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.