What Happens to Untreated Uterine Fibroids?

Untreated uterine fibroids can have serious repercussions for the patients who suffer from this disease, which is why it is vital to attend the doctor once the woman starts to bleed abnormally. Tests such as transvaginal ultrasound confirm the diagnosis of fibroids in the uterus. In most cases, it can be treated with medications, but surgery is required on other occasions.

What Happens to Untreated Uterine Fibroids?

There are some natural complications of the untreated uterine fibroids, such as the following:

Menorrhagia: It is very frequent in symptomatic fibroids. The typical bleeding pattern of a fibroid uterus is hypermenorrhea (greater than 7 days) and irregular pattern. It seems that it could be due to vascular alterations in the endometrium, with vascular obstruction and venous ectasia, these causes a congestion of the myometrium and endometrium originating hemorrhage.

Increase in Volume and Neighboring Organ Pressure:

Pressure on the bladder causes increased urination, nocturia, urgency, difficulty in emptying and sometimes obstruction of the ureters with secondary hydronephrosis. Sometimes fibroids press the ureterovesical junction, with obstruction and secondary pyelonephritis, the prolapse of a large fibroid through the vagina can also cause obstruction and secondary renal failure.

If the fibroids are posterior and large, it can press on the rectosigmoid area, producing constipation due to the incarceration of the fibroids in the cul-de-sac. Also the vascular structures, like the iliac arteries can be affected by this mass effect and produce a claudication of the circulation in the limbs.

Untreated Uterine Fibroids Lead To Abdominal Pain

It is not a frequent symptom, usually due to the torsion of a subserous fibroids pedicle, due to the dilatation of a submucosal fibroid or by necrosis of the fibroids.

Untreated Uterine Fibroids Lead to Sterility Problems

Submucosal and intramural fibroids are associated with a decrease in the percentage of gestations, with its extirpation this percentage increases considerably reaching 81%, if primary sterility and 63% in cases of recurrent abortions, regardless of the used technique for its removal.

Untreated Uterine Fibroids Lead to Malignant Degeneration

If a fibroid grows rapidly, especially at menopause, with a suspicious image and a negative or inconclusive endometrial biopsy, doctors think of sarcoma. Also, if they perform treatment to reduce the size of the tumor, analgesia or embolization, and it is not possible to reduce the size or it recovers very soon,  endometrial biopsy or surgery of the tumor should be performed.

The diagnosis of sarcoma with an ultrasound is very difficult; the magnetic resonance imaging is valid in the diagnosis.

Rare Complications of Untreated Uterine Fibroids

  1. Paraneoplastic syndrome: In giant fibroids of the ovary, with epileptic seizures, without brain injury, with abdominal pain and abdominal distension.
  2. Spontaneous hemoperitoneum: Acute pelvic pain, pallor, abdominal distension, sensitive subpubic mass and low blood pressure. After laparotomy, rupture of the serosa of uterus and complete enucleation of the fibroids is observed.
  3. Hypovolemic shock of fibroids after childbirth: The history of fibroids that grows in pregnancy and that after childbirth grows even more with pain and hypotension. It’s pedicle is long and large. Great intercellular edema in the uterine fibroids.
  4. Giant fibroids: It is considered when weighing more than 11.4 kg. The clinical presentation is compression of neighboring organs, it produces a large blood sequestration, adhesions to nearby areas.
  5. Piofibroids: Especially in pregnant women due to hemorrhage and necrosis, and in postmenopausal, due to a vascular deficit. It is secondary to fibroids infarction and infection. Mortality of 30%.
  6. Ovarian fibroids: They are small, asymptomatic, and unilateral.
  7. Fibroids trapped in the placenta: Its origin may be due to tissue of the fetoplacental mesenchyme, it can be an intra-endometrial fibroids or a pediatric fibroids side incorporated secondarily to the placenta. It is easily separated from the decidua.
  8. Ectopic pregnancy in the myomectomy scar: Implantation in the uterine scar due to a migration of the embryo through a fistula.
  9. Fibroids parasites: Secondary in most of the cases to a myomectomy. A missing fibroids or a piece of fibroids loses its vascular relationship with the uterus, which is why it is considered a recurrent fibroids. Doctors are especially careful with the extraction of all the fibroid pieces.

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