Which are the symptoms?
The most frequent symptom is abnormal uterine bleeding that could lead to anemia. Other common signs and symptoms, such as pollakiuria, urinary urgency, and urinary retention, are caused by compression on the bladder. Involvement of the gastrointestinal tract could lead to constipation. Dysfunctions of the reproductive sphere could be caused either by anatomical distortion of the endometrial cavity and obstruction of the tubal ostia, thus resulting in the difficulty of implantation; or to disorders of pregnancy such as miscarriage, preterm delivery, abnormal fetal presentation and post partum hemorrhage. In 20% of cases patients are asymptomatic.
- abnormal uterine bleeding
- abdominal pain and pelvic weight bearing
- urinary and/or intestinal disorders
- reproductive spherical dysfunction
- repeated implantation failures
How is it diagnosed?
- 2D/3D gynaecology examination
- gynecological ultrasound
How is it treated?
Treatment depends on symptomatology, patient's age, reproductive desire, size, number and location of fibroids. There are three different approaches: medical therapy, surgical therapy, and waiting. As far as medical therapy is concerned, there is no solution that can definitively reduce the volume of myomas or prevent their formation. Progestins are used, which are exclusively effective in controlling hemorrhagic symptoms. At the same time, GnRh agonist analogues are effective in volume reduction, but with a temporary effect. The latter are frequently used in preoperative treatment, if the patient is not a candidate for surgery or if the menopause is close. As for the surgical approach, it is diversified both in the modalities (laparotomy, laparoscopy, hysteroscopy) and in the type of intervention (conservative or demolition). The most commonly performed surgery is myomectomy consisting in the removal of myomas and reconstruction of the uterine wall. If the patient is in menopause or has fulfilled her desire for offspring, the symptoms, number, location or size of myomas are such that the possibility of conservative treatment is not feasible, a radical treatment involving hysterectomy will be performed. The latter can also be performed in different modalities based on previous abdominopelvic surgery, previous episodes of P.I.D., history of endometriosis, patient's vaginal compliance, parity, number, location and size of myomas, volume of uterine viscera.