Urology treats urinary tract diseases in all genders and male reproductive issues, covering the kidneys, bladder, prostate, urethra, from infections to complex cancers.
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To understand uterine fibroids, it helps to first look at the basic structure and function of the uterus. The uterus is a hormone-sensitive, pear-shaped organ in the female pelvis, sitting between the bladder in front and the rectum behind. Ligaments such as the broad, round, uterosacral, and cardinal ligaments support it. The uterus has three main layers, each with a specific role in reproductive health.
A Uterine Fibroid, clinically termed a Leiomyoma or Myoma, arises exclusively from the myometrium. It is defined as a monoclonal, benign (non-cancerous) mesenchymal tumor. The term “monoclonal” is crucial; it means that each fibroid originates from the uncontrolled division of a single mutated smooth muscle stem cell. As this progenitor cell divides, it creates a clone of identical cells that form a distinct mass. Unlike malignant tumors, which invade surrounding tissues and metastasize to distant organs, fibroids are typically cohesive, well-circumscribed, and encapsulated. They are surrounded by a pseudocapsule—a thin layer of compressed muscle fibers and areolar tissue. This anatomical feature is of immense surgical importance, as it provides a natural plane of cleavage that facilitates the “shelling out” (enucleation) of the tumor during myomectomy, minimizing damage to the adjacent healthy myometrium and reducing blood loss.
Histological Characteristics Under microscopic examination, fibroids are characterized by whorled, anastomosing fascicles of uniform, spindle-shaped smooth muscle cells. However, what distinguishes them from normal muscle is the excessive deposition of Extracellular Matrix (ECM). Fibroid cells secrete abnormal amounts of disordered collagen (types I and III), proteoglycans, and fibronectin. This dense fibrous composition confers upon them their characteristic firm, rubbery, or hard texture, which is easily palpable and distinguishable from the softer surrounding myometrium during a pelvic exam or surgery.
The etiology of uterine fibroids is not a simple cause-and-effect scenario but rather a multifactorial interplay between genetic susceptibility, hormonal environment, and epigenetic factors. Recent genomic studies have revolutionized our understanding of why these tumors form.
The effect a fibroid has—such as causing bleeding, pain, or infertility—depends more on where it is in the uterus than on its size. To help with diagnosis and treatment, the International Federation of Gynecology and Obstetrics (FIGO) created a system that classifies fibroids into eight types as part of the PALM-COEIN system for abnormal uterine bleeding.
Submucosal Fibroids (Types 0, 1, 2): These tumors originate from the inner myometrium and project into the uterine cavity. They are the most symptomatic, causing severe menorrhagia and infertility even when tiny (1-2 cm) due to their disruption of the endometrial lining.
Intramural Fibroids (Types 3, 4): These develop within the muscular wall of the uterus. They are the most common type.
Subserosal Fibroids (Types 5, 6, 7): These tumors originate from the outer myometrial layer and project outward into the pelvic cavity.
Other (Type 8): This category includes fibroids in atypical locations, such as cervical fibroids (arising from the cervix) or parasitic fibroids (which have detached from the uterus and acquired a blood supply from adjacent organs, such as the omentum or bowel).
Types of Degeneration
As fibroids enlarge, they often outgrow their blood supply, leading to various forms of degeneration that change the tumor’s consistency, appearance on imaging, and clinical presentation.
Uterine fibroids are very common, which makes them an important public health concern.
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While both are intrauterine growths, they are histologically distinct. Fibroids (leiomyomas) arise from the smooth muscle of the uterine wall and are generally dense, fibrous, and complex. Polyps arise from the overgrown endometrial lining (glandular tissue), are soft, fleshy, and vascular. Polyps are more likely to cause intermenstrual spotting, while fibroids typically cause heavy menstrual bleeding and bulk symptoms.
The risk of a benign fibroid transforming into a malignant leiomyosarcoma is exceptionally low, estimated at less than 1 in 1000 cases (0.1%). Most medical consensus holds that leiomyosarcomas arise de novo from a distinct cell lineage, rather than from pre-existing benign fibroids. However, rapid growth in a postmenopausal woman is a “red flag” that warrants prompt investigation
The exact etiology is unknown, but it is likely multifactorial. Research points to genetic variations (polymorphisms in hormone receptors and the COMT gene), higher average circulating estrogen levels, potential dietary factors (lower dairy intake, Vitamin D deficiency), and higher exposure to environmental endocrine disruptors (phthalates) as contributing factors to the earlier onset and greater severity.
In the vast majority of cases, the cessation of ovarian estrogen and progesterone production during menopause leads to the atrophy and shrinkage of fibroids. However, they do not disappear completely; they remain as small calcified scars. Women taking Hormone Replacement Therapy (HRT) may experience persistent growth or symptoms due to the exogenous hormones.
Immunosuppressive Therapy is not a quick fix. It typically takes 3 to 6 months to see a meaningful improvement in blood counts. Patience is key. During this time, the patient remains dependent on transfusions and careful infection prevention.
Robotic hysterectomy is a new way to treat gynecological issues. A big worry for patients is how long it takes to get better. Studies show
Did you know that nearly 600,000 women in the United States undergo hysterectomy every year? This surgery removes the uterus and is a common treatment
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