Αριστοτέλης Γ. Αποστολίδης, Απεικόνιση των Ινομυωμάτων και της Αδενομύωσης, 2016. Υπερηχογραφια τομ.13, τευχ.3, σελ. 111-118 ACOG, Uterine Fibroids. Gynecologic Problems, 2018 (Greek Version: Μπαμπάτσιας Λ.) ACOG, Uterine Fibroids - Frequently Asked Questions: Gynecologic Problems, December 2018 Aymara Mas et al., Updated approaches for management of uterine fibroids. Int J Womens Health. 2017; 9: 607–617. Published online 2017 Sep 5. doi: 10.2147/IJWH.S138982. PMCID: PMC5592915, PMID: 28919823 Hee Joong Lee, MD, et al., Contemporary Management of Fibroids in Pregnancy. Rev Obstet Gynecol. 2010 Winter; 3(1): 20–27. PMCID: PMC2876319. PMID: 20508779 Ioannis K Thanasas, Maria Boursiani, Rare Localizations of Genital Leiomyomas in Woman’s System, October 2015. ACHAIKI IATRIKI Volume 34, Issue 2 Jessica Shields, D.O., Can uterine fibroids harm my pregnancy?, March 31, 2020 Li H, Du J, Jin L, Shi Z, Liu M. Myomectomy during cesarean section. Acta Obstet Gynecol Scand 2009, 88:183-6. Sharma JB, Kumar S, Rahman SM, Roy KK, Malhotra N. Non-puerperal incomplete uterine inversion due to large sub-mucous fundal fibroid found at hysterectomy: a report of two cases. Arch Gynecol Obstet 2009, 279:565-7. WebMD, Uterine Fibroids and Pregnancy: How UF Affects Pregnancy. www.webmd.com

1. THEME:
Uterine Fibroids
Midwifery Student
Eleni Maria
Sotiropoulou
@midwifeonduty_,

2. UTERINE FIBROIDS
 Fibromyomas or leiomyomas are benign tumors located in the
muscular lining of the uterine wall (myometrium).
 It is one of the most common benign uterine tumors. Only 2%
of fibroids are associated with malignancy - sarcoma.
 It is common in women 30 to 40 years old but can occur at
any age.
 They consist of swollen smooth muscle fibers and fibrous
connective tissue.
Jessica Shields, D.O, 2020
ACOG,2018

3. HISTOLOGICAL DATA
 They have a spherical shape.
 Macroscopic appearance: cells of normal appearance grouped
together.
 Microscopic appearance: distinct round masses of white color
clearly separated from the uterine tissue.
 Their size varies from very few centimeters to very large that
occupy the entire abdomen and appear as abdominal swelling
(diameter 1-15 cm) and respectively the weight ranges from a
few grams to a few kilograms.
ACOG,2018

4. RISK FACTORS
 Heredity
 The action of female sex hormones
Elevated levels of estrogen and progesterone
 Age
Before adolescence not found (<15 years)
Due to the direct dependence on female hormones occurs in women of
reproductive age
In postmenopausal women they relapse
 Ethnicity: 2-3 times more frequent the black race in contrast to the
white for fibroid growth
 Obesity
 Polycystic Ovaries (PCOS)
 Diabetes
 Hypertension
ACOG,2018

5. TYPES OF UTERINE FIBROIDS - LOCALIZATION
1. Hypogonadism: located on the outer surface of the uterus (serous
membrane). As they grow they form a lump.
2. Intramural: located in the width of the uterine wall (muscle sheath).
As they grow, they also increase the size of the organ.
3. Submucosal: protruding into the endometrium (mucous membrane)
4. Stems: are attached to the uterus with a thin stem.
5. Intra-ligaments: located in the ligaments of the uterus.
Αριστοτέλης Γ. Αποστολίδης, 2016

9. CLINICAL PICTURE
Usually fibroids do not cause any symptoms, especially before they
develop,
The severity of the symptoms depends on their location and size. Thus,
the symptoms are:
 Abnormalities appear during the period:
Menorrhagia or uterine bleeding
Dysmenorrhea
Periods that last longer or occur more frequently
 Iron deficiency anemia due to increased blood loss
 Abdominal pain (dull or acute) - abdominal cramps
 Pain during sex (insomnia)
 Difficulty urinating or frequent urination
 Constipation, rectal pain
 Pelvic pain
 Feeling of pressure in the pelvis
 Infertility
ACOG,2018

