Q: What is the most common tumor among women?
A: The most common tumor among women is uterine fibroids. In the past, the incidence of uterine fibroids was described in obstetrics and gynecology textbooks as over 20%, but in fact, it is higher. Don’t worry, uterine fibroids are benign tumors and are generally not life-threatening.
Q: Can fibroids become malignant?
A: The risk of fibroids becoming malignant is very small, less than 1%, and more than 99% will not become malignant. Previous medical literature reports that the malignancy rate of fibroids is 0.4%~0.8%, which means that out of every 1000 cases of fibroids, about 4~8 cases will be malignant, and the probability of malignancy is very low. Although, there is no need to worry too much, you have to care about your body and pay attention to medical checkups.
Q: What are the effects of having fibroids on the body? What are the dangers?
A: The very majority of fibroids have no obvious effect on the body and are detected during health check-ups. In a few cases, there may be excessive menstruation, prolonged menstruation or abnormal uterine bleeding, which may cause anemia in serious cases; the large fibroids pressing the bladder in front or the rectum in the back may cause abnormal urination or stool; fibroids changing the shape of the uterine cavity may cause infertility or spontaneous abortion and affect fertility; of course, very few fast-growing ones may become malignant.
Q: Can fibroids be prevented?
A: Because the cause of fibroids is not clearly understood, there are no effective preventive measures.
Q: What should I do if I have fibroids?
A: For most patients with fibroids who have no obvious abnormal symptoms, there is usually no need for any treatment, as long as they visit their gynecologist regularly and have a gynecological examination to understand the size of the uterus. Ultrasound can measure the size of the uterus and fibroids more objectively and compare it with the previous examination results. For a more objective comparison, it is best to choose to see your gynecologist within 3 to 7 days of your menstrual period each time. In addition, make sure to check the blood count to see if there is any anemia? Is it iron deficiency anemia caused by excessive menstruation? The interval between visits to the doctor is 3~6 months, which means every 3~6 months, see your gynecologist.
However, a few fibroids may require surgical treatment: for example, anemia caused by excessive menstruation, prolonged menstruation or abnormal uterine bleeding; abnormal urination or stool due to large fibroid pressure; fibroids that cause infertility or spontaneous abortion and affect fertility; fibroids that grow rapidly and have the potential for malignancy; fibroids in the cervix that increase in size and cause difficulty in surgery and increased intraoperative bleeding; and an oversized uterus, such as beyond 10 weeks of gestation. If the fibroids continue to grow, it will increase the difficulty of surgery and intraoperative bleeding.
Q: Is it possible to choose medication for fibroids without surgery?
A: There is no medication that can cure fibroids. Some medications can temporarily shrink fibroids and reduce bleeding, but after stopping medication, fibroids will increase again and bleeding will increase. Of course, for some huge fibroids that need surgery or combined with anemia that cannot be operated temporarily, temporary medication can be administered to shrink the fibroids to facilitate surgery and reduce or temporarily stop menstruation, which helps to correct anemia and create the necessary conditions for successful surgery.
Some patients with uterine fibroids who have excessive menstruation and tendency to anemia or mild anemia can apply hemostatic drugs such as tranexamic acid orally for about 3 days during menstruation to reduce menstrual flow and decrease the chance of surgery. Androgens can also be taken under the guidance of the doctor, which not only help to reduce the menstrual flow but also help to correct the anemia.
Q: I heard that there are surgical procedures that preserve the uterus and those that don’t. How can I choose the correct surgical procedure?
A: Uterus-preserving surgery refers to myomectomy, or myomectomy, which is mainly suitable for patients whose fibroids have affected their reproductive function, caused infertility or spontaneous abortion, and who wish to have children and, at the same time, can bear the recurrence of fibroids. If you get pregnant after myomectomy, you should beware of uterine rupture during pregnancy or delivery, which may endanger the life of mother and child. Do not go for myomectomy without abnormalities or without problems that need to be solved by surgery. After surgery to preserve the uterus, about 50% or more will recur, and 1/3 or more will need to be treated with surgery again.
If you want to eradicate fibroids and have no requirement for childbirth, you can choose hysterectomy, and you should usually have a total hysterectomy. Cervical fibroids, or other cervical lesions may occur after subtotal hysterectomy with preservation of the hysterus.
Q: After total hysterectomy, will it affect the reproductive function?
A: Theoretically, the uterus changes during intercourse and should be involved in intercourse. Removal of a lesion-free uterus will definitely affect the quality of sexual life. However, because there are lesions in the uterus, these lesions will more or less affect normal sexual intercourse, such as bleeding, fatigue, pain, etc. This means that the quality of sex life of the patient is not ideal before the surgery. One study found that after hysterectomy for uterine fibroids, there was a significant increase in sexual desire, an increase in the number of sexual intercourse, and a decrease in discomfort during intercourse. This suggests that removal of the diseased uterus can improve sexual life.
Q: Does subtotal hysterectomy with preservation of the cervix have less impact on sexual function?
A: No. The main part of sexual intercourse is in the vagina, and neither total hysterectomy, nor subtotal hysterectomy affects the vagina. It has been found that the length of the vagina after total hysterectomy is slightly longer than after subtotal hysterectomy, but the difference is not significant; there is no difference in sexual desire and pleasure of intercourse. Perhaps, psychologically, the patient feels that preserving the cervix of the uterus implies that she will be more satisfied with her sexual life.
Q: If surgery is needed for fertility because of the presence of fibroids that affect pregnancy or cause spontaneous abortion, what is the surgical route to choose?
A: The surgical routes for myoma removal are: hysteroscopic surgery, laparoscopic surgery and traditional open surgery. Depending on your condition, choose the appropriate surgical route for you.
In general, submucosal fibroids and interstitial fibroids protruding into the uterine cavity tend to affect fertility, therefore, hysteroscopic surgery can be chosen to remove submucosal fibroids and interstitial fibroids protruding into the uterine cavity, and multiple surgeries can be performed if one cut is not clean. This is the most minimally invasive myomectomy available, with little damage to the patient, quick recovery, and relatively less likely to result in uterine rupture in subsequent pregnancies.
A small number of multiple fibroids can also affect fertility and can be removed by laparoscopic surgery or traditional open surgery. Laparoscopic surgery has a smaller abdominal incision, which is an advantage, but suturing the incision on the uterus is still easy and reliable with open surgery. That said, the risk of uterine rupture may be less in those who are pregnant after open surgery than in those who undergo laparoscopic surgery.
Q: If the condition necessitates hysterectomy, how do I choose the surgical route?
A: The surgical routes of hysterectomy are: transvaginal hysterectomy, laparoscopic hysterectomy and open hysterectomy. From the modern minimally invasive concept, transvaginal hysterectomy is the least invasive hysterectomy for patients and is economical. It should be the preferred route of hysterectomy. If, because of the limitations of the surgeon’s skill or condition, transvaginal hysterectomy is difficult to perform, laparoscopic hysterectomy can also be chosen, but the cost will increase. Of course, if due to technical and equipment limitations, then open hysterectomy is an option.