In fertile age, the most frequent tumor in the woman's reproductive tract are uterine fibroids. Approximately 70% of women have a myoma at age 50, at 35 the prevalence is around 40% with a maximum incidence period between 30 and 40 years. Currently, the age of the woman's first birth has been delayed, so it ends up in the same decade as the maximum development of fibroids, and this presents a major challenge in advising sterile women with a myomatous uterus .
According to specialists in Gynecology and Obstetrics , fibroids arise from genetic alterations in isolated myometrial cells. The symptomatology and form of onset is very heterogeneous, from the asymptomatic finding to the invalidating or potentially lethal disease, that is why it is crucial to evaluate each specific process in a thorough way. It should be borne in mind that this is a benign disease, the likelihood of a leiomyosarcoma is so remote (0.1% in fertile women and 0.23% of HT), which should be excluded from the differential diagnosis even in those growth masses Quick. The risk of a hysterectomy is high, so it is not advisable to perform it in a preventive way. Although it is recommended in menopausal women (incidence reaches 1.7%), bleeding and pain, and in black women who take tamoxifen or have undergone radiotherapy.
Therapeutic target of uterine fibroids
As benign pathology, whose growth and symptomatology usually give in menopause, the main objective is to eradicate the symptoms and improve the quality of life during the fertile period of the woman. There are therapies that act directly on the myoma, symptomatic treatments and, finally, surgical options that use the new technologies of interventional radiology, ultrasound and radiofrequency.
In order to apply any treatment, it is convenient to evaluate the characteristics of myoma (number, size and location) and patient (age, symptomatology and reproductive desire). Size and number are not absolute indications, although it is true that as they increase, so does the severity of symptoms. Cases with a desire for fertility of gestation are treated differently.
Uterine fibroids and infertility
The effect of fibroids on fertility is not just clear. They are responsible for 2-3% of infertility cases, although they are found in 5-10% of infertile patients. Although they do not interfere with ovulation. The localization of the myoma is the fundamental factor, therefore those submucosal ones that alter the contour of the endometrial cavity must be removed. In the case of intramural myomas, its effect is not clear, although they do affect the rate of gestation by IVF when they are greater than 5 cm.
Excision of fibroids is recommended in women with unexplained infertility, especially if they are going to undergo fertility treatments. Subseroses do not generally affect fertility.
Myomas and gestation
Approximately 10% of pregnant women have fibroids. They usually increase in size greatly during the first trimester, to stagnate, and even shrink after. They slightly increase the risk, by location, of abnormal presentation, premature delivery and CST, as well as the rate of spontaneous abortions. In rare cases, it may alter placental insertion. Myomectomy is not indicated during pregnancy to prevent complications, but in the rare cases it may be necessary.