Uterine Fibroids

What Is a Fibroid? Symptoms, Causes, and Treatment

A fibroid is a mostly benign tumor that develops from the muscle tissue of the uterus. Known medically as a uterine fibroid (myoma), it is one of the most common gynecological problems in women. It is particularly common in women between the ages of 30 and 50. Most fibroids are harmless, and the risk of them turning into cancer is quite low. In some cases, however, they can cause complaints such as heavy menstrual bleeding, groin pain, abdominal swelling, and infertility. Fibroid treatment is planned according to the fibroid’s size, number, location, and the patient’s desire for children.

Scarless Fibroid Surgery

Scarless (closed) fibroid surgery is one of the modern surgical options that offers faster recovery and minimal scarring in suitable patients. You can consult your physician for more detailed information about which patients it is suitable for and its advantages.

What Is a Fibroid (Uterine Myoma)?

A uterine fibroid is a benign mass that develops from the smooth muscle cells of the uterus. There may be a single fibroid, or several may occur. Their sizes can range from a few millimeters up to 15–20 cm. Fibroids generally grow slowly. In some women they cause no symptoms at all, while in others they can lead to significant bleeding and pain.

What Causes Fibroids?

Although the exact cause of fibroids is not fully known, some factors are thought to increase the risk of their development. In particular, the effect of the hormones estrogen and progesterone plays an important role in the growth of fibroids. A family history of fibroids increases genetic predisposition, and starting menstruation at an early age is also among the risk factors. In addition, obesity and never having given birth have been associated with fibroid development. Fibroids generally tend to grow during the reproductive years, while during menopause, as hormone levels drop, they often shrink.

What Are the Symptoms of Fibroids?

Fibroid symptoms vary according to the size and location of the fibroid. The most common symptoms are:

• Heavy menstrual bleeding
• Prolonged menstrual periods
• Bleeding between periods
• Groin and lower back pain
• Abdominal swelling
• Frequent urination
• Constipation
• Pain during sexual intercourse
• Infertility or risk of miscarriage

In some women, fibroids cause no symptoms at all and are discovered incidentally during a routine gynecological examination.

Do Fibroids Cause Pain?

Fibroids do not always cause pain; however, especially large ones or those pressing on surrounding tissues can cause groin, abdominal, lower back, and back pain, as well as severe cramps during menstruation. The pain is usually felt as dull and pressure-like, may increase with menstruation, and large fibroids can create a feeling of heaviness in the abdomen. In rare cases, sudden and severe pain may develop, and in that situation a doctor should definitely be consulted.

Can Fibroids Turn Into Cancer?

The likelihood of fibroids turning into cancer is very low. Uterine fibroids are overwhelmingly benign formations. One of the questions most frequently asked is “can a fibroid turn into cancer?” Medical data show that the risk of a fibroid transforming into a malignant tumor is far below 1%. Malignant tumors seen in the uterus (sarcomas) generally develop independently of fibroids. In other words, in most cases a fibroid does not turn into cancer.

Do Fibroids Prevent Pregnancy?

Not every fibroid prevents pregnancy. However, the fibroid’s location, size, and number can affect the chance of pregnancy. In particular, fibroids that distort the uterine cavity can make it harder for the embryo to implant. Large fibroids can negatively affect pregnancy by narrowing the space inside the uterus. Situations with a higher likelihood of interfering with pregnancy:

• Fibroids growing toward the uterine cavity
• Fibroids larger than 4–5 cm
• The presence of multiple fibroids
• A history of recurrent miscarriage

However, small fibroids located on the outer surface of the uterus usually do not interfere with pregnancy. In women planning a pregnancy, the fibroid must be evaluated in detail.

Do Fibroids Cause Infertility?

Fibroids can cause infertility in some cases, but not every woman with a fibroid is infertile. Fibroids can lead to infertility through the following mechanisms:

• Preventing embryo implantation by distorting the uterine cavity
• Blocking the openings of the tubes and hindering sperm passage
• Disrupting the blood supply of the uterine lining
• Affecting hormonal balance through continuous bleeding

The type most associated with infertility is the submucosal fibroid growing into the uterine cavity. With the right patient selection, pregnancy rates can increase after fibroid surgery.

Do Fibroids Grow? How Large Do They Get?

Yes, fibroids can grow. Fibroids are sensitive to hormones (especially estrogen and progesterone). For this reason, they tend to grow during the reproductive years. Fibroids can:

• Remain millimeter-sized
• Grow slowly over the years
• Grow rapidly in rare cases

Their sizes can range from a few millimeters up to 15–20 cm.

What Are the Types of Fibroids?

