How to Treat Multiple Uterine Fibroids

Multiple uterine fibroids, also known as leiomyomas, refer to the presence of distinct fibroid tumors of different types simultaneously within the uterus. They are categorized based on their location within the uterine wall: intramural fibroids, which develop within the uterine muscle wall and account for approximately 60 to 70% of cases; subserosal fibroids, which grow on the outer surface of the uterus and make up about 20%; and submucosal fibroids, which protrude into the uterine cavity and represent roughly 10%. Epidemiological data suggests that around 20% of women aged 35 and above may have multiple fibroids. However, most cases remain asymptomatic and undiagnosed, leading to a reported clinical incidence rate of only 4 to 11%. Importantly, uterine fibroids are benign tumors, and there is no current medical evidence to support the transformation of fibroids into uterine sarcomas.

I. Symptoms of Multiple Uterine Fibroids

1. Compressive Symptoms: Large posterior fibroids can compress the rectum, causing constipation. Large fibroids within the broad ligament may compress the ureters, potentially leading to urinary tract issues.
2. Pain: Acute abdominal pain can occur when a pedunculated subserosal fibroid undergoes torsion. Submucosal fibroids may also cause dysmenorrhea, or painful periods.
3. Infertility and Pregnancy Risks: While the rate is not extremely high, fibroids can impact fertility. Additionally, larger fibroids increase the risk of miscarriage during pregnancy, a risk slightly higher than that associated with single fibroids.
4. Abnormal Uterine Bleeding: Submucosal fibroids and those that enlarge the uterine cavity can lead to menorrhagia (heavy menstrual bleeding) and prolonged periods. In cases of severe or chronic bleeding leading to anemia, medical treatment is often ineffective, and more aggressive interventions are required.

II. Focused Ultrasound Ablation: A Premier Minimally Invasive Treatment

For many patients with multiple fibroids, especially those seeking to preserve their uterus, Focused Ultrasound Ablation (FUA), also known as High-Intensity Focused Ultrasound (HIFU), is considered an optimal and minimally invasive therapeutic option.

• Procedure: FUA uses focused thermal energy to precisely target and destroy fibroid tissue without incisions. The ultrasound waves are concentrated to raise the temperature of the targeted fibroid cells, causing them to undergo necrosis and be naturally absorbed by the body.
• Advantages: It is a non-invasive procedure that preserves the integrity of the uterus, has a shorter recovery time compared to surgery, minimizes blood loss and risk of infection, and allows for the preservation of fertility. It is particularly effective for multiple fibroids as it can treat numerous lesions in a single session.
• Considerations: Candidates are carefully evaluated based on fibroid size, location, and the patient's overall health. Post-procedure, patients may experience temporary soreness or vaginal discharge, and follow-up imaging is recommended to monitor the treated area.

III. Causes of Multiple Uterine Fibroids

The exact cause remains unknown, but they are strongly associated with elevated levels of endogenous estrogen.

1. Hormonal Influence: They are rare in pre-menarcheal girls, common in reproductive-aged women, and often regress or stop growing after menopause due to declining estrogen levels.
2. Associated Conditions: They are frequently comorbid with endometrial hyperplasia. Women with ovarian tumors that secrete estrogen, such as granulosa cell tumors or theca cell tumors, often also have fibroids.
3. Pregnancy: Increased estrogen levels during pregnancy can cause fibroids to grow rapidly.
4. Exogenous Estrogens: Exposure to external sources of estrogen, such as certain medications or hormone replacement therapies, can accelerate fibroid growth.

IV. Self-Examination and Screening

1. Monitor Menstrual Bleeding: Unexplained changes in menstrual flow, post-menopausal bleeding, or contact bleeding should be evaluated, as they may be signs of fibroids.
2. Assess Vaginal Discharge: Normal discharge is clear, slightly viscous, and changes with the menstrual cycle. Abnormal discharge, such as that which is purulent, bloody, or watery, warrants medical attention.
3. Palpate for Masses: In the morning, empty your bladder and lie flat. Gently press on your lower abdomen from light to deep pressure. A firm mass may be felt if fibroids are large.
4. Note Pain: Persistent pain in the lower abdomen, lower back, or sacral area should not be ignored.

V. Treatment Strategies

1. Watchful Waiting: Asymptomatic patients approaching menopause may simply undergo regular B超 examinations every three to six months. Even with fibroids,若无症状,定期监测 is sufficient.
2. Diagnostic Procedures: In cases of abnormal bleeding beyond the menstrual cycle, a diagnostic dilation and curettage (D&C) with pathological examination may be performed to rule out other pathology.
3. Medication: For menorrhagia, androgenic medications can be used to counteract estrogen effects, causing the endometrium to atrophy and reducing bleeding. Traditional Chinese Medicine can help manage bleeding but has limited effect in shrinking fibroids.
4. Surgical Treatment: Indicated for large fibroids, severe symptoms, or when non-surgical treatments fail. Options include myomectomy (removal of fibroids while preserving the uterus) or hysterectomy (removal of the uterus), depending on the patient's age, fertility goals, and symptom severity.