10. COMPLICATIONS
o Stem fibroid torsion: This presents with an acute abdomen image and
requires immediate surgery.
o Necrosis: Necrosis (degeneration) can be of different histological
types, such as vitreous, calcareous, red, etc. Red degeneration is
more common during pregnancy, with an acute abdomen and fever.
o Sarcomatous change: Occurs very rarely and especially in large
fibroids of perimenopausal patients. The final diagnosis is made after
laparotomy and histological examination and is treated with a total
hysterectomy with the accessories.
o Uterine inversion: Very rare, (incomplete) uterine inversion due to
large bottom submucosal fibroid may be found
Sharma et al 2009

11. HOW ARE FIBROMYOMAS DIAGNOSED?
 History
 Pelvic examination - if they are large they are
palpable
 Two-handed gynecological examination
 Ultrasound (transvaginal or intra-abdominal)
 MRI
 Diagnostic hysteroscopy
 Diagnostic laparoscopy
 HSG
ACOG, 2018

12. TREATMENT - CONSERVATIVE TREATMENT
 Non-Steroidal Anti-
Inflammatory (NSAID)
 Contraceptives (combination
of estrogen - progesterone
or progestogens only)
 Progesterone Regulators
 Iron (Fe)
 Donazul
 GnRH agonist
 Uterine arterial vaccination
 Arterial ligation of the uterus
Medication Non-surgical ways
The treatment of fibroids should be individualized based on their size and
location, their growth rate, the symptoms they cause, the desire to have
children, the age of the woman

13. TREATMENT - INTERVENTIONAL METHODS
Fibromyomectomy: It is aimed at women who want to maintain their fertility, but
the removal of fibroids is necessary. Can with various surgeries:
 Open fibromyectomy
 Laparoscopic fibromyectomy
 Robotically assisted laparoscopic fibromyectomy
Hysterectomy: It is a method of choice for menopausal women with fibroids that
increase in size, but it is also an option for premenopausal women who have
completed their reproductive cycle and have not responded to more conservative
solutions or have recurrences after fibroids, or have fibroids. , uterine prolapse,
cervical dysplasia.
Hysterectomy is distinguished:
 Removal of the body of the uterus with preservation of the cervix (partial or superficial)
 Body and neck removal (total)
 Removal of uterus, cervix and appendages - ovaries and fallopian tubes (Total
hysterectomy with bilateral fallopian tube ovulation). There must be other reasons to
proceed with this method
Hysterectomy can be done with: i) Laparotomy ii) Laparoscopic iii) Vaginal iv)
With robotic assistance
Aymara Mas et al., 2017

14. Aymara Mas et al., 2017

15. RARE DETECTION OF FIBROIDS IN THE
FEMALE GENITAL SYSTEM
 Cervical: Located in the lower part of the uterus, in the cervix (0.6%).
Cervical fibroids can be solitary or multiple, very small or large
 Parasitic: they grow away from the uterus, in the abdomen and are
usually tissue remnants after previous fibroid removal.
 Ovarian: are called fibroids located in the ovaries. Ovarian fibroids
are the rare benign tumors of the ovaries.
 Vaginal: they grow on the vaginal wall. Vaginal fibroid usually starts
from the outer vaginal wall. The most common location of
leiomyomas in the vagina is the anterior vaginal wall, but they can
also be found in the lateral vaginal walls or in the posterior wall of the
vagina. Vaginal fibroids are extremely rare.
 Vaginal fibroids: located in the area of ​​the vulva. Vaginal fibroids are
rare.
Ioannis K Thanasas, Maria Boursiani, 2015

16. FIBROIDS AND PREGNANCY
 In pregnancy, fibroids may increase in size resulting in threatened
dystocia. In this case, a caesarean section is selected. If they grow
up, this is more likely to happen in the first trimester of pregnancy.
The increase in size is due to the increased blood flow to the uterus
due to pregnancy and increased demands on hormones.
 It is supported by studies that most fibroids do not grow during
pregnancy and fibroid pregnancy usually does not show any
particular symptoms, showing a normal course and a normal course
of labor.
(Hee Joong Lee et al., 2010)

