How to Treat Multiple Uterine Fibroids

Different types of uterine fibroids can occur simultaneously in the same uterus, which is called multiple uterine fibroids. Their positional distribution has three situations: about 60-70% are intramural, 20% are subserosal, and 10% are submucosal.

According to statistical data, about 20% of women over 35 years old have multiple uterine fibroids. However, most patients fail to detect them because the fibroids are small and asymptomatic, so the clinically reported incidence of multiple uterine fibroids is only between 4-11%. Uterine fibroids are benign, and there is currently no medical evidence to prove that uterine sarcoma is transformed from uterine fibroids.

I. Symptoms of Multiple Uterine Fibroids

1. Compression symptoms: Larger posterior wall fibroids can compress the rectum, causing constipation; larger fibroids in the broad ligament can compress the ureter.

2. Pain: Torsion of subserosal pedunculated fibroids can suddenly cause pain; submucosal fibroids sometimes cause dysmenorrhea.

3. Infertility: Women of childbearing age may experience infertility, though this proportion is not very high. At the same time, if the fibroids are too large, they are likely to cause miscarriage, and this proportion is higher than that of single uterine fibroids.

4. Bleeding: Submucosal fibroids and intramural fibroids cause an increase in the uterine cavity area, leading to heavy menstrual flow. Multiple uterine fibroids can cause massive bleeding, or long-term excessive menstrual flow and prolonged menstrual periods leading to anemia, which generally cannot be cured by drugs. Currently, ultrasound ablation is a relatively optimal choice for the treatment of multiple uterine fibroids.

II. Etiology of Multiple Uterine Fibroids

The exact etiology is unknown, but it may be related to excessively high estrogen levels in the body and long-term stimulation by estrogen.

1. Multiple uterine fibroids occasionally occur in women after menarche, are more common in women of childbearing age, and most fibroids stop growing and gradually atrophy after menopause.

2. Multiple uterine fibroids are often complicated by endometrial hyperplasia.

3. Patients with ovarian granulosa cell tumors and theca cell tumors (which can secrete estrogen) are often complicated with uterine fibroids.

4. During pregnancy, estrogen levels increase, and fibroids often grow rapidly.

5. Exogenous estrogen can accelerate the growth of fibroids.

III. Self-Examination of Multiple Uterine Fibroids

1. Observe menstrual blood: Increased menstrual flow, postmenopausal bleeding, or contact bleeding are often caused by fibroids in the cervix or uterine body. Therefore, any bleeding other than normal menstruation should be investigated to make a symptomatic diagnosis and treatment.

2. Observe leucorrhea: Normal leucorrhea is a small amount of slightly sticky colorless and transparent discharge, which changes slightly with the menstrual cycle, but purulent, bloody, and watery leucorrhea are all abnormal.

3. Feel for lumps: In the early morning, lie on the bed on an empty stomach, slightly bend the knees, relax the abdomen, and touch the lower abdomen with both hands from light to deep; larger tumors can be detected.

4. Feel for pain: Pain in the lower abdomen, lower back, or sacrococcygeal region should attract attention.

IV. Treatment of Multiple Uterine Fibroids

1. Observation: Which fibroids can be observed? Women approaching menopause with no obvious symptoms should have a B-ultrasound examination every three months or six months; those with fibroids but no symptoms can have regular re-examinations and observations.

2. For those with irregular vaginal bleeding other than menstruation, diagnostic curettage and pathological examination can be performed.

3. Drug treatment: For those with excessive menstrual flow, androgen drugs can be selected. Such drugs can antagonize estrogen, cause endometrial atrophy, and at the same time contract uterine smooth muscle and uterine vascular smooth muscle, reducing bleeding. Traditional Chinese medicine treatment can also reduce menstrual flow, but it has no obvious effect on reducing the size of fibroids.

4. Surgical treatment: It is suitable for patients with large fibroids, obvious symptoms, and ineffective non-surgical treatment. Common surgical methods include total hysterectomy, subtotal hysterectomy, and myomectomy. The choice of surgical method depends on the patient’s age, fertility needs, and the size and location of fibroids. For women of childbearing age who want to retain fertility, myomectomy can be considered to remove fibroids while preserving the uterus; for menopausal women or those with no fertility needs, total hysterectomy is often the preferred option to avoid recurrence.

In addition, ultrasound ablation, as a minimally invasive and non-surgical treatment method, is particularly suitable for patients with multiple uterine fibroids. It uses high-intensity focused ultrasound energy to accurately ablate multiple fibroids one by one, with the advantages of no incision, less bleeding, fast recovery, and preservation of the uterus. It is especially suitable for patients who cannot tolerate surgery or refuse surgical treatment.