Uterine fibroids are benign tumors formed by the 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 are asymptomatic and are often diagnosed with uterine fibroids during routine gynecological examinations.
As the most common benign gynecological tumor, uterine fibroids predominantly affect women aged 30–50. Based on their location within the uterine wall, fibroids are classified as intramural, subserosal, submucosal, or intraligamentary fibroids.
1. Observation and Follow‑up
If fibroids are small, asymptomatic, without complications or degeneration, treatment is generally unnecessary. This is especially true for perimenopausal women, as fibroids often shrink or disappear spontaneously after menopause due to low estrogen levels. Regular follow‑up every 3–6 months is recommended. Further treatment may be considered if fibroids enlarge or symptoms become significant during follow‑up.
2. Surgical Treatment
(1) Hysterectomy
Indicated when the uterus is larger than that at 3 months of gestation, when fibroids are small but cause severe symptoms, or when rapid growth raises suspicion of malignancy.
(2) Myomectomy
Suitable for patients under 35 years old who are unmarried or nulliparous (have not yet given birth).
3. Medical Treatment
Used for patients with small fibroids, mild symptoms, perimenopausal status, or poor general health that precludes surgery.
(1) Androgens
- Methyltestosterone
- Testosterone propionate
(2) Progestins
- Norethisterone, for patients desiring fertility
- Medroxyprogesterone, megestrol, or norethisterone (any one may be chosen)
- Luteinizing hormone‑releasing hormone agonists (LHRH‑a)
4. Ultrasound Ablation (Focused Ultrasound Surgery)
Absolute Indications
Absolute indications are mandatory conditions for treatment.
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Patient factors
- The patient must consent and voluntarily choose this treatment.
- The patient must understand focused ultrasound technology.
- The diagnosis must be confirmed, and malignant diseases (uterine sarcoma, other uterine lesions, cervical malignancies) must be excluded.
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Technical factors
- Fibroids must be visible on intraoperative ultrasound.
Relative Indications
- Cervical fibroids, pedunculated submucosal or subserosal fibroids, vascular leiomyomas.
- Acute or chronic pelvic inflammatory disease, which may become treatable after medical control.
- History of multiple abdominal surgeries, intestinal adhesions, or foreign bodies in the acoustic pathway.
- Severe, rigid abdominal surgical scars causing significant ultrasound attenuation.
- Some relative indications may be converted to absolute indications.
- Inability to lie prone for more than 1 hour.
Prevention
Women with uterine fibroids should undergo regular examinations, such as B‑ultrasound or gynecological checks every 3–6 months.
In older women, rapid fibroid growth or postmenopausal vaginal bleeding requires evaluation for possible sarcomatous degeneration. Patients with excessive menstrual bleeding should actively correct anemia to prevent the development of anemic heart disease and myocardial degenerative changes.