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  • On 21/08/2020


Definition and particularities

A benign tumor that grows at the expense of muscle fibers in the uterus.

Fibroids are the most common benign tumors in women; their frequency in Europe is around 20% of women from 30 years old and 40% of women at 50 years old. This frequency increases in black women.

They grow under the influence of several factors and in particular, estrogen and growth hormone.

It is a solid, very firm tumor of variable volume (from a few mm to several tens of cm) and a weight ranging from a few grams to more than 1000 grams.

The uterus may be the seat of a single fibroid, but in truth, in 2/3 of cases, the fibroids are multiple (from a few fibroid nuclei to several dozen in the same woman,)

Their limits are rounded, regular but without real capsule and when cut, they take on the appearance of a fasciculated structure of pinkish beige color.

The blood network vascularizing the fibroid is found in the plane of cleavage of the spant of the contiguous myometrium, with sometimes a few rare vessels which penetrate within its leiomyomatous structure.

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See the macroscopic appearance of a fibroid from the outside then the appearance of its contents


Uterine myoma



The location of the fibroid can be:

in the uterus:

The locations of fibroids in the uterus are very variable, they can be classified into locations:

on the uterine body: in this case the fibroid can be:

interstitial (or intramural) when it is localized in the muscular wall of the uterus,, (ultrasound image, Polymyomatous uterus with two subserous myomas and one submucosal myoma; MRI,,; myomectomy by laparotomy);

submucosa Polymyomatous uterus with two subserous myomas and one submucosal (endocavitary) myoma when it develops in the uterine cavity and the endometrium covers the protruding part in this cavity, (ultrasound image,, hysterosalpingography and by MRI,) ;

We can distinguish three types of submucosal fibroids:

pedunculated submucosal fibroma (type I Pedicled fibroma of the uterine fundus, 14 x 12.3 x 7 mm in diameter; case 2 in a partitioned uterus Pedicled fibroma of the uterine fundus, 14 x 12.3 x 7 mm in diameter) when the fibroma is connected to the wall of the uterine cavity by a pedicle, and therefore it grows in its entirety in the uterine cavity;

In some cases, the pedicle is long enough so that the fibroid, under the effect of uterine contractions dilates the cervical canal and appears at the level of the external opening of the uterine cervix or in the vagina, it is the fibroid delivered by the collar . This type of fibroid is exposed to infection and necrosis (or sphacele = mortification or gangrene).

sessile submucosal fibroma Polymyomatous uterus with two subserous myomas and one submucosal myoma: for surgical therapeutic choices, these fibromas are divided into:

submucosal fibroma with large intracavitary diameter (type II or submucosal at an acute angle): in this type of fibroma, less than half of the fibroma is interstitial, i.e. it is located in the muscular wall of the uterus Uterus polymyomatous with two subserous myomas and one submucosal myoma; Polymyomatous uterus with two subserous myomas and one submucosal myoma;

Large-diameter intramural submucosal fibroma (type III or obtuse-angled submucosal) where the majority of the fibroid is intramural and there is only a small portion that develops in the uterine cavity Polymyomatous uterus with two sub-myomas serous and submucosal myoma.

sub serous when it develops on the outer surface of the uterus; in this case the fibroid can be:

either sub serous sessile Sub serous myomas (pedicled and sessile) when it is attached to the uterus by a large implantation base

either under pedicled serosa Myomas under serosa (pedicled and sessile), Myoma under pedicled serosa when it is attached to the uterus by a more or less long pedicle.

on the uterine isthmus (isthmic): the fibroid can develop in the uterine wall but in some its development is done in the parameter causing phenomena of ureteral compression

on the cervix (cervical) when it develops at the level of the cervix:

Cervical fibroma can develop either in the lumen of the cervical canal as a sessile or pedicled fibroma (plypoid), or it develops in the wall of the cervix (cervical intramural fibroma) Intramural or pedicled cervical fibroma (ikkustration), Ultrasound: cervico-isthmic fibroma, Ultrasound; giant intracervical fibroma previa, Intramural cervical fibroma developing in the supravaginal and intravaginal portion of the anterior wall of the cervix;

It often develops in the supravaginal portion of the cervix and rarely in its intra-vaginal portion, then sometimes it develops in both parts of the uterine cervix (the supravaginal and intravaginal portion Intramural cervical fibroma developing in the supravaginal and intravaginal portion of the anterior wall of the cervix, Ultrasound appearance of anterior intramural cervical fibroma, Ultrasound; giant intracervical fibroma previa); in some cases, it can be very large Intramural cervical fibroma developing in the supravaginal and intravaginal portion of the anterior wall of the uterine cervix, Intramural cervical fibroma developing in the supravaginal and intravaginal portion of the anterior wall of the uterine cervix, causing compression phenomena (example: urinary retention).

Intraligamentary when the fibroid is located on a ligament supporting the uterus such as the round ligament, for example.

Fibroids of the ovary (Fibroma of the ovary: MRI, Fibroma of the ovary: laparoscopic aspect, Fibroma of the ovary: macroscopic aspect): rare locations compared to locations in the uterus; they often the main and causative element of Demons-Meigs syndrome, a triad associating: ovarian fibroma (more rarely, certain types of solid ovarian tumors) + ascites + pleural effusion.

