1.What is uterine fibroids? Uterine fibroids are the most common benign tumors of female reproductive organs, commonly found in women aged 30-50 years old, with a low malignancy rate (about 0.4-0.8%). Uterine fibroids are divided into uterine body fibroids and cervical fibroids according to the location of fibroids, and interstitial fibroids, subplasma fibroids and submucosal fibroids according to the relationship between fibroids and uterine muscle wall. 2.What factors are related to the development of fibroids? Uterine fibroids are estrogen-dependent tumors. It is currently believed that increasing age (premenopause) and ethnic differences are the main risk factors for the development of fibroids, and environmental factors and genetic mutations are also associated with the formation of fibroids. 3.What are the symptoms of uterine fibroids? Most patients are asymptomatic and are only occasionally detected during pelvic examination or ultrasonography. If there are symptoms, they are closely related to the growth site, speed, degeneration and complications of fibroids, but less related to the size and number of fibroids. The common clinical symptoms are: (1) abnormal uterine bleeding: it is the most important symptom of fibroids and occurs in more than half of the patients. The most common symptoms are cyclic bleeding, which can be manifested as increased menstrual flow, prolonged periods or shortened cycles. It may also manifest as irregular vaginal bleeding without menstrual cycle. Uterine bleeding is more common with submucosal and interstitial myomas, while subplasmalemma rarely causes uterine bleeding. (2) Abdominal mass and pressure symptoms: When the fibroid grows gradually and enlarges beyond the size of a 3-month gestation uterus or is a large subplasma fibroid located at the base of the uterus, a mass can often be found in the abdomen, which is more obvious in the early morning when the bladder is full. The mass is solid, movable and painless. When the fibroid grows to a certain size, it can cause symptoms of pressure on the surrounding organs. Anterior wall fibroids close to the bladder can cause frequent and urgent urination; huge cervical fibroids compressing the bladder can cause dyspareunia or even urinary retention; posterior wall fibroids, especially those in the isthmus or posterior lip of the cervix, can compress the rectum, causing dyspareunia and discomfort after defecation; huge broad ligament fibroids can compress the ureter and even cause hydronephrosis. (3) Pain: Usually fibroids do not cause pain, but many patients may complain of lower abdominal cramping and lower back pain. Acute abdominal pain can occur when subplasma fibroids are twisted or when red degeneration of fibroids occurs, and it is not uncommon for fibroids to be combined with endometriosis or adenomyosis, which can cause dysmenorrhea. (4) Anemia: Due to prolonged heavy menstruation or irregular vaginal bleeding can cause blood loss anemia, more severe anemia is seen in patients with submucosal fibroids …… (5) Infertility and miscarriage: Some patients with uterine fibroids are infertile or prone to miscarriage, the effect on conception and pregnancy outcome may be related to the growth site, size and number of fibroids. Large fibroids can cause deformation of the uterine cavity, preventing the implantation of the gestational sac and the growth of the embryo; compression of the fallopian tubes by fibroids can lead to dysfunctional lumen; submucosal fibroids can prevent the implantation of the gestational sac or affect the entry of sperm into the uterine cavity. The rate of spontaneous abortion is higher in patients with leiomyoma than in the normal population, with a ratio of about 4:1. 4. Under what circumstances is treatment necessary? If there are no obvious symptoms or signs of malignant change, regular follow-up can be done. If the following conditions occur, further consultation or even surgery may be required: excessive menstruation leading to secondary anemia, drug treatment is ineffective; severe abdominal pain, painful intercourse, chronic abdominal pain, acute abdominal pain with twisted myoma; symptoms of bladder and rectal compression; it can be determined that myoma is the only cause of infertility or recurrent miscarriage; myoma is growing fast and malignancy is suspected. 5.What are the treatment methods for fibroids? For female patients who are older (especially after menopause) and have difficulty in preserving the uterus, hysterectomy can be considered to completely eradicate fibroids. For patients who want to preserve the uterus, we can consider drug treatment and surgical treatment to preserve the uterus, such as radiofrequency ablation, focused ultrasound, uterine artery embolization, myomectomy (open/laparoscopic), hysteroscopic submucosal myomectomy, etc. 6.What is the relationship between fibroids and pregnancy? Generally, it takes about 2 years for contraception to heal the fibers of the uterus before pregnancy, and there is a possibility of uterine rupture during pregnancy and delivery, while subplasma and submucosal fibroids have little effect on pregnancy after treatment. However, submucosal myomas and interstitial myomas that protrude into the uterine cavity can cause infertility and early abortion. During pregnancy and puerperium, due to the high estrogen level, myomas are prone to red degeneration and rapid enlargement, causing severe abdominal pain, fever and elevated white blood cell count, which can usually be relieved by conservative treatment. If the fibroids obstruct the fetal descent during labor and cause obstructed labor, a cesarean section should be performed in a timely manner. The decision of whether to remove the fibroids at the same time during surgery should be based on the size, location and condition of the fibroids, and improper treatment may lead to postpartum hemorrhage.