Fibroids are divided into different types according to the region of the uterus where they are located, and this classification is of great importance both for the treatment plan to be applied and for their effects on pregnancy. Each type of fibroid can show different symptoms and can affect the patient’s quality of life in different ways.

Submucosal Fibroid

Submucosal fibroids grow toward the uterine cavity and are the type of fibroid that generally causes the most pronounced complaints. These fibroids can lead to heavy and prolonged bleeding, especially during menstrual periods. As a result, the development of anemia is quite common. At the same time, because they distort the internal structure of the uterus, they can make it harder for a pregnancy to occur and are considered the type of fibroid with the greatest impact on infertility.

Intramural Fibroid

Intramural fibroids are located within the muscular layer of the uterus and are the most common type of fibroid. Over time, these fibroids can grow and cause enlargement of the overall structure of the uterus. Patients may experience complaints such as heavy menstrual bleeding, pain during menstrual periods, a feeling of fullness in the abdominal area, and enlargement of the uterus. Particularly when they reach large sizes, they have the potential to negatively affect the course of a pregnancy.

Subserosal Fibroid

Subserosal fibroids grow toward the outer surface of the uterus and generally cause symptoms by pressing on surrounding organs. These fibroids usually do not disrupt the menstrual pattern, but depending on their size, they can cause a feeling of swelling in the abdominal area. If they press on the bladder, complaints such as frequent urination may occur; if they press on the bowel, constipation may develop. Their effects on pregnancy are generally less than those of other fibroid types.

How Are Fibroids Diagnosed?

Fibroids are usually diagnosed through a gynecological examination and ultrasound, and they are often noticed incidentally during routine gynecological check-ups. In a pelvic examination, the doctor can evaluate especially large fibroids by feeling enlargement or irregularity of the uterus. The most commonly used diagnostic method is ultrasonography; vaginal ultrasound shows small fibroids more clearly, while abdominal ultrasound is preferred for evaluating larger fibroids. In situations requiring more detailed examination — particularly when multiple fibroids are present, in surgical planning, or when the fibroid’s location is unclear — MRI is used. In addition, with hysteroscopy, the inside of the uterus is viewed with a camera, allowing submucosal fibroids in particular to be evaluated both diagnostically and therapeutically.

How Are Fibroids Treated?

Fibroid treatment is planned individually, taking into account many factors such as the fibroid’s size, number, location, the patient’s age, and her desire to have children. Not every fibroid requires surgery, and in some cases regular follow-up alone may be sufficient.

Observation (Monitoring)

If the fibroid is small, causes no symptoms, and does not show rapid growth over time, regular check-ups may be sufficient without active treatment. In these patients, the fibroid’s status is usually monitored with gynecological examinations and ultrasound checks at intervals ranging from 6 months to 1 year.

Medication

Medication does not eliminate the fibroid entirely but helps reduce the patient’s complaints. It is preferred particularly to reduce heavy menstrual bleeding, to control pain, and in some cases to achieve temporary shrinkage of the fibroid. It is generally used in preparation for surgery or in cases where complaints are mild.

Fibroid Surgery (Myomectomy)

Myomectomy is a surgical method in which only the fibroid is removed and the uterus is preserved. Preferred especially in patients planning to have children, this method can be performed with different techniques depending on the fibroid’s location and size. For fibroids growing toward the uterine cavity, the hysteroscopic method is used, while for other locations, laparoscopic (closed) surgery may be preferred. For very large fibroids, open surgery may be required.

Removal of the Uterus (Hysterectomy)

For fibroids that have reached very large sizes, are numerous, or cause continuous bleeding, complete removal of the uterus may be necessary. This method is generally preferred in patients who no longer plan to have children and provides a permanent solution.

Non-Surgical Methods

In some suitable patients, non-surgical treatment options can also be considered. With uterine artery embolization, the vessels feeding the fibroid are blocked, allowing it to shrink. In addition, methods such as MRI-guided focused ultrasound can target and treat the fibroid tissue. These methods are not suitable for every patient and are chosen after careful evaluation.

How Is Fibroid Surgery Performed?

Fibroid surgery is planned according to the fibroid’s size, number, location, and the patient’s desire for children. The aim is either to remove only the fibroid (myomectomy) or, in some cases, to remove the uterus entirely (hysterectomy). Not every fibroid requires surgery. However, surgery is preferred in the following situations:

• Severe menstrual bleeding
• Development of anemia
• A fibroid larger than 5 cm
• Rapid growth
• Infertility or recurrent miscarriage
• Severe pain

What Are the Methods of Fibroid Surgery?

Fibroid surgery can be performed with different methods depending on the fibroid’s location, number, and size, and the most appropriate technique is determined individually for each patient.

