5 Fibrous fibroids

She went to 3 doctors for bleeding and anemia… They were going to remove her uterus, but Dr. Arturo Valdés, Creafam fertility expert, explains to us how it is possible to operate on multiple encapsulated and fibrous fibroids, as well as the options to make a diagnosis online.

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Ok, good morning, how are you? Here again talking about the same topic of uterine fibroids, we are somewhat repetitive in the talks or in the sessions, because we have too many cases that are writing to us, they are asking us questions, we are even doing too many consultations via Zoom and Skype and that is interesting to me. sometimes reinforce knowledge, remember #KnowledgeIsSuccess

About the patient

This patient is from Coatzacoalcos, we operated on her just yesterday, she is 36 years old but obviously she has not had babies and she gave us a first consultation via Skype because she had three opinions from doctors from there in Veracruz who had told her that she did not have any. probability of preserving the uterus and that the best option was to do a hysterectomy, this patient had fibroids with large elements, 5 in total, but also her main problem was the uterine bleeding or hemorrhages that she had during her menstrual periods that lasted many days but They were also very abundant and therefore with a pathology of moderate anemia, that is, the bleeding caused fatigue, she felt a little tired, and when doing small exercises such as bathing or dressing, she began to have a little sweating and tachycardia.

So we treated him two or three months ago after his first visit with medication to raise hemoglobin and thus be able to schedule the surgery. This surgery is very interesting because although they are well-defined fibroids, the same uterine size and the same sizes of the fibroids It made these fibroids too fibrous and very attached to the muscles, but because of the large blood vessels that were made around them. We are going to see it in the video, they are very thick blood vessels with a lot of blood perfusion and she also had multiple fibroids on all sides of the uterus, it was on the anterior right lateral side, on the left lateral side also anteriorly slightly attached to the great vessels , in the uterine fundus in the musculature and behind intramural but from there another one came out that was pure subserous and so what we did is start first with the right side, then with the left side, then we went to the fundus and finally we We went to the bilobed that was subserous, but it is a surgery that took us about three hours, he did not have to do a blood transfusion, he only bled 500 milliliters, but it is very important to know that when we have multiple fibroids the surgery is going to be more complicated .

I explained to the patient that, yes, many times one of the best options is to remove the uterus, however, in a patient who does not have reproduction or a satisfied reproductive life, the main thing is to preserve the uterus and, after surgery, assess which It is the prognosis of fertility in itself. So the most important thing is for people to know that myomectomy is the first step and should generally be the only or the main step before thinking about removing the uterus.

Fibroid surgery

Let’s start, the anatomy cannot be shown but he has a fibroid on the anterior intramural right lateral aspect and another fibroid more or less in the lower third of the left lateral aspect that are close to the round ligaments in the great arms and he has two very tumors. large subserosum, we are going to start with this one and little by little we are going to show how the fibroids come out so that you can see them. They are fibroids that are slightly intramural subserosal, but the detail is that they have the muscle, that is, the musculature is too thick. When the muscles are too thick there is another problem of some bleeding, so right now we are going with the digital dissection, the first fibroid has already come out, this one is missing and two others are apparently missing, although… Maybe and there is a fifth one there .

See, this is a completely subserous fibroid, look at the large vessels it has, it is in the right horn posteriorly attached to the ligament, but we need to do an infiltration because the pedicle is too large, so let’s start… Here is the pedicle vascular with the uterus, so here we are going to hit the pedicle directly, directly, directly and we are going to do what we have normally always said, we are going to make a middle incision, remove the capsule and then take it out so that we can split that pedicle into 2.

Perfect, ready, we’re done, I wanted you to see the incision. Obviously it’s a little bigger, it’s about 6 centimeters but I’m going to tell you, she already has a gallbladder incision… Appendix, sorry! It is almost the same size as that of fibroids and see all the languages that we get, there are four fibroids with very large elements and two small ones here.


Another very common question we are asked is: How can I know or what are the symptoms that I have myomatosis? Remember that fibroids generally or almost all start from very small lesions between 3 or 4 millimeters and continue throughout your reproductive life or your menstrual cycles and increase in size, which means that since we begin our menstrual cycles we are already conditioning ourselves. for that fibroid, if there is an injury to the muscle, to begin to grow.

Not all fibroids will cause symptoms that are visible, but it is true that one of the small symptoms is:

  • More abundant bleeding.
  • Intermenstrual pains.
  • Pain with sexual relations.
  • Intermenstrual spotting
  • Distension or bulging

But the most important thing you should know is that when a woman has a sexual life, she should have a gynecological check-up with a specialist every year at least and preferably also have a vaginal ultrasound. Please call us at Creafam, we We can make a virtual appointment for you.

Recommended studies for online diagnostic

It is essential to have a photo or video ultrasound and optionally it is worth having:

  • Hysterosonography.
  • Hysteroscopy.
  • Tomography or CT Scan.
  • Hematic biometry.
  • Blood chemistry.

We are doing a very specific study on many patients who are foreigners that is a little more expensive than a traditional ultrasound, which is called tomography or magnetic resonance imaging, what it does are very small cuts at the pelvic level not only to assess the anatomy of that uterus, the location of the fibroids, the number of fibroids, the size of the fibroids and that we give ourselves a clearer idea… Because the first consultation, being virtual, we cannot do an ultrasound evaluation and with this we can already scheduling the surgery without the need for them to come other than the day they are going to come for the surgery, so remember, at Creafam we are specialists in women’s health, but we are also experts in assisted reproduction and part of the expertise also comes from the timely and adequate management of Patients with uterine fibroids of medium or large elements, call us.

“Yes, many times the best option is to remove the uterus, however, she has not had a reproductive life and the main thing is to preserve the uterus”

Dr. Arturo Valdés
Dr. Arturo Valdés
Reproductive Medicine and Gynecological Endocrinology
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