17. RISKS - COMPLICATIONS
The risk and type of complication depend on the number, size and
location of the fibroid:
 Irregular projections / shape
 Pelvic outlet obstruction
 If the placenta is implanted on or near a fibroid then there is a risk:
First trimester miscarriage
Prematurity
Premature placental abruption
ΠΡΕΥ
IUGR
 If fibroids are located in the lower part of the uterus, they increase
the chance of bleeding after childbirth (uterine atony).
 Rare complication during pregnancy and childbirth, necrosis of the
fibroid due to torsion or limited perfusion may occur
Jessica Shields, D.O, 2020
Hee Joong Lee et al., 2010

18. TREATMENT OF FIBROIDS IN PREGNANCY
 In symptomatology of fibroids in pregnant women, the doctor
considers it necessary to monitor her in the hospital for fear of
impending complications, using conservative treatment - analgesics
to relieve the feeling of pressure and pain and tocolytics in the
presentation of premature myometrial contractions.
 Surgery is avoided due to significant postpartum hemorrhage.
However, a 2009 study in China showed that fibroids during
caesarean section is a safe and effective method. (Li et al 2009).
Hee Joong Lee et al., 2010

19. KEYS MESSAGES
 Fibromyomas are also asymptomatic.
 Frequent follow-up of the patient with fibroids or history is necessary.
 The treatment of fibroids should be individualized and adapted to the
woman's needs, desires and should be oriented to the relief of symptoms.
 Fibromyectomy is a safe and effective method. No uterine removal is
performed. So, the woman can still have children.
 Definitive treatment is hysterectomy, if after a fibromyomectomy the woman
may reappear fibroids in her body. Hysterectomy is performed only if
necessary because of the condition ‘the woman no longer wants fertility - as
she is fully aware of alternatives and risks.
 Women with fibroid bleeding are treated with:
 Estrogen administration
 Hysteroscopy / scraping
 Hysterectomy
 Concerns about complications during pregnancy are not an indication for
fibroids, unless there is a history of complications in a previous pregnancy.

20. BIBLIOGRAPHY
• Αριστοτέλης Γ. Αποστολίδης, Απεικόνιση των Ινομυωμάτων και της Αδενομύωσης,
2016. Υπερηχογραφια τομ.13, τευχ.3, σελ. 111-118
• ACOG, Uterine Fibroids. Gynecologic Problems, 2018 (Greek Version:
Μπαμπάτσιας Λ.)
• ACOG, Uterine Fibroids - Frequently Asked Questions: Gynecologic Problems,
December 2018
• Aymara Mas et al., Updated approaches for management of uterine fibroids. Int J
Womens Health. 2017; 9: 607–617. Published online 2017 Sep 5. doi:
10.2147/IJWH.S138982. PMCID: PMC5592915, PMID: 28919823
• Hee Joong Lee, MD, et al., Contemporary Management of Fibroids in Pregnancy.
Rev Obstet Gynecol. 2010 Winter; 3(1): 20–27. PMCID: PMC2876319. PMID:
20508779
• Ioannis K Thanasas, Maria Boursiani, Rare Localizations of Genital Leiomyomas in
Woman’s System, October 2015. ACHAIKI IATRIKI Volume 34, Issue 2
• Jessica Shields, D.O., Can uterine fibroids harm my pregnancy?, March 31, 2020
• Li H, Du J, Jin L, Shi Z, Liu M. Myomectomy during cesarean section. Acta Obstet
Gynecol Scand 2009, 88:183-6.
• Sharma JB, Kumar S, Rahman SM, Roy KK, Malhotra N. Non-puerperal incomplete
uterine inversion due to large sub-mucous fundal fibroid found at hysterectomy: a
report of two cases. Arch Gynecol Obstet 2009, 279:565-7.
• WebMD, Uterine Fibroids and Pregnancy: How UF Affects Pregnancy.
www.webmd.com