What is a uterine fibroid?
A uterine fibroid (or myoma) is a benign tumour that develops in or around the uterus from the smooth muscle cells of the uterine wall. It is the most common benign gynaecological condition: it is estimated that 20 to 40% of women of reproductive age are affected.
Fibroids vary considerably in size (from a few millimetres to several centimetres), number (single or multiple), and location:
- Intramural fibroids: the most common, situated within the thickness of the uterine wall
- Submucosal fibroids: growing towards the uterine cavity, the most likely to cause bleeding and fertility problems
- Subserosal fibroids: growing towards the outside of the uterus
Important: a fibroid is always benign. Malignant transformation (sarcoma) is exceptional and must not be confused with a progressive fibroid.
Recognising the symptoms
Around half of all fibroids remain asymptomatic. When they do cause symptoms, the most common are:
- Heavy and prolonged periods (menorrhagia) which can lead to anaemia
- Chronic pelvic pain or intense menstrual cramps
- Sensation of pressure or heaviness in the lower abdomen
- Frequent urges to urinate or difficulty urinating if the fibroid compresses the bladder
- Constipation in cases of rectal compression
- A rounded abdomen when fibroids are large
- Difficulties conceiving or recurrent miscarriages
Diagnosis in Marseille
Dr. Yasmine Maazouzi carries out a full assessment to precisely map your fibroids:
Clinical examination and medical history
The interview covers the nature and intensity of your symptoms, their impact on your daily life, your gynaecological history, and any plans for pregnancy.
Pelvic ultrasound scan
Abdominal and endovaginal ultrasound is the first-line investigation. It allows fibroids to be located, their size assessed, and their relationship to the uterine cavity evaluated.
Pelvic MRI
MRI is indicated in cases of multiple fibroids, diagnostic uncertainty, or to plan complex surgery. It provides a precise map of all fibroids and their vascularisation.
Diagnostic hysteroscopy
If a submucosal fibroid is suspected, a diagnostic hysteroscopy (examination of the uterine cavity using a small camera) may be performed.
Treatments available in Marseille
Management is always personalised according to the nature and intensity of symptoms, the size and location of the fibroids, your age, and your pregnancy plans.
Watchful waiting
A small, asymptomatic fibroid with no impact on fertility may simply be monitored. Regular gynaecological follow-up (1 to 2 times per year) with ultrasound is sufficient in this case.
Medical treatment
Medical treatment does not eliminate fibroids, but it can reduce symptoms:
- Progestins or hormonal contraception to reduce bleeding
- Levonorgestrel intrauterine device (hormonal IUD), highly effective for menorrhagia
- GnRH analogues to temporarily reduce the size of fibroids before surgery
Operative hysteroscopy
Operative hysteroscopy is the treatment of choice for submucosal fibroids. It involves removing the fibroid via the natural route (without any incision) using a resectoscope introduced into the uterus. The procedure is performed as a day case, with no scar and very rapid recovery.
Myomectomy
Myomectomy is the surgical removal of the fibroid(s) whilst preserving the uterus. It is indicated for patients wishing to preserve their fertility. It can be performed by:
- Laparoscopy (minimally invasive, 3 to 4 small abdominal incisions)
- vNOTES — natural vaginal route, with no abdominal incision, offered by Dr. Maazouzi
- Laparotomy (abdominal opening) for very large or multiple fibroids
Radiofrequency treatment (Acessa®)
This minimally invasive technique destroys fibroids using heat delivered by a radiofrequency probe guided by ultrasound, without removing tissue. It is indicated for patients wishing to preserve their uterus whilst avoiding resection surgery.
Hysterectomy
Hysterectomy (removal of the uterus) is reserved for cases involving multiple large fibroids, severe symptoms resistant to other treatments, and no desire for pregnancy. It can be performed by vNOTES or laparoscopy, without an abdominal scar.
Uterine fibroids and pregnancy: what you need to know
The majority of women with fibroids go through a normal pregnancy. However, depending on their location and size, fibroids may:
- Reduce the chances of conception (particularly submucosal fibroids)
- Increase the risk of early miscarriage
- Require closer monitoring during pregnancy
For patients with plans for motherhood, Dr. Maazouzi assesses the benefit-to-risk ratio of surgical intervention prior to pregnancy, taking into account the precise location of the fibroids.
When to seek a consultation?
Seek a consultation promptly if you experience:
- Very heavy periods (changing protection every 1 to 2 hours, passing clots)
- Chronic pelvic pain or increasingly painful periods
- Unusual fatigue (which may indicate anaemia related to bleeding)
- Difficulties conceiving for more than one year
- A sensation of mass or pressure in the lower abdomen
Consult Dr. Yasmine Maazouzi at the Hôpital Privé Beauregard (23 Rue des Linots, Bât. B5 ICOGM, Marseille 13004) for a full assessment and tailored management of your fibroids.