Generality
The fibromatous uterus is the pathology of the female reproductive system, in which the uterus, after the appearance of numerous fibroids at its expense (uterine fibroids), loses its characteristic elasticity and increases in volume.
Currently, the causes of the fibrous uterus are being studied; suspected factors include: hormonal abnormalities, familiarity with the development of uterine fibroids, obesity and an altered sensitivity of the uterus to growth factors.
The fibrous uterus can be a symptomatic or asymptomatic condition, depending on whether the uterine fibroids are large or not.
For the diagnosis of fibromatous uterus, the pelvic exam and pelvic ultrasound are essential.
The treatment of the fibromatous uterus varies from patient to patient, based on the severity of the symptoms, the health status of the patient and her age.
Short reference to the uterus
Unequal and hollow, the uterus is the female genital organ, which serves to receive the fertilized egg cell (that is, the future fetus) and to guarantee its correct development during the 9 months of pregnancy.
It resides in the small pelvis, precisely between bladder (anteriorly), rectum (posteriorly), intestinal loops (superiorly) and vagina (inferiorly).
During the lifetime, the uterus changes its shape; if up to the pre-pubertal age it has an elongated appearance similar to a glove finger, in adulthood it looks a lot like an inverted (or upside-down) pear, while in the post-menopausal phase it gradually reduces its volume and is crushed.
From a macroscopic point of view, doctors divide the uterus into two distinct main regions: a larger and larger portion, called the uterus body (or uterine body ), and a narrower portion, called the cervix (or cervix ).
What is the Fibrous Uterus?
" Fibrous uterus " is the medical expression indicating a pathology of the female reproductive system, characterized by the appearance of numerous fibroids in the uterus ( uterine fibroids ) and by the consequent loss, by the same uterus, of its characteristic elasticity and anatomy .
The fibromatous uterus, therefore, is the condition of the uterus resulting from the formation of a high number of uterine fibroids and characterized by the consequences of these fibroids.
Important note
A small uterine fibroid does not have a great impact on the affected organ and is not sufficient to be able to speak of a fibromatous uterus; this condition, in fact, can only be established when the uterine fibroids are many and are such as to cover a large part of the surface of the uterus .
What are Uterine Fibroids and why do they alter the elasticity of the uterus?
To understand why the fibrous uterus affects the elastic properties of the uterus, it is necessary to take a step back and review what uterine fibroids are.
Known as leiomyomas or uterine myomas, uterine fibroids are benign tumors of the uterus, which generally develop from the myometrium, which is the characteristic layer of uterine muscle cells.
Uterine fibroids appear as nodules of predominantly fibrous tissue, varying in size from a few millimeters to even 15-20 centimeters.
The fibromatous uterus compromises the elasticity of the uterus, because the fibrous tissue of uterine fibroids is a hard, inelastic and retraent tissue .
Did you know that ...
Uterine fibroids are very common; according to statistics, in fact, at least 80% of women can say, at the age of 50, they have developed at least one uterine fibroid up to that point.
How does the Uterus in women with Uterus Fibroma become?
In addition to affecting the elasticity of the uterus, the uterine fibroids that characterize the fibromatous uterus make the affected organ larger and larger than normal; in pathology, a similar dimensional change in the uterus is called an enlarged uterus .
Types of Uterine Fibroid
Depending on its location within the cellular layers of the uterus, a uterine fibroid can be:
- Submucosa : it is the type of uterine fibroid that tends towards the internal cavity of the uterus, ie towards the endometrium;
- Suberous : it is the type of uterine fibroid that tends towards the external surface of the uterus;
- Intramural : it is the type of uterine fibroid that is kept inside the myometrium;
- Cervical : it is the type of uterine fibroid that affects the cervix;
- Infralegamentario : is the type of uterine fibroid interposed between the sheets of the so-called uterine ligament.
