The uterus is an organ that consists of a layer of muscle. The uterine cavity is lined from the inside, like a wallpaper of mucous membrane, the so-called endometrium. In many women, formations consisting of connective tissue are found in the muscular layer.
These are called fibroids. Depending on their size and location, they can cause various problems. Women often struggle with bleeding problems because the muscle fibers of the uterus cannot contract adequately after menstruation due to the fibroids.
It is often difficult to diagnose whether a fibroid affects the uterine cavity, thus reducing pregnancy chances.
Various studies have shown that fibroids that lie just below the serosa (subserosa) of the uterus have hardly any influence on fertility and therefore do not need to be removed.
Similarly, fibroids confined to the muscular layer of the uterus (intra- and transmural) do not affect fertility unless they deform the uterus cavity. Myomas that lie directly under the muscular layer (submucous) and protrude into the uterine cavity are associated with miscarriage and implantation failure. Removal of these increases the likelihood of pregnancy on the one hand and significantly reduces the risk of miscarriage on the other.
Diagnostics
To assess whether a fibroid is affecting the uterine cavity and thus impairing fertility, a 3D ultrasound or an MRI scan is often performed. These examinations allow us to assess the uterus cavity in three dimensions and visualize contact points with the fibroids.
Treatment
The exact procedure chosen depends on the location and size of the fibroid. Usually, hysteroscopy and laparoscopy are performed to remove fibroids. Caution is always advised if the uterine cavity is opened during the fibroid removal because it can require a healing period of approximately one year before a pregnancy is attempted to prevent the risk of a rupture of the scar area.
A new procedure that is supposed to help here and has found its way into gynecology in the last few years for treating fibroids are devices through which sonographically controlled energy is released to shrink them.
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