Complications
The most significant complication related to the treatment of uterine fibroids is regrowth and associated return of bothersome symptoms. Myomectomy is associated with some risk of fibroid recurrence (reported ranges from 0 to 25%), and it is estimated that 10% of women undergoing myomectomy will go on to need a hysterectomy within 5 to 10 years.[82] Risk of recurrence is associated with age, preoperative number of fibroids, uterine size, associated disease, and childbirth after myomectomy.[166] For women in their 30s, the chance of needing further treatment for fibroids with the next 2 years was 6% to 7% after medical treatment or myomectomy and 44% after uterine artery embolization (UAE).[82]
One study found that 29% of patients who underwent UAE required further invasive therapy between 3 to 5 years following the procedure.[73] Options following treatment failures include repeat conservative surgery versus hysterectomy.
Usually presents as acute abdominal pain and with symptoms associated with the incarcerated organ: for example, urinary retention.
Surgical removal of the fibroid is the treatment of choice.
Anemia is the most common problem, associated with heavy menstrual bleeding, menstrual cycles that are shorter (<21 days) and more frequent than usual, and intermenstrual bleeding. The course is usually insidious and progressive, leading to depletion of body iron stores and iron deficiency anemia.
Hemorrhage is a known surgical risk in myomectomy, uterine artery embolization, and hysterectomy.
In myomectomy, it does rarely occur that heavy bleeding will require emergent hysterectomy.
Infection is a known surgical complication in myomectomy, uterine artery embolization, and hysterectomy.
Uterine fibroids are associated with poor obstetric outcomes. Leiomyomas that distort the uterus are associated with an increased risk of miscarriage. Pregnant women who have uterine fibroids are at increased risk of malpresentation, placental abruption, fetal growth restriction, preterm labor and birth, cesarean delivery, and postpartum hemorrhage.[170]
Usually presents during pregnancy with acute abdominal pain with significant local tenderness over the site of the mass.
Most common type of degeneration during pregnancy is red type, believed to occur due to rapid fibroid cellular growth that exceeds the blood supply.
Usually requires admission to the hospital for pain therapy, usually with nonsteroidal anti-inflammatory drugs. However, these drugs should be used with caution to avoid fetal problems, such as premature closure of the ductus arteriosus.[9][72]
The prevalence of fibroid-associated infertility is felt to be low.[23] The negative impact on fertility by uterine fibroids have been variously postulated to occur via resultant changes in uterine architecture and interference in sperm transport or ovum implantation, altered uterine contractility, or obstructed tubal ostia.[168]
Studies have shown that uterine/endometrial architecture disruption would be the most likely mechanism.[75][169]
There exist a number of hypotheses regarding the mechanism of action of spontaneous abortion in patient with uterine fibroids including altered uterine contractility, altered uterine vasculature, and/or supporting extracellular matrix.[23]
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