Uterine fibroids - diagnosis and treatment at OpenMed Warsaw
At OpenMed Warsaw we see patients with suspected or diagnosed uterine fibroids. We help both when the lesion has been found incidentally during an ultrasound scan and in the case of heavy periods, lower abdominal pain, a feeling of pressure or difficulty conceiving.
During the consultation the gynaecologist assesses the number, size and position of the fibroids and their effect on the uterine cavity. Depending on the indications, diagnostics may include a transvaginal ultrasound or a 3D ultrasound. Based on the result, the symptoms and plans regarding pregnancy, the doctor determines further care: observation, conservative treatment, additional tests or referral for surgical treatment.
Who we help
We help patients who:
- have a fibroid detected during a follow-up or routine ultrasound,
- need monitoring of previously diagnosed lesions,
- have heavy, prolonged or painful periods,
- notice clots or bleeding between periods,
- feel pain, distension or pressure in the lower abdomen,
- urinate more often or have constipation related to pressure in the pelvis,
- experience pain during intercourse or in the lumbar region,
- have symptoms of anaemia such as weakness, drowsiness, pallor or breathlessness on exertion,
- are planning a pregnancy or want to assess the effect of fibroids on fertility,
- need to establish whether observation is enough or treatment is indicated.
Doctors diagnosing uterine fibroids in Warsaw
Meet the gynaecologists at OpenMed Warsaw who see patients with suspected or diagnosed uterine fibroids. The doctor reviews the symptoms and previous results, performs or orders the appropriate ultrasound and determines whether observation, conservative treatment or referral for a procedure is needed.
Uterine fibroids - when to see a gynaecologist
A consultation is advisable when a fibroid has been found during a follow-up ultrasound or when heavy periods, bleeding between periods, lower abdominal pain or a feeling of pressure in the pelvis have appeared. The visit makes it possible to confirm whether the complaints really do result from fibroids, because similar symptoms may also be caused by endometrial polyps, adenomyosis, endometriosis and hormonal disorders.
It is also worth seeing a gynaecologist when a previously diagnosed fibroid has grown, changed appearance on ultrasound or started to cause new symptoms. Fibroids in patients planning a pregnancy and lesions detected after the menopause also require assessment. The diagnosis itself does not, however, mean that surgery is necessary - many fibroids can be safely observed.
Symptoms of uterine fibroids that should not be ignored
Small fibroids often cause no complaints at all. Symptoms depend above all on their position, number and effect on the uterine cavity or neighbouring organs. Even a small fibroid growing into the uterine cavity may cause intense bleeding, while a larger lesion on the outer surface of the uterus may produce no symptoms for a long time.
Fibroids may cause:
- heavy, prolonged or painful periods,
- bleeding and spotting between periods,
- large clots during menstruation,
- pain, distension or a feeling of heaviness in the lower abdomen,
- an increase in abdominal girth,
- pain in the sacral and lumbar region,
- frequent urination or sudden urinary urgency,
- constipation and a feeling of pressure on the rectum,
- pain or discomfort during intercourse,
- weakness, breathlessness on exertion and palpitations related to anaemia,
- difficulty conceiving or recurrent obstetric complications.
These symptoms are not specific to fibroids alone, which is why they require a consultation and a gynaecological examination.
How we diagnose uterine fibroids at OpenMed
We begin the diagnostic process with a history covering bleeding, pain, the menstrual cycle, previous pregnancies and procedures, and reproductive plans. The doctor also asks about hormonal and anticoagulant medication, how quickly the symptoms have developed and the results of earlier tests.
The basis of diagnosis is a gynaecological ultrasound, which makes it possible to determine the number, size and position of the fibroids. The doctor also assesses whether the lesions distort the uterine cavity, press on the endometrium or grow towards the bladder or bowel.
Further diagnostics may include:
- a full blood count and ferritin measurement with heavy periods,
- 3D and 4D ultrasound allowing a more detailed assessment of the uterine cavity,
- hysteroscopy where a submucosal fibroid is suspected,
- magnetic resonance imaging with multiple, very large or inconclusive lesions,
- endometrial biopsy if the character of the bleeding, the age or risk factors require assessment of the uterine lining,
- histopathological examination.
Once diagnostics are complete the patient receives a discussion of the result together with recommendations on observation, conservative treatment or further surgical assessment.
Gynaecological ultrasound in the assessment of uterine fibroids
A transvaginal ultrasound is the basic imaging test where fibroids are suspected. In specific situations it is supplemented by a scan through the abdominal wall, which allows a broader assessment of a large uterus or of lesions extending beyond the pelvis.
During the ultrasound the doctor determines:
- the number of fibroids,
- the three dimensions of each significant lesion,
- the position in relation to the endometrium and the outer surface of the uterus,
- the effect of the fibroid on the shape of the uterine cavity,
- the structure, borders and vascularity of the lesion,
- the presence of calcifications or degenerative changes,
- the overall dimensions of the uterus and the thickness of the endometrium,
- the appearance of the ovaries and the remaining pelvic structures.
