Frequently Asked Questions About Fibroids

Hearing a diagnosis of fibroids often causes anxiety in many women; however, fibroids are the most common benign uterine masses in women of reproductive age, and most do not cause any symptoms. Below, we have compiled the most frequently asked topics during examinations.

What Are Fibroids?

Fibroids are benign masses originating from the smooth muscle cells of the uterine wall. In medical terms, they are also called leiomyomas or fibroids. Their size can range from a few millimeters to, rarely, large enough to noticeably enlarge the abdomen. They can be solitary or multiple fibroids can be present in the same uterus.

How Common Are They and What Causes Them?

Fibroids are quite common in women of reproductive age, and their frequency increases with age. Although the exact cause is not fully understood, it is accepted that estrogen and progesterone hormones play a role in their growth, and genetic predisposition is also influential. Factors often associated include a family history of fibroids, early onset of menstruation, and obesity.

What Symptoms Do They Cause?

• Heavy, prolonged, or clotty menstrual bleeding
• Fatigue and anemia due to bleeding
• Pressure, fullness, or pain in the groin area
• Frequent urination, feeling of incomplete bladder emptying
• Constipation or pressure on the intestines
• Discomfort during sexual intercourse
• Difficulty conceiving or recurrent pregnancy loss in some locations

The presence of symptoms is more related to the location of the fibroid than its size; a small fibroid adjacent to the uterine cavity can cause more bleeding than a large fibroid growing outward.

Why Is the Location Important?

Fibroids are classified into three main groups based on their location in the uterine wall. Submucosal fibroids growing toward the uterine cavity are more associated with bleeding and difficulty conceiving. Intramural fibroids located within the muscle layer can cause bleeding and pressure symptoms depending on their size. Subserosal fibroids growing outward from the outer surface of the uterus mainly cause pressure symptoms on adjacent organs. Treatment planning is made considering this distinction.

How Is the Diagnosis Made?

The diagnosis is mostly made through gynecological examination and ultrasonography. When detailed evaluation of the uterine cavity is needed, saline infusion sonography or hysteroscopy can be used. In cases with multiple or large fibroids, magnetic resonance imaging may be requested to clarify surgical planning. In patients with bleeding complaints, blood counts and, if necessary, endometrial tissue sampling may be performed.

Does Every Fibroid Require Surgery?

No. In fibroids that do not cause symptoms, do not cause anemia, and do not affect pregnancy plans, follow-up at certain intervals is often sufficient. The treatment decision is made together based on how much the symptoms affect daily life, the location and size of the fibroid, the woman's age, and her desire for children.

What Are the Treatment Options?

• Monitoring: Follow-up with regular examinations and ultrasonography if there are no complaints
• Medication treatments: Options primarily aimed at controlling bleeding and symptoms; the medication and duration are determined by the physician
• Hysteroscopic myomectomy: Removal of fibroids extending into the uterine cavity without making an incision, by entering through the cervix
• Laparoscopic or open myomectomy: Removal of fibroids while preserving the uterus; the preferred option for women who wish to have children
• Hysterectomy: Removal of the uterus in selected patients with ongoing symptoms, no desire for children, and when other methods are not suitable

It is important to know that new fibroids can develop after myomectomy and that there is a possibility of recurrence, to maintain realistic expectations.

Do Fibroids Affect Pregnancy?

Most women with fibroids conceive and complete their pregnancies without problems. However, fibroids that significantly distort the uterine cavity can make conception and maintaining pregnancy more difficult. Fibroids may grow during pregnancy and cause pain due to circulatory disturbances inside them; this is usually managed with rest and pain control. The location of the fibroid can also influence the decision regarding the mode of delivery.

Can They Turn into Cancer?

It is very rare for fibroids to transform into malignant tumors. However, masses that grow rapidly, continue to grow after menopause, or have unusual features on imaging are evaluated more carefully. Therefore, it is important to adhere to follow-up intervals.

What Happens During Menopause?

With menopause, hormone levels decrease, so fibroids usually shrink and bleeding symptoms disappear. Any bleeding occurring after menopause should be thoroughly investigated before attributing it to fibroids.

Do Nutrition and Lifestyle Affect Fibroids?

Currently, there is no food, herbal mixture, or diet proven to dissolve fibroids. However, maintaining a healthy weight, a diet rich in vegetables and whole grains, regular physical activity, and properly treating iron deficiency if anemia is present are beneficial for overall health. It is not recommended to turn to "fibroid dissolving" products circulating on the internet, as this may delay diagnosis and follow-up.

What Should Be Considered After Fibroid Surgery?

The recovery time varies depending on whether the surgery was performed laparoscopically or openly, and on the number and location of the removed fibroids. In the early period, avoid heavy lifting, abstain from sexual intercourse for the duration specified by your doctor, and attend the recommended follow-ups. In patients who had deep intervention on the uterine wall, the mode of delivery in a subsequent pregnancy will be planned accordingly; therefore, it is important to keep your surgery report.

When Should You Seek Medical Attention?

• Menstrual bleeding that progressively increases, becomes clotty, or lasts longer than seven days
• Symptoms of anemia such as fatigue, palpitations, or shortness of breath
• Increasing pressure sensation in the groin or abdominal enlargement
• Sudden onset, severe, and persistent abdominal pain
• Any bleeding occurring after menopause

This article is prepared for general informational purposes and does not replace a medical examination. Please be sure to consult a doctor for your complaints.