Uterine fibroids are benign tumors formed by hyperplasia of uterine smooth muscle tissue. Common manifestations include uterine bleeding, pain, abdominal masses, pressure symptoms on adjacent organs, increased vaginal discharge, anemia, and cardiac dysfunction. Some patients have no symptoms and are only diagnosed during routine gynecological examinations. As the most common benign gynecological tumor, uterine fibroids mainly affect women aged 30–50. According to their location in the uterine wall, fibroids are classified as intramural, subserosal, submucosal, or intraligamentary.
1. Observation and Follow-Up
For small, asymptomatic fibroids with no complications or degeneration, no immediate treatment is needed, especially for perimenopausal women. After menopause, declining estrogen levels often cause fibroids to shrink or disappear naturally. Follow‑up examinations every 3–6 months are recommended. Further treatment may be considered if fibroids enlarge or symptoms worsen.
2. Surgical Treatment
- Hysterectomy: Suitable for women with a uterus larger than that at 12 weeks of gestation, severe symptoms despite small fibroids, or rapidly growing fibroids where malignancy cannot be excluded.
- Myomectomy: Recommended for women under 35 who are unmarried or have not yet completed childbearing.
3. Medical Treatment
Indicated for small fibroids with mild symptoms, perimenopausal patients, or those unfit for surgery.
- Androgens: Methyltestosterone, Testosterone Propionate
- Progestogens:
- Norethisterone (for women wishing to conceive)
- Medroxyprogesterone, Megestrol, or Norethisterone
- Luteinizing hormone-releasing hormone analogs (LHRH‑a)
4. Ultrasound Ablation (High-Intensity Focused Ultrasound, HIFU)
Absolute Indications
- Patient consent and full understanding of focused ultrasound technology.
- Confirmed diagnosis with exclusion of malignancies (uterine sarcoma, other uterine or cervical malignant lesions).
- Fibroids clearly visible on intraoperative ultrasound.
Relative Indications
- Cervical fibroids, pedunculated submucosal/subserosal fibroids, vascular leiomyomas.
- Acute or chronic pelvic inflammatory disease (after medical control).
- History of multiple abdominal surgeries, intestinal adhesions, or foreign bodies in the acoustic pathway.
- Severe, firm lower abdominal scars causing significant ultrasound attenuation.
- Some relative indications may be converted to absolute ones.
- Inability to lie prone for more than one hour.
Prevention
Women with uterine fibroids should have regular examinations (ultrasound or gynecological checkups every 3–6 months). Rapid fibroid growth in older women or postmenopausal vaginal bleeding requires evaluation for possible sarcomatous changes. Patients with heavy menstrual bleeding should receive prompt treatment for anemia to prevent anemic heart disease and myocardial degeneration.