Causes
Doctors have not yet clearly clarified the causes of the fibrous uterus, however they have noted that there is an important correlation between the formation of uterine fibroids and factors such as:
- An altered sensitivity to sex hormones .
Scientific research has shown that uterine fibroids contain many more receptors for estrogen and progesterone than do normal uterine tissue.
This evidence led scientists to hypothesize that the development of a uterine fibroid may depend on an abnormal concentration, in some points of the uterus, of receptors for sex hormones;
- Familiarity to the development of fibroids on the uterus .
Years of investigations relating to uterine fibroids have shown that women with the tendency to develop this type of benign tumors very often come from families in which the relatives relatives (mothers, grandmothers, possible sisters etc.) present the same inclination.
This peculiarity has led, therefore, experts to believe that uterine fibroids and their possible consequences, such as the fibromatous uterus, may have a genetic-family basis;
- An altered sensitivity to growth factors .
Several scientific studies have found that the lack of a fine regulation of growth factors affects the development and growth of uterine fibroids;
- Obesity .
Statistics show that uterine fibroids and the fibrous uterus are more common in obese people.
Risk factors: who most frequently develop the Fibromatous Uterus?
According to statistics, they would represent factors favoring the uterine fibromatosis conditions such as:
- Belonging to a family in which, among female members, the problem of uterine fibroids and the fibromatous uterus occurs;
- Belonging to the black race;
- Obesity;
- Vitamin D deficiency;
- Consume large quantities of red meat and little fruit and vegetables;
- Abuse alcohol;
- The early onset of menstruation.
Symptoms and Complications
If uterine fibroids are small, the fibromatous uterus tends to be an asymptomatic condition; if uterine fibroids are large, however, the presence of fibromatous uterus is often related to symptoms, such as:
- Pelvic pain that increases during the days of menstruation;
- Heavy menstruation ( menorrhagia );
- Blood loss outside the period of menstruation ( metrorrhagia );
- Anemia due to excess bleeding during the days of menstruation;
- Lumpy abdomen and sense of pressure at the pelvic level . They depend on the uterus which, being enlarged, pushes on the internal abdominal wall;
- Constipation, diarrhea and / or frequent urination . They are three disorders that are observed when the uterus compresses the neighboring organs of the intestine and / or bladder.
The symptoms of the fibromatous uterus are non-specific manifestations, in the sense that they can characterize other pathologies affecting the uterus.
Complications
Women suffering from a severe form of fibromatous uterus (where severe is meant that the uterine fibroids are numerous and large) may undergo complications, such as: reduction of fertility and predisposition to spontaneous abortion, during pregnancy.
When should I go to the doctor?
A woman should always contact her trusted gynecologist, whenever she suffers from one or more of the symptoms reported above; disorders such as pelvic pain, heavy menstruation, blood loss outside the period of menstruation etc., in fact, are all signs of something abnormal in the female reproductive system, particularly the uterus.
Diagnosis
For the diagnosis of fibromatous uterus, the information from the pelvic exam and pelvic ultrasound is sufficient; however, very often, doctors prescribe to patients with the disease in further investigation questions, in order to investigate the severity of uterine fibroids and anatomical alterations of the uterus.
Additional investigations that a woman with a fibrous uterus may need to perform include:
- Transvaginal ultrasound ;
- Magnetic resonance imaging related to pelvic organs;
- Hysterosalpingography ;
- Hysteroscopy .
Therapy
Currently, the therapeutic choice for those suffering from fibromatous uterus is wide and articulated ; the treatments available today for the aforementioned pathology, in fact, are numerous and adapt to the needs of most patients.
The choice of therapy against fibromyalus: how does it happen?
Before exposing the various therapies available to the carriers of the fibrous uterus, it is necessary to inform the readers about how doctors choose the therapeutic approach.
The choice of how to deal with a condition such as the fibrous uterus is based, in order of importance, on: the presence and severity of the symptomatology, the state of health of the patient and her age .