Evolution of fibroids:

Volume changes:

Fibroids can remain stable in volume, but the tendency to increase in size is the most common event.

The increase in volume of fibroids occurs either vertically, that is to say towards the abdominal cavity, or horizontally and from a certain volume it can be the cause of compression phenomena in neighboring organs (bladder , rectum ureters, pelvic vessels ...).


Fibroids are tumors liable to be the scene of disturbances in the vascularization; acute or chronic vascular insufficiency explains certain structural transformations such as:

edema; hyalinization; thrombosis;

calcification (ultrasound appearance; Calcified intramural sosu mucous myoma; Calcified intramural sosu mucous myoma and radiological appearance);

adipose involution or fibroma takes on the appearance of a lipoma;

aseptic necrobiosis: it is a fibroid infarction, it is frequently seen during pregnancy and in the immediate postpartum period (after childbirth).

The aseptic necrobiosis of the fibroid can result several years later by its involution and the significant reduction in its volume.

cavitation (pseudocystic transformation) as a result of necrobiosis where part of the fibroid liquefies, resulting in irregular cavity formations, with cloudy contents devoid of coating, hollowed out in full myomatous tissue;

Cystic degeneration of fibroids without necrobiosis

the twisting of pedunculated subserous fibroids which leads to necrobiosis of the fibroid and the rupture of its superficial venous pedicles with the risk of intraperitoneal hemorrhage.

delivery through the cervix long-pedicle submucosal fibroids with infection and necrosis (sphacele) that are often associated with this event.

Clinical manifestations:

Uterine fibroids can remain asymptomatic Polymyomatous uterus with two subserous myomas and one submucosal myoma but can also be the cause of one or more symptoms such as:


pelvic pain: these are chronic pain but in some cases they are acute pain (in the event of twisting of a pedicled sub-serous fibroma, or acute aseptic necrobiosis, etc.);

menorrhagia Polymyomatous uterus with two subserous myomas and one submucosal myoma, Polymyomatous uterus with two subserous myomas and one submucosal myoma;


symptoms and signs of compression of nearby organs such as the bladder, ureter and rectum;

fibroids could be responsible for 2 to 10% of sterility problems, either because they compress the tubes or because they prevent the implantation of the embryo;

during pregnancy, they can cause repeated abortions and in some special cases disturbances in the course of labor, childbirth and delivery of the placenta; then the particular case of fibroma previa (preceding the fetal presentation) where delivery by natural route is impossible, therefore the cesarean section is essential but the intervention is often delicate and requires a great surgical experience.

Diagnostic :

The diagnosis of uterine fibroids and their locations can be made:

By clinical (physical) examination;

By abdominal and endovaginal ultrasound and;

By radiology:

a simple x-ray of the pelvis, may draw attention to the presence of calcified myoma;

hysterosalpingography: it is especially useful for the diagnosis of submucosal fibroids (endocavitary);

the scanner ;

Magnetic resonance imaging (MRI) Sub-serous myomas (pedicled and sessile) is one of the best means of diagnosing uterine myomas and their locations.

Diagnostic hysteroscopy Pedicled fibroma of the uterine fundus, 14 x 12.3 x 7 mm in diameter, especially for submucosal fibroids; laparoscopy in certain sub-serous fibromas.


Small, asymptomatic uterine fibroids do not need to be treated (50-80% of fibroids); on the other hand, symptomatic fibroids must be treated; this treatment is different according to the age of the woman and her desire for pregnancy; for this reason :

In young women, and women wanting children, the treatment consists of the removal of the fibroid (this surgical act is called myomectomy Myomectomy of an intramural cervical fibroid) and which can be done:

either by hysteroscopy, pedicled fibroma of the uterine fundus, 14 x 12.3 x 7 mm in operative diameter for small submucosal fibroids:

According to J. Hamou "Hysteroscopic resection". In JB Dubuisson, C. Chapron, JBde Jolinère "Uterine fibroids" Ed Arnette 1994; 9: 39-44) Usually hysteroscopic resection is indicated for fibroids:

submucosa with a large intracavitary diameter (type II, or at an acute angle) less than or equal to 5 cm in size,

fibroids 3 to 5 cm in size can benefit from prior treatment with GnRH analogues because this treatment can reduce, after 2 to 3 months by 20 to 50%, the volume of the fibroid;

depending on the operator, this same prior medical treatment can be administered for fibroids less than 3 cm in diameter.

either by operative laparoscopy for interstitial and subserosal fibroids less than 8 cm in size and less than three in number;

for all other cases the myomectomy is done by laparotomy (classic opening of the abdominal wall);

You should know that pregnancy is quite possible even in the presence of a uterine fibroid. ,

In elderly women and women who do not want children; hysterectomy is often considered

In some centers, doctors offer a treatment called embolization, which consists of drying out the fibroid, which reduces its size and consequently eliminates the symptoms that accompany it. In this treatment, the radiologist, using radiological techniques locates and blocks the artery which supplies the fibroid, which makes it possible to stop its growth and cause its decrease.

There is a treatment known under the name of "Laparoscopic Myolysis" It is based on the combination of a prior medical treatment with a GnRH analogues followed by devascularization of the fibroid carried out by Yag laser shots on its vascular crown (marked with Doppler ultrasound during the operation).

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