Fibroids
Fibroids (also known as leiomyomas) are benign tumors of the uterus that develop from the muscular wall of the uterus and are very common among women of reproductive age. They often do not require treatment and tend to regress after menopause. Although they are asymptomatic in most cases, fibroids may sometimes be associated with symptoms such as heavy or prolonged menstrual bleeding, which may eventually lead to anemia, pelvic pain or pressure, frequent urination, pregnancy complications, and infertility. The presence of symptoms depends on the location and size of the fibroids. Fibroids may affect fertility through various mechanisms, including alterations in the morphology and function of the endometrial environment, ultimately affecting embryo implantation. The main diagnostic tools for detecting fibroids are ultrasound examination and magnetic resonance imaging (MRI).
Adenomyosis
Adenomyosis is a benign condition of the uterus in which tissue that normally lines the inside of the uterus (endometrium) grows within the muscular wall of the uterus, causing thickening and enlargement of the uterus. It is a common condition that is often underdiagnosed and may coexist with uterine fibroids. Symptoms vary and may include very heavy menstrual bleeding (menorrhagia), severe menstrual pain, chronic pelvic pain, pain during sexual intercourse, bloating, and a feeling of pelvic pressure. Adenomyosis can affect fertility through multiple mechanisms. The main diagnostic tools used for its evaluation are ultrasound examination and magnetic resonance imaging (MRI).
Endometriosis
Endometriosis is a common, chronic gynecological condition (affecting approximately 10% of women of reproductive age worldwide), in which tissue similar to the endometrium (the inner lining of the uterus) develops outside the uterus, within the pelvic cavity (ovaries, fallopian tubes, peritoneum), and in some cases even in the chest. It may be asymptomatic; however, when symptoms are present, the most common include severe menstrual pain (dysmenorrhea), pain during sexual intercourse, chronic pelvic pain, pain during urination or bowel movements, and infertility. The exact causes of endometriosis remain largely unknown.
Endometriosis is considered an autoimmune disorder and often coexists with other autoimmune diseases, such as systemic lupus erythematosus, multiple sclerosis, and inflammatory bowel disease. Diagnosis can be challenging, and worldwide it appears to be delayed, often occurring 4–12 years after the onset of the disease. Diagnosis may also be established based solely on the woman’s clinical presentation and symptoms.
Additional diagnostic tools include ultrasound examination and magnetic resonance imaging (MRI). Laparoscopy may be required to confirm the diagnosis and treat endometriosis. Endometriosis affects fertility through various mechanisms. Among women with infertility, 25–50% have endometriosis. There is currently no definitive cure for the condition. Management may include medical treatment (non-steroidal anti-inflammatory drugs and hormonal therapies) and/or surgical intervention. Early diagnosis is essential, while the primary goal of treatment is symptom relief and the prevention or management of long-term consequences. Regarding fertility, when needed, assisted reproductive techniques, with appropriately tailored treatment protocols, can be highly effective.
Hysteroscopy
Hysteroscopy is a procedure in which a very thin instrument with a camera (hysteroscope) is used to directly examine the inside of the uterus. It allows the evaluation of conditions such as polyps, fibroids, adhesions, uterine septum, as well as the thickness and appearance of the endometrium. If any abnormality is identified, it can often be treated immediately during the same procedure.