Fibromyoma: the uterine fibroma

By Cristiano Antonino On Nov 8, 2022

Fibromyoma, more frequently known as uterine fibroma, is the most frequent benign tumour of the uterus. Synonyms are myoma and leiomyoma

Fibroma is a typical pathology of the fertile age and as such can be stimulated in its growth by ovarian hormone production.

Indeed, with menopause there is often a reduction in its volume.

More than 25% of women over 30 have one or more fibroids, but less than 25% of these fibroids are accompanied by symptoms.

The possibility that a fibroid may degenerate into a malignant form is extremely rare (about 1 in 1000); such a risk may be suspected in the face of a rapid increase in volume detected during clinical or ultrasound examinations.

With menopause, when hormonal stimulation ceases, fibromyoma tends to regress spontaneously.

How do we notice fibromyoma (or uterine fibroid)?

Three times out of four, fibromioma is occasionally discovered during a gynaecological check-up or ultrasound examination.

The most frequent symptom is menorrhagia, i.e. the appearance of menstrual flows that are much more abundant than usual and with a tendency to haemorrhage: menometrorrhagic cycles.

In some women, who do not worry about increased menstruation, a hypochromic sideropenic anaemia may be a sign of fibroma.

Very often the presence of a fibroma, especially a large one, may cause pain and/or a sense of weight in the lower abdomen or lumbosacral area.

In addition, depending on the volume and location of the fibroma, urinary symptoms may be present (urge to urinate frequently or sometimes urinary incontinence) in the event of pressure on the bladder (which is in close proximity to the uterus), or bowel symptoms due to compression on the rectum with consequent difficulty in defecation.

In some cases, the presence of a fibroid can cause infertility problems and repeated miscarriages.

Tests to diagnose fibromyoma

The first examination to diagnose a fibroid is the normal gynaecological examination: a very large fibroid can sometimes already be suspected on palpation of the abdomen.

The bimanual examination and vaginal exploration enable the uterus to be appreciated as irregularly increased in volume and consistency.

In diagnosing uterine fibroids, ultrasound is essential: abdominal ultrasound is always necessary to assess the size and location of large fibroids; transvaginal ultrasound may be useful for a more precise analysis of the uterine walls.

The best time to have an ultrasound scan is within the first eight days after the beginning of the cycle to better control even small fibroids protruding inside the uterine cavity.

The ultrasound scan is very useful in monitoring any tendency for fibroids to grow over time. To better study the uterine cavity, hysteroscopy and hysterosalpingography are necessary.

Fibromyoma, what to expect

The prognosis of myofibromas is good.

In the case of pregnancy, complications are rare, but assiduous monitoring is necessary to specify changes in volume, its location in relation to the insertion of the placenta and, at the end of pregnancy, in relation to the position of the foetus.

The menopause causes, in most cases, a reduction in the volume of fibroids.

What to do in case of fibromyoma (or uterine fibroid)

The choice of therapy depends on various factors: the possible presence of symptoms and their extent, the patient’s age, the possible desire to become pregnant, and the volume of the fibroid.

For a fibroid that is not very voluminous, in a patient with no symptoms, it may be sufficient to keep a wait-and-see attitude, limiting oneself to periodic check-ups (gynaecological examination and ultrasound every six months).

On the contrary, in a symptomatic patient, therapeutic choices must be made, which may be pharmacological in some cases, and more frequently, surgical.

Pharmacological therapy may be useful mainly to control the bleeding tendency and, if necessary, to cope with the pain.

However, total regression of the fibroma cannot be expected from medical therapy.

Several categories of drugs are available to control the haemorrhagic symptoms:

Antihaemorrhagics: these are particularly useful for controlling menorrhagia and should be taken as needed orally or by intramuscular injection. They have no side effects but must be taken strictly on a full stomach.
Progestins: these are particularly useful in blocking menometrorrhagia and sometimes even manage to reduce the pain symptoms. They are usually taken orally (in tablet form) for 10 to 15 days per cycle for several cycles starting on the 13th to 15th day of the cycle and according to the treating gynaecologist’s instructions.
Danazol: this preparation is also effective in controlling menometrorrhagia, and therapy must be continued for 4-6 months and can curb further development of the fibroid (or fibromatous uterus); however, it is a drug with side effects and must be administered under close supervision.
GnRH analogues: these preparations (usually administered in the form of intramuscular injections) involve a temporary blockage of hormone production by the ovaries. This triggers a kind of reversible pharmacological menopause, as a result of which there is a cessation of menstruation (amenorrhoea) and a certain reduction in the volume of fibroids. However, these effects are not permanent: after discontinuing the therapy, the previous haemorrhagic symptoms may reappear, and the growth of fibroids may resume.

The latter therapy cannot be continued for a very long time because of the unpleasant menopausal-like symptoms (e.g. hot flushes) and the osteoporosis-promoting effect it may entail.

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Therefore this therapeutic choice is made either with a view to surgery (with the intention of favouring a reduction in the volume of the fibroid to facilitate the operation), or in a patient very close to the menopause to control the menometrorrhagia until the spontaneous cessation of menstruation.

The choice of surgical therapy is necessary in cases where haemorrhages are frequent and abundant and there has been no benefit with medical therapy, or in cases where the conspicuous volume of a fibroid (or a fibromatous uterus) creates pain or discomfort from compression of nearby organs (bladder and/or intestines).

Surgery is necessary to remove a fibroid that by its location hinders fertility.

The surgical procedures are

myomectomy: simple removal of one or more fibroids, thus preserving the uterus. This choice is usually preferred for small fibroids and when the patient is of child-bearing age;
hysterectomy: total removal of the uterus. This choice is more indicated in the peri- or postmenopausal patient, and in more complex cases such as the presence of multiple and/or voluminous myomas.

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