Therapeutic Approaches to Fibromatous Uterus
The therapeutic management of the fibrous uterus aims to counteract the uterine fibroids, stopping their growth or destroying / eliminating them .
To achieve the aforementioned purpose, patients with a fibrous uterus can count on:
- Drugs ;
- A non-invasive medical procedure called focused ultrasound guided by magnetic resonance (in English, is known as FUS );
- Minimally invasive surgical procedures ;
- Traditional surgical procedures .
DRUGS
Drugs that can be used in the presence of a fibromatous uterus do not eliminate uterine fibroids, but stop their growth and, in some cases, reduce their size.
The drugs in question include:
- GnRH agonists . They stop the growth of uterine fibroids, blocking the production of estrogen and progesterone.
Women who use these medicines enter a temporary post-menopausal state, which ends with the cessation of hiring.
- The so-called progesterone medicated spiral . It consists of a particular device, which, once inserted into the uterus, releases progesterone, in order to alleviate symptoms.
- The contraceptive pill . It is used to reduce blood loss, in all those patients with heavy menstruation.
- Tranexemic acid . It is indicated to reduce the most abundant and painful menstrual flows. It is not a hormonal drug.
- NSAIDs . They are used to combat pelvic pain.
FOCUSED ULTRASOUNDS DRIVEN BY MAGNETIC RESONANCE
Focused ultrasound guided by magnetic resonance is a completely innovative procedure, which allows the destruction of uterine fibroids in a non-invasive way.
As it can be guessed from its name, this procedure involves the use of ultrasounds and the addressing of these on the uterus, through a special tool.
The big advantage of focused ultrasound guided by MRI is that their use does not require surgical incisions.
What does "guided by MRI" mean?
"Guided by magnetic resonance" means that the attending physician uses the instrumentation for magnetic resonance imaging, to identify the precise point of the uterus on which to point the ultrasounds.
MINIMALLY INVASIVE SURGICAL PROCEDURES
Minimally invasive surgery involves: local (rarely general) anesthesia, small surgical incisions, targeted tumor or anomaly action to be eliminated and a quick recovery phase.
Indicated for patients of still fertile age (and therefore who may need to preserve the uterus), minimally invasive surgical procedures for the treatment of the fibrous uterus include:
- Uterine artery embolization . It is based on the principle of blocking direct blood supply to uterine fibroids, so as to induce death by the absence of oxygen and nutrients.
- Myolysis . It consists in exposing the uterine fibroids to a laser or an electric current beam, so as to cause the destruction of benign tumor masses and the vessels that feed them.
- Laparoscopic or robotic myomectomy . Myomectomy is the surgical procedure to remove uterine fibroids, leaving the uterus in place.
When performed with laparoscopic or robotic technique, it means that the treating surgeon performs three small incisions on the abdomen (with the robotic technique, he uses a real robot to perform the elimination of uterine fibroids).
- Hysteroscopic myomectomy . It is myomectomy performed using the resectoscope, an instrument that emits electrical discharges capable of eliminating uterine fibroids.
The use of the resectoscope does not involve incisions, but its insertion into the vagina and then into the uterus.
TRADITIONAL SURGICAL PROCEDURES
Traditional surgery involves: general anesthesia, large surgical incisions, little specific action on the target organ and long recovery times.
Indicated when uterine fibroids are very large or when patients are beyond fertile age, traditional surgical procedures for the treatment of the fibrous uterus consist of:
- Traditional myomectomy . It is the operation of myomectomy performed in laparotomy, that is through the incision and opening of the abdomen.
- Hysterectomy . It is the uterus removal surgery; with its execution, the patient of childbearing age will no longer be able to have children.
Prognosis
The prognosis in the case of fibromatous uterus varies from patient to patient and depends on the number and size of uterine fibroids.
Undoubtedly, the more contained the number and size of uterine fibroids and the more the fibromatous uterus is a successfully controllable condition.
