What are the types and symptoms of uterine fibroids?

  Uterine fibroids are the most common benign tumors in the female genitalia and one of the most common tumors in the human body. Uterine fibroids are mainly formed by the proliferation of smooth muscle cells that constitute the muscle wall of the uterus, so their exact name should be “uterine smooth muscle tumor”, commonly known as uterine fibroids.  According to a large number of autopsy materials, the incidence of uterine fibroids is 20% in women over 30 years of age, and the highest incidence is in women aged 40-50 years, which can be as high as 50–77%.  Uterine fibroids tend to occur in women aged 30-50 and have the potential to shrink after menopause, proving that: the growth of uterine fibroids is related to excessive estrogen stimulation in the body. The size of uterine fibroids varies greatly, with small ones being less than 1 cm in diameter, like the size of a soybean, and large ones reaching tens of kilograms, far exceeding the size of a full-term pregnant belly, and the number of fibroids varying from a single one to hundreds.  Uterine fibroids can be divided into three types: “intermural fibroids”, “submucosal fibroids”, and “subplasma fibroids” according to their growth location in relation to the various layers of the uterine wall. If the fibroids are always located in the myometrium, they are called “interstitial fibroids”; interstitial fibroids often increase the size of the uterus, bend and deform the uterine cavity, increase the endometrial area, and affect the contraction of the uterus due to the presence of interstitial fibroids. Therefore, they often cause excessive menstrual bleeding, prolonged menstruation, frequent menstruation and infertility.  In the process of growth, fibroids tend to develop in the direction of less resistance, and when they protrude into the uterine cavity, their surface is covered only with a layer of endometrium, called “submucosal fibroids”, which are connected to the uterus only by a tip; submucosal fibroids are like “foreign bodies” in the uterine cavity, stimulating the uterus, and promoting its spasm. The submucosal fibroids are like a foreign body in the uterine cavity, stimulating the uterus to contract spasmodically, causing abdominal pain, which is similar to miscarriage: when the submucosal fibroids are being squeezed down, the tissues are gradually elongated. As the submucosal myoma often extends into the vagina, and the blood flow to the tip is poor, it is prone to infection and necrosis. In addition to menstrual changes, which are more severe than interstitial leiomyoma, irregular vaginal bleeding, pus and blood leucorrhea, and odor can occur. Therefore, submucosal leiomyoma is the most serious type of leiomyoma in terms of symptoms.  Or the myoma protrudes toward the surface of the uterine body. It is covered by a layer of peritoneum, which is called “subplasmic fibroid”. When the fibroid continues to grow into the abdominal cavity, it may eventually form a subplasmic fibroid with only a tip attached to the uterus. The blood vessels in the tip are the only source of blood for the fibroids. In case of twisting of the tumor, the tumor may be necrotic and detached from the abdominal cavity and adhere to the adjacent tissues such as the omentum and mesentery. Sometimes, it can be twisted or blocked in the large omentum and leak out, forming ascites. With the popularization of women’s screening and ultrasound, such cases are no longer common.  The clinical symptoms of fibroids depend on the site of growth, size, growth rate, secondary degeneration and comorbidities, etc. Subplasmaline fibroids mostly have abdominal mass as the main symptom, and uterine bleeding and infertility rarely occur. When the fibroid grows to a certain extent, it can produce symptoms of pressure on the adjacent organs. If it presses on the bladder, it may cause frequent urination, urgent urination and difficulty in urination; if it presses on the rectum, it may cause a feeling of anal swelling, difficulty in defecation and thinning of the stool.