A uterine cyst or fibroid, also called a uterine fibroid or fibroid, is an abnormal growth of cells in the muscle tissue of the uterus (myometrium). It is considered a benign, non-cancerous tumor. It affects between 20 and 40% of women of reproductive age (from puberty to menopause).
General symptoms and characteristics
Uterine fibroids or cysts can appear at different levels of the myometrium. Based on this, they can be classified into submucous (inside the myometrium, towards the endometrium), intramural (in the myometrium) and subserous (on the outside of the myometrium outside the uterus, with or without a peduncle) fibroids. .
They are usually asymptomatic but can cause pelvic pain, fertility problems, or menstrual bleeding that is heavy (hypermenorrhea) or that lasts longer than usual. Because of these general symptoms, many uterine fibroids go undetected until an ultrasound or pelvic exam is done for another reason or during routine exams.
Submucous fibroids are the ones that most often cause heavy bleeding during menstruation or between periods and can cause problems if the patient is trying to conceive. Subserous fibroids, which grow outside the uterus, can put pressure on the bladder or rectum and cause incontinence or constipation, depending on the case. Subserous uterine cysts can also cause lower back pain if they grow in the back of the uterus and put pressure on nerve endings in the spinal cord.
If the fibroid is large, you may notice symptoms of the size of the fibroid, such as discomfort and swelling in the belly area.
The specific causes that cause uterine cysts to develop are not known, the most important factors being genetic abnormalities, hormonal fluctuations, and family history (genetic predisposition).
The diagnosis of fibroids can be done by manual examination by the gynecologist, although the most accurate methods use imaging diagnosis.
o Abdominal or vaginal ultrasound This is the method for diagnosing fibroids that has the best cost-effectiveness ratio. Modern ultrasound techniques allow detecting small fibroids from 5 mm. Other diagnostic imaging techniques used are CT (Computed Axial Tomography) or NMR (Nuclear Magnetic Resonance). The latter are much more expensive and, in the case of uterine fibroids, do not offer significant advantages over ultrasound, with rare exceptions.
Hysteroscopy is also frequently diagnosed, which consists of introducing a device through the vagina that allows direct visualization. It can reach the cervix and the beginning of the fallopian tubes, which is especially helpful in determining if a fibroid is causing difficulties getting pregnant.
Most uterine fibroids do not require treatment. Patients in whom symptoms do not improve may receive treatment to promote fibroid shrinkage as well as to relieve symptoms.
Because it relieves symptoms, it is a first choice for NSAIDs (non-steroidal anti-inflammatory drugs) and hormonal treatments, such as hormonal contraceptives, which help control menstruation-related symptoms. None of these treatments decrease the size of the fibroid. The drugs that have shown the best results in reducing fibroids are androgen agonists, such as Pituitary Gonadotropin Releasing Hormone (GnRH) Analogs, although their side effects greatly limit their use1.
In severe cases or cases that do not respond to pharmacological treatment, the best treatment is surgical removal. Surgery is often the treatment of choice because it is the most effective and because there are minimally invasive techniques. Instruments inserted through the vagina with a camera on the tip can be used; the fibroid is localized and frozen with liquid nitrogen, destroyed by an electrical current, or blood flow to the fibroid is inhibited, forcing the fibroid to shrink (embolization). Not in all cases these non-invasive surgical techniques can be used.
The last resort, used in much more severe cases and which represents the permanent and definitive solution, is a hysterectomy, an operation in which the entire uterus is removed.
when to go to the doctor
Any woman who notices abnormal heavy bleeding, bleeding for more than seven days, or other menstrual problems should see her doctor or gynecologist so they can study the case and determine if there are uterine fibroids or cysts. Cases in which pelvic pain, bladder problems or bowel problems occur without an apparent cause to explain them should also be evaluated.