3D and 4D ultrasound makes it possible to obtain a spatial image of the uterus. It is particularly helpful in assessing fibroids located close to the endometrium, lesions distorting the uterine cavity and in the diagnostics of patients planning a pregnancy. The ultrasound result allows further care to be planned, but in inconclusive cases MRI or hysteroscopy may be necessary.
Types of fibroids and the significance of their location
Fibroids are classified above all according to their position in relation to the uterine wall and cavity. Location often matters more for symptoms than the diameter of the lesion itself.
- Submucosal fibroids grow towards the uterine cavity and may distort it. They most often correspond to FIGO types 0-2. Even when small they may cause heavy bleeding, anaemia and problems with embryo implantation.
- Intramural fibroids develop within the uterine muscle. FIGO types 3-4 may cause enlargement of the uterus, painful periods and bleeding, and larger lesions may also press on the bladder or bowel.
- Subserosal fibroids grow towards the outer surface of the uterus and most often correspond to FIGO types 5-7. They less often make periods heavier, but they may cause distension, an increase in abdominal girth and pressure symptoms.
- Pedunculated fibroids are connected to the uterus by a narrower stalk. They may grow into the uterine cavity or outside the organ.
- Cervical fibroids and other atypically located lesions are classified as FIGO type 8. Their location may make surgical treatment more difficult or affect the function of the bladder and genital tract.
One patient may have fibroids of several types at the same time. That is why an ultrasound report should record not only their dimensions but also their exact position and their effect on uterine anatomy.
When can fibroids be observed and when do they require treatment?
Observation is often sufficient if the fibroids cause no symptoms, do not significantly distort the uterine cavity and are not growing quickly. The doctor sets the date of the next ultrasound individually - for example after 6 or 12 months. Shorter follow-up may be needed with a newly detected, large or inconclusive lesion.
Treatment is considered above all when fibroids cause:
- bleeding leading to anaemia,
- pain not adequately controlled by medication,
- pressure on the bladder, bowel or other organs,
- a marked increase in abdominal girth,
- distortion of the uterine cavity relevant to fertility,
- problems during pregnancy or recurrent miscarriage,
- deterioration of everyday functioning,
- further growth after the menopause.
There is no single diameter above which every fibroid must be removed. A 2 cm submucosal fibroid may cause intense bleeding, while a 6 cm subserosal lesion may require only follow-up if it produces no symptoms and remains stable in size.
Treatment of uterine fibroids - matching the method to the diagnostic result
The aim of treatment may be to reduce bleeding, ease pain and pressure, improve blood parameters or remove lesions affecting fertility. The choice of method depends on the location and number of fibroids, the severity of symptoms, the patient age and her plans regarding pregnancy.
Conservative treatment may include painkillers and anti-inflammatory medication, tranexamic acid to limit bleeding, and appropriately selected hormonal treatment. In some patients a hormone-releasing intrauterine system is used, provided the fibroids do not significantly distort the uterine cavity. Medication acting on the hormonal axis may temporarily reduce symptoms and the size of fibroids, for example in preparation for surgery. Pharmacotherapy usually controls the complaints but does not remove the lesions themselves.
Surgical methods include:
- hysteroscopic removal of fibroids growing into the uterine cavity,
- laparoscopic, robotic or open myomectomy, that is removal of the fibroids with the uterus preserved,
- uterine artery embolisation, which limits the blood supply to the lesions,
- HIFU, that is destruction of selected fibroids with focused ultrasound waves,
- hysterectomy, that is removal of the uterus, used in justified cases in patients not planning a pregnancy.
If hospital treatment is needed, the doctor can prepare the patient for further assessment and indicate the appropriate direction of care.
Uterine fibroids, heavy periods, anaemia and lower abdominal pain
Fibroids growing towards the uterine cavity may increase the surface area of the endometrium and disturb the normal contraction of the uterus. The result may be periods lasting more than 7 days, the need to change a pad or tampon every 1-2 hours, bleeding at night, leaking despite double protection, and the presence of large clots.
Regular blood loss may lead to iron deficiency and anaemia. Its symptoms are chronic fatigue, pallor, headaches and dizziness, palpitations, poorer exercise tolerance, breathlessness and problems with concentration. With such complaints it is worth having a full blood count and a ferritin measurement, because iron deficiency may appear even before the haemoglobin level falls.
Pain may result from intense uterine contractions, pressure from larger lesions or degenerative changes inside a fibroid. Treatment should address both the cause of the bleeding and pain and the replacement of iron deficiency, if it has been confirmed in tests.
Uterine fibroids, fertility and planning a pregnancy
Most women with fibroids can conceive. The significance for fertility does, however, depend on the location, size and number of the lesions. Submucosal fibroids and other lesions distorting the uterine cavity have the greatest effect, because they may make embryo implantation more difficult. Large intramural fibroids may also matter, while subserosal lesions usually have a weaker effect on fertility.
Before starting to try for a baby the doctor may recommend a detailed assessment of the uterine cavity with 3D and 4D ultrasound and, in selected cases, hysteroscopy, sonohysterography or a Sono-HSG tubal patency examination, all also available at OpenMed. This makes it possible to assess whether a fibroid really may hinder conception and whether removing it will improve the chance of a normal pregnancy.
