain, dysuric disorders, bowel dysfunction and lead to pregnancy complications. The diagnosis is established based on examination of the pelvic organs. Treatment depends on whether the patient wants to have children and whether she wants to preserve reproductive function. Such patients are prescribed conservative treatment using combined oral contraceptives, in preparation for surgery, GnRH is prescribed to reduce fibrous nodes. The following types of surgical intervention are performed: conservative myomectomy, hysterectomy, endometrial ablation.
[ What causes uterine fibroids?
Fibroids are the most common benign tumors of the female reproductive system, occurring in approximately 70% of patients. However, fibroids are often asymptomatic and small. Approximately 25% of white and 50% of black women have symptomatic fibroids. Risk factors for fibroids include skin color and high body mass index in patients. Potentially protective factors include parity and cigarette smoking.
According to the classification, the following types of location of fibromatous nodes in the uterus are distinguished: submucosal (located in the uterine cavity); intraligamentary (interligamentous), most often found in the broad ligaments of the uterus; subserous nodes (located towards the abdominal cavity); intramural nodes (located in the thickness of the myometrium); cervical nodes. Fibrous tumors are often multiple, but all nodes develop from a single individual monoclonal smooth muscle cell. Since the tumors have estrogen receptors, they tend to grow throughout the reproductive period of patients and regress in the postmenopausal period.
Degeneration of the nodes is accompanied by bloody vaginal discharge. The tumor contains hyaline, myxomatous, calcified areas with cystic fatty and red degeneration (usually only during pregnancy). Patients often worry about the presence of cancer in fibrous nodes, but malignancy of these tumors is extremely rare.
Symptoms of uterine fibroids
Fibrous tumors of the uterus can cause menorrhagia or menometrorrhagia. Pain is typical with tumor growth or node degeneration; pain increases with torsion of subserous nodes. With large tumors, adjacent organs are affected: dysuric disorders, painful urination with tumor pressure on the bladder. Intestinal disorders (tenesmus, constipation) are also observed when the tumor compresses it. The presence of fibroids and pregnancy leads to miscarriage, premature birth, abnormal positions and presentations of the fetus, which is an indication for cesarean section.
Diagnosis of fibrous tumors of the uterus
Bimanual examination reveals an enlarged, mobile uterus with nodes. The uterus is palpated above the pubis. At the present stage, ultrasonography is widely used for diagnostic purposes, especially sonohysterography, in which a saline solution is introduced into the uterus, which allows the ultrasound diagnostic specialist to more specifically determine the location of fibrous nodes in the uterus. If ultrasound is insufficiently informative, MRI can be used.
Treatment of fibrous tumors of the uterus
Asymptomatic uterine fibroids do not require special treatment. For symptomatic uterine fibroids, GnRH agonists are widely used at the present stage to stop bleeding and to prepare for surgical treatment to reduce myomatous nodes.
The main drugs used for conservative treatment. Synthetic progestins are used to suppress the growth of myomatous nodes and suppress estrogens. Medroxyprogesterone acetate is used at 5-10 mg orally once a day or megestrol acetate at 10-20 mg orally once a day for 10-14 days of each menstrual cycle, which can reduce bleeding after 12 cycles of taking the drug. The above drugs can be prescribed continuously every day for a month, which leads to a decrease in bleeding and provides a contraceptive effect. Depot medroxyprogesterone acetate is prescribed intramuscularly at 150 mg once a month (No. 3) and provides a similar effect. Before prescribing progestin drugs, patients must be warned about side effects: for example, weight gain, depression and irregular bleeding.
Danazol is an androgen agonist and can suppress fibroid growth. However, this drug has many side effects (e.g., weight gain, acne, hirsutism, edema, hair loss, deepening of the voice, sweating, vaginal dryness) and is therefore less acceptable to patients.
GnRH agonists (eg, leuprorelin 3.75 mg intramuscularly once a month; goserelin 3.6 mg subcutaneously in the abdomen once every 28 days or nasal spray) can reduce estrogen production. GnRH agonists are the most promising in terms of preoperative preparation to reduce the size of fibrous nodes, which makes the operation technically more feasible with reduced blood loss. In general, these drugs should not be used long-term, because after 6 months the original tumor size is restored and bone loss is observed. In patients under 35 years of age, after GnRH therapy is stopped, bone mass is restored on its own, in patients after 35 years - no. It is assumed that the administration of estrogens to them can prevent osteoporosis.
Surgical treatment
Indications for surgical treatment include rapidly growing uterine fibroids, uterine bleeding that does not respond to conservative therapy, persistent aching or unbearable pain, and urinary and intestinal dysfunction. Surgical treatment includes myomectomy and hysterectomy. However, myomectomy is only performed in patients who want to preserve reproductive function or want to preserve the uterus. In 55% of women with infertility due to fibroids, myomectomy can restore reproductive function and lead to pregnancy 15 months after surgery. Multiple myomectomy is a more difficult surgical intervention to perform than hysterectomy. It is necessary to give patients full information about the expected difficulties and complications when performing myomectomy and hysterectomy. Hysterectomy can worsen the quality of life.
Modern methods of treatment include laparoscopic surgery. Resectoscopy is gaining wide significance, using an instrument with a wide-angle telescope and an electric wire loop to excise nodes located in the uterine cavity. These surgical manipulations can be used in the treatment of patients who want to preserve the uterus. If the risk of surgical intervention is very high, the operation of choice is embolization of the uterine arteries.