There are so many types of uterine fibroids. Can hysteroscopy detect them all?

Author: Zhang Qi Beijing Tiantan Hospital, Capital Medical University

Reviewer: Feng Limin Professor, Chief Physician, Director of Obstetrics and Gynecology, Beijing Tiantan Hospital, Capital Medical University

In recent years, the incidence of uterine fibroids has been increasing. Although uterine fibroids develop slowly, they are prone to recurrence and often cause headaches for female friends. Today, let's talk about what uterine fibroids are, how uterine fibroids are classified, and how they appear under hysteroscopy?

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1. What is uterine fibroids?

Uterine fibroids are common benign gynecological tumors in clinical practice, also known as uterine fibroids and fibromyomas, and are more common in women aged 30 to 50. Uterine fibroids are mostly caused by the proliferation of uterine smooth muscle cells, so they are also called uterine leiomyoma.

In clinical practice, many patients with uterine fibroids do not have special symptoms at the beginning, and most of them are discovered through physical examinations. However, some patients also experience symptoms such as abnormal menstrual cycles, abdominal masses, increased leucorrhea, and lower abdominal distension. Different types of uterine fibroids have different symptoms.

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Types of uterine fibroids

Depending on the location of the patient's uterine fibroids, they can be divided into the following four categories.

1. Intramural fibroids : If the uterus is compared to a house, then intramural fibroids are fibroids that grow inside the wall and are tightly wrapped by the uterine myometrium. This type of uterine fibroid is the most common in clinical practice, accounting for 60% to 70%.

2. Subserosal fibroids : They grow in the serosa layer of the uterus, and the tumor protrudes outside the uterine cavity. In layman's terms, the fibroids grow outside the "uterine wall". This type of fibroids accounts for about 20%.

3. Submucosal fibroids : They grow in the mucosal layer of the uterus, with the tumor protruding into the uterine cavity and directly contacting the mucosal layer, accounting for about 10%. There is often a pedicle connecting it to the uterus, and if the pedicle is too long, it may protrude into the vagina.

The European Society of Gynecological Endoscopy divides submucosal uterine fibroids into three types: Type 0, the fibroids are entirely located in the uterine cavity, have not yet involved the myometrium, and have a pedicle or a short pedicle; Type I, ≥50% of the tumor is located in the uterine cavity; Type II, <50% of the tumor protrudes into the uterine cavity.

4. Cervical fibroids : Relatively rare, cervical fibroids refer to fibroids that grow in the cervix of the uterus. Because the fibroids grow in a relatively low location, there is a risk of becoming lodged in the pelvic cavity, which can cause compression symptoms. This type of fibroid is difficult to surgically remove and can easily damage the ureter and bladder.

Uterine fibroids are often multiple, and different types of fibroids may occur in the same patient at the same time, which is clinically called multiple uterine fibroids.

3. Different types of uterine fibroids under hysteroscopy

Hysteroscopy is one of the important means to diagnose and treat uterine fibroids. During the diagnosis process, different types of uterine fibroids will have different manifestations under hysteroscopy due to their different growth directions.

1. Intramural fibroids under hysteroscopy are smooth and spherical and protrude into the uterus. A wide base or a narrow pedicle can be seen connected to the uterus.

2. Under hysteroscopy, there is no significant difference in the intramural fibroids, subserosal fibroids, and cervical fibroids in the uterine cavity compared with the normal uterine cavity. When the fibroids are larger, the uterine cavity may be enlarged.

3. The 3 different types of submucosal fibroids also have different manifestations under hysteroscopy. Type 0: Under hysteroscopy, it can be seen that the tumor is completely located in the uterine cavity, with only one pedicle connected to the uterus; Type I: Under hysteroscopy, it can be seen that most of the tumor protrudes into the uterine cavity, and only a small part is buried in the uterine wall; Type II: Under hysteroscopy, only a small part of the tumor protrudes into the uterine cavity, and the rest is mostly buried in the uterine wall.

Conclusion

In summary, uterine fibroids are a particularly common benign tumor. Through hysteroscopy, the location and development of uterine fibroids can be visually and clearly seen. Therefore, female friends should not be too worried and anxious, and should do relevant examinations for uterine fibroids at any time. According to the examination results, take necessary treatment measures, relax, and provide nutritional support, which is conducive to recovery.