Not every patient planning a child requires a myomectomy. Surgery also involves a scar on the uterus and a risk of adhesions, which is why the decision is taken after weighing the benefits against the possible consequences of the procedure. Reproductive plans also matter when embolisation or HIFU is being considered.
When is an urgent gynaecological consultation needed?
Very heavy bleeding requires urgent assessment, especially if a pad or tampon becomes completely soaked within an hour for several hours in a row. You should not wait for a scheduled visit if the bleeding is accompanied by fainting, breathlessness, palpitations, marked weakness, pallor or severe dizziness.
Prompt help is also required for:
- sudden and very severe lower abdominal pain,
- pain combined with fever or vomiting,
- bleeding and pain with suspected pregnancy,
- rapid worsening of existing symptoms.
Bleeding after the menopause always requires diagnostics, even if fibroids were diagnosed earlier. Enlargement of a lesion or of the uterus after the menopause does not automatically mean cancer, but it should be assessed by a gynaecologist without delaying the visit. In case of loss of consciousness, breathlessness or bleeding that cannot be controlled you should go to a hospital emergency department or call 112.
How to prepare for the consultation and ultrasound
It is worth bringing previous ultrasound reports and images, MRI results, hospital discharge summaries and documentation of procedures you have had. The doctor will also need a list of the medication you take, especially hormonal and anticoagulant preparations and those affecting bleeding. You should not stop taking them on your own before the consultation.
Before the visit, prepare information on:
- the date of your last period and the length of your cycle,
- the number of days of bleeding,
- how often you change pads or tampons,
- the presence of clots and bleeding at night,
- how long the pain lasts and what makes it worse,
- previous pregnancies, miscarriages and surgery,
- your plans regarding pregnancy.
A transvaginal ultrasound is usually performed after emptying the bladder, while a scan through the abdominal wall may require a full bladder. You do not need to fast. A period usually does not prevent an ultrasound from being performed, although for a detailed assessment of the endometrium and the uterine cavity the doctor may recommend a date in the first part of the cycle.
Why have uterine fibroids assessed at OpenMed Warsaw?
At OpenMed the patient can have a gynaecological consultation and an ultrasound that allows assessment of the uterus, endometrium, ovaries and the remaining pelvic structures. Depending on the indications we perform a transvaginal, transabdominal or 3D and 4D ultrasound, which is particularly useful in assessing lesions that distort the uterine cavity.
The patient receives a report of the examination together with a discussion of what the detected lesions mean and with recommendations. Further care may include a follow-up ultrasound, treatment of bleeding and pain, tests for anaemia, extended diagnostics or referral for surgical treatment. The OpenMed Gynaecology and Obstetrics clinic is located at ul. Wschowska 8 in Warsaw Wola.
Frequently asked questions about the diagnosis and treatment of uterine fibroids
Fibroids are benign tumours built of smooth muscle cells and connective tissue. Malignant uterine sarcomas are rare and most often do not arise from the transformation of a pre-existing fibroid. An atypical appearance, growth of a lesion after the menopause or new symptoms do, however, require more detailed assessment.
No. Fibroids may change size under the influence of hormones, age and pregnancy. The doctor compares the growth rate, the structure of the lesion and the complaints present. Growth alone neither determines that surgery is needed nor confirms cancer.
Many fibroids shrink after the menopause as hormonal activity declines. If, however, the uterus or a previously diagnosed lesion continues to enlarge, or pain or bleeding appears, repeat diagnostics are needed.
Pharmacotherapy above all limits bleeding and pain. Some hormonal medication may temporarily reduce the size of the lesions, but after treatment ends the fibroids may enlarge again. Permanent removal of a fibroid requires an appropriately selected procedure.
It may be considered with heavy periods, provided the fibroids do not significantly distort the uterine cavity. With submucosal lesions correct insertion and retention of the device may be difficult, which is why the decision is preceded by an ultrasound.
Size is only one of the criteria. The location, the number of lesions, the symptoms and reproductive plans are equally important. A small fibroid growing into the uterine cavity may qualify for hysteroscopy, while a larger lesion on the outer surface of the uterus may only be observed.
No. Methods that preserve the uterus are available, such as hysteroscopic or laparoscopic removal of a fibroid, embolisation and HIFU. Hysterectomy is considered in specific cases, after taking into account age, symptoms, previous treatment and the plans of the patient.
A fibroid is located within the uterine muscle, which is why a standard endometrial biopsy does not diagnose it. Sampling the uterine lining may, however, be needed with abnormal bleeding, in order to exclude other causes of the complaints.
There is no diet or supplement that removes or shrinks fibroids in a predictable way. A balanced diet may support general health, and a diet rich in iron helps with deficiencies related to bleeding, but it does not replace diagnostics and treatment.
Uterine fibroid diagnosis and treatment price list
Service available at the following clinics:
- Warsaw Wola - price list
Have questions? Contact us - 22 100 45 20.