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One of the most common health problems in women is uterine fibroids, also known as benign tumors. These fibroids develop in the uterus and often do not cause specific symptoms, so they are frequently detected during routine check-ups. It is estimated that 20–50% of women of reproductive age have fibroids, and in the 30–44 age group this rate can exceed 60% [1, 2].
Although fibroids are usually harmless, it is important to monitor them at regular intervals.
“ ”Most fibroids do not cause symptoms and do not require treatment. However, for fibroids that lead to heavy bleeding, pain, or infertility, a permanent solution is possible with personalized surgical approaches.
What Are Fibroids?
Fibroids are tumors that originate from the muscular layer of the uterus and consist of smooth muscle and connective tissue. They are benign, and the risk of malignant transformation is extremely low [1]. The size of fibroids can vary significantly. Based on their location, they are classified into three main types [3]:
- Subserosal fibroids: Develop on the outer wall of the uterus
- Submucosal fibroids: Develop on the inner uterine lining; they carry the highest risk of bleeding and infertility
- Intramural fibroids: Develop within the muscular layer of the uterus; the most common type
What Are the Symptoms of Fibroids?
Approximately 30% of fibroid cases cause symptoms that affect quality of life; heavy menstrual bleeding and iron deficiency anemia are among the most common complaints [2]. The main symptoms include:
- Abnormal and heavy menstrual bleeding
- Severe menstrual pain
- Anemia due to prolonged and heavy bleeding
- Severe back pain
- Pain during sexual intercourse
- Palpable masses in the lower abdomen
- Pressure and pain during bowel movements
- Frequent urination due to pressure on the bladder
Additionally, especially submucosal fibroids may interfere with embryo implantation and make pregnancy more difficult [3].
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How Are Fibroids Diagnosed?
Since fibroids often do not present specific symptoms, they are usually detected during routine gynecological examinations. If fibroids are suspected, ultrasound is used to determine their size and location. If the mass is very large or the uterine structure cannot be clearly evaluated, MRI is used to obtain the most accurate information about soft tissues [3].
How Are Fibroids Treated?
The treatment of fibroids is determined entirely based on their effects on the patient [2, 3, 4]:
- Observation: Fibroids that do not cause symptoms and do not show rapid growth can be monitored regularly.
- Medical treatment: NSAIDs, tranexamic acid, combined oral contraceptives, or GnRH agonists/antagonists may be used to manage symptoms temporarily; however, growth may recur after discontinuation [2].
- Myomectomy (removal of fibroids only): Preferred for women who wish to have children. Studies report a successful pregnancy rate of 75.6% after myomectomy [4]. It can be performed laparoscopically, hysteroscopically, or via open surgery.
- Hysterectomy (removal of the uterus): Provides a permanent solution for women who do not plan to have children, especially in the perimenopausal period [3].
- Uterine artery embolization (UAE) and focused ultrasound: May be alternatives for patients who want to preserve the uterus but avoid surgery; careful evaluation is required for those with fertility goals [2].
The decision for surgery depends on the patient’s age, the size and location of the fibroids, the severity of symptoms, and the desire to have children.
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