Uterine fibroids [Explained with fruits]

Dr. Arturo Valdés, Creafam fertility expert, explains to us how the size and location of fibroids affects the uterus and the chances of achieving a pregnancy, using fruits to exemplify small, medium, large and giant fibroids.

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Good afternoon, we are going to talk about myomatosis, remember #KnowledgeIsSuccess on this occasion we are going to outline the sizes of fruits from small to large elements and with two full-scale models that this is what the uterus measures between 7 to 9 centimeters.

Fibroids and their location

Sometimes it confuses patients when the doctor gives them the diagnosis of a fibroid with medium elements or large elements and the location mainly, as we have always said: Size matters and the location also matters a lot, so, we wanted to show them to you. In a more didactic and practical way, first what the uterus is and then the size of each representative fibroid in a fruit so that we understand it.

You have to see that a uterus mainly measures approximately 7 to 9 centimeters from where the cervix begins to where the uterine fund ends. I wanted to give you two diagrams because this is very nice to anatomically see how we have above the uterus or in front, the bladder and the pubis, below this is the bladder, the vagina and then what comes in the sigmoid rectum, then, it is good Anatomy is important because sometimes we mention to them “you have a fibroid on the anterior side” that is, near the front in the bladder or in the uterine fundus, on the posterior side since it would obviously be in the back part of the uterus that sometimes impacts the rectum sigmoid or on the posterior surface near the cervix or even, in many cases. I’m going to remove this plate. Look, we have had fibroids on many occasions that are pedunculated, so there is significant bleeding because this biome is in the vagina and produces towards the vagina and the vehicle is generally in the cervical canal. These fibroids are sometimes difficult to dissect or perform surgery, but ultimately the The approach is vaginal instead of upper abdominal and the fibroids that are inside the uterine cavity, remember, this is the muscle, those that are on the outside are called subserosal, those that are in the muscle are called intramural and those that are in the cavity are called submucosal.

So why is it important to know? This representation is very good because you see the size of a uterus is approximately the size of a peach, so when they tell us that we have a myoma of small elements they will be similar to a walnut or similar to a grape or similar to the best is a prune. But what is important? That it is not the same to have this little nut within the submucosal period or the submucosal anatomy because although it is here it will have an impact both for reproduction and size for fertility, just as if we have this small grape inside that cavity uterine.

If these fibroids are intramural, they can be monitored or observed to see if this intramural is going towards the cavity or going out, over time or with controls every six months or every year depending on the age of the woman and of the desire for fertility, this type of fibroids with small elements can be visualized. But what happens when I have a medium-sized fibroid or many medium-sized fibroids? If I only have this fibroid medium elements that is an intramural lemon or in the subserous uterine fundus we can also monitor it and especially in young women or in women who have already had pregnancies and do not want reproduction, however, if this fibroid is close to the uterine cavity or in the uterine cavity it is important to remove it.

Size: Small, medium, large and giant elements

Likewise, a fibroid with medium elements but that is already the size of this peach, which is between 5 to 6 centimeters, generally requires surgery because, as I tell patients, if the doctor tells me I have an intramural medium-element fibroid and I have 28 years old, perhaps the ideal is to have surgery at 28 years old rather than wait until we are 35-40, as this fibroid will surely become the size of a grapefruit over time and then it is no longer the same to operate on a fibroid. of medium-sized single elements, when it can be a very small surgery or even a laparoscopic approach, since I already have large fibroids.

Look, I wanted to make a representation of fibroids with large elements. A fibroid with large elements can range from an orange to a watermelon and this watermelon is small, this watermelon weighs 3 kilos, we have removed fibroids of 4 kilos or 6 kilos, so it is not the same to operate on a fibroid that is like an orange although Whether intramural or even if it is subserous, only to operate on a fibroid that is the size of a melon, just look at the representation, the uterus already looks small compared to that fibroids, so, starting from an orange we should not let it be postponed because there are patients who sometimes come to us for a second or third opinion but who have already spent seven years since the first diagnosis of a medium-sized fibroid and who now already have an orange or a grapefruit inside that uterus.

Getting pregnant with fibroids

On many occasions they tell us, well, can I get pregnant with that fibroid or is it necessary to remove it? It depends on the location, even if it is a fibroid with small elements, if I have it here inside the cavity called submucosal or here in the cervix or here in the vagina, the normal or ideal thing is to remove it either vaginally through a hysteroscopy or If it is intramural, if it is very close to the cavity it is necessary to resect it.

Fibroids and their symptoms

Look at the difference between a fibroid with small elements versus one with large elements, the comparison is ridiculous. This measures more or less 50 times larger than this fibroid and it is not the same to have it here, to have it here or to have it here, we have had fibroids on the posterior surface of large elements and the main symptom of that is constipation and the patient struggles to evacuate and also have pain during sexual relations or when we have it above the uterus that puts pressure on the bladder, in many cases in the tomography a little bit of water is already observed in the kidneys, which is called hydronephrosis, due to the pure reflux of Those ureters, those ducts that reach the kidney bladder, become a little blocked and then that urine returns through the ureter to the kidney and then hydronephrosis begins.

The size does matter and the location is also very important, so the idea of schematizing this is that the size does matter even if it is for small elements, we have to see the location of where that myoma of small elements is, but if it is for large elements Definitely don’t let time pass, come to Creafam and we will give you a solution and if it is medium-sized elements that would be from the size of a lemon, to the size more or less of a peach, we can visualize or observe them depending on the location, the number of fibroids and the age of the woman, whether or not she needs fertility or whether or not she wants fertility at this moment or in the future, because if it is in the future we can monitor them but if they go to the experts, with people or with doctors who know about fertility and obviously that they know about uterine fibroids.

“When they are small we can monitor them, but if they are already medium-sized it is better to operate on them because they will continue to grow. And if you want a soon pregnancy it is also better to operate”

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