Hysteroscopic Fibroid Surgery

Hysteroscopic fibroid surgery is a method preferred for submucosal fibroids growing toward the uterine cavity. Because it is performed through the vaginal route with a camera and without any incision, patients generally have a more comfortable experience, and the recovery time is quite short.

Laparoscopic (Closed) Fibroid Surgery

The laparoscopic method is a modern surgical technique performed with the help of a camera through small incisions made in the abdominal area. With this method, postoperative pain is less, patients recover faster, and the scars on the skin remain quite minimal.

Open Fibroid Surgery

Open surgery is preferred particularly in cases where fibroids have reached very large sizes or are numerous. Although the recovery time with this method is longer than with closed surgery, it can be a safe and effective option for some patients.

Hysterectomy (Removal of the Uterus)

Hysterectomy is a surgical method that involves the complete removal of the uterus and is generally performed for fibroids that are very large, recurrent, or causing serious complaints, in patients who do not plan to have children. While this method provides a permanent solution, the decision for surgery must be made with a detailed patient-specific evaluation.

Which Department Should You Visit for Fibroids?

People with a suspected fibroid should consult the Obstetrics and Gynecology department. The gynecologist establishes the diagnosis by performing a gynecological examination and evaluating the fibroid with ultrasound, plans further tests when necessary, and manages the treatment process. Especially if there are complaints such as heavy menstrual bleeding, groin pain, or abdominal swelling, or if a pregnancy is planned, it is important to consult a specialist without delay.

Do Fibroids Go Away on Their Own?

Fibroids generally do not disappear on their own. However, their growth rates can vary. Key points:

• They can grow during the reproductive years due to hormones.
• Temporary growth may be seen during pregnancy.
• After menopause, most fibroids shrink as hormone levels decline.

Shrinkage does not mean complete disappearance. For this reason, regular follow-up is important. For small fibroids that cause no symptoms, monitoring alone may be sufficient.

What Is the Relationship Between Fibroids and Menstrual Irregularity?

Fibroids can cause menstrual irregularity, and this is more pronounced in fibroids located close to the inner lining of the uterus. These fibroids can increase the amount and duration of menstrual bleeding, leading to changes in the normal menstrual pattern. Because they affect the muscular structure and inner surface of the uterus, the most frequently encountered problem is heavy and prolonged menstrual bleeding.

How Do Fibroids Cause Menstrual Irregularity?

Fibroids can increase the amount of bleeding by enlarging the inner surface area of the uterus, make bleeding harder to control by disrupting the uterus’s contraction pattern, and cause heavier bleeding by increasing vascularization. They can also negatively affect the menstrual pattern by causing irregular thickening of the uterine lining. Submucosal fibroids in particular stand out as one of the most common causes of menstrual irregularity.

What Menstrual Problems Do Fibroids Cause?

In the presence of fibroids, menstrual bleeding can be heavier and longer than normal, bleeding between periods may occur, and large clots may form during menstruation. In addition, severe menstrual pain may be experienced, and anemia can develop due to prolonged heavy bleeding. Iron deficiency is common, especially in women who experience continuous heavy bleeding.

Does Every Fibroid Cause Menstrual Irregularity?

Not every fibroid causes menstrual irregularity. Small fibroids growing toward the outer surface of the uterus generally do not affect the menstrual pattern, while menstrual irregularities are seen mostly with fibroids that affect the uterine cavity.

Do Fibroids Affect Sexual Life?

Fibroids can affect sexual life in some cases, but not every fibroid leads to such problems. The effect generally depends on the fibroid’s size, location, and the pressure it exerts on surrounding tissues. In particular, large fibroids or those located near the lower part of the uterus can cause pain during intercourse.

Do Fibroids Cause Pain During Intercourse?

In the presence of fibroids, complaints such as deep pain during intercourse (dyspareunia), a feeling of pressure in the lower abdomen, and spotting after intercourse may occur. Fibroids located on the back wall of the uterus or those that have reached large sizes in particular can cause pain during deep penetration.

Do Fibroids Reduce Sexual Desire?

Fibroids do not directly reduce sexual desire, but conditions such as pain, heavy menstrual bleeding, fatigue due to anemia, and a feeling of abdominal swelling can indirectly lower libido.

Does Every Fibroid Affect Sexual Life?

Not every fibroid affects sexual life. Small fibroids located on the outer surface of the uterus generally cause no symptoms, while complaints arise mostly from fibroids that are large, close to the lower part of the uterus, or pressing on the vagina.

Does Sexual Life Improve After Fibroid Treatment?

If the complaints are related to the fibroid, a noticeable improvement in sexual life is seen after appropriate treatment, and pain generally decreases, especially after surgery.