16/03/2024
MYOMA UTERI
Uterine fibroids, also known as myoma uteri, are non-cancerous growths that can occur in the uterus. It's essential to recognize that these lesions have various treatment options available. Rather than being fearful, it's important to be informed about them. We, obstetrician-gynecologists (OB-GYN) can assist you in determining the most suitable treatment plan. Please know that we are here to support and assist you throughout this process.
DEFINITION
Myoma, also known as uterine fibroids, are noncancerous growths that develop in the uterus. They are made up of muscle and fibrous tissue and can vary in size, ranging from small and undetectable to large enough to distort the shape of the uterus.
CAUSES OF MYOMA UTERI
1. Hormonal factors: Estrogen and progesterone, two female hormones, are known to stimulate the growth of the uterine lining during the menstrual cycle. It is believed that an imbalance in these hormones can contribute to the development of myomas.
2. Genetic factors: There is evidence to suggest that genetic factors may play a role in the development of myomas. Women with a family history of myomas are at an increased risk of developing them.
3. Age and reproductive factors: Myomas are more commonly found in women during their reproductive years, particularly between the ages of 30 and 50. The risk of developing myomas decreases after menopause when estrogen and progesterone levels decline. Additionally, women who have never given birth or had their first child at a later age may be at a higher risk.
4. Ethnicity: Studies have shown that certain ethnic groups, such as African-American women, have a higher prevalence of myomas compared to other populations.
5. Obesity: Obesity has been associated with an increased risk of myomas. Excess body weight can lead to an imbalance in hormone levels, which may contribute to the development of myomas.
6. Lifestyle factors: Some lifestyle factors, such as a diet high in red meat and low in fruits and vegetables, as well as alcohol consumption, have been linked to an increased risk of myomas. However, more research is needed to establish a clear link.
SIGNS AND SYMPTOMS
The symptoms of myomas can vary depending on their size, number, and location. Some women may have fibroids without experiencing any symptoms at all. However, when symptoms do occur, they may include:
1. Heavy or prolonged menstrual periods: This is one of the most common symptoms of myomas. Fibroids can cause excessive bleeding during menstruation, leading to longer and heavier periods.
2. Pelvic pain or pressure: Large fibroids can cause discomfort or pain in the pelvic region. You may experience a feeling of fullness or pressure in the lower abdomen.
3. Abdominal swelling: Enlarged fibroids can make your abdomen appear swollen or distended.
4. Frequent urination: If a fibroid puts pressure on the bladder, it can cause frequent urination or a constant urge to urinate.
5. Difficulty emptying the bladder: In some cases, fibroids can obstruct the bladder, leading to difficulty fully emptying it.
6. Constipation: Fibroids located near the colon or re**um can create pressure and cause constipation.
7. Pain during in*******se: Fibroids can cause pain or discomfort during sexual in*******se.
8. Lower back pain: Fibroids located at the back of the uterus can press against the muscles and nerves of the lower back, resulting in back pain.
9. Infertility or recurrent miscarriages: Depending on their size and location, fibroids can interfere with conception or cause complications during pregnancy, leading to infertility or recurrent miscarriages.
EFFECTS OF MYOMA ON THE BODY
The effects of myoma on the body can vary depending on their size, location, and number. Here are some potential effects:
1. Menstrual changes: Myomas can cause heavy or prolonged menstrual bleeding, leading to anemia, fatigue, and weakness. Some women may also experience irregular menstrual cycles.
2. Pelvic pain and pressure: Large myomas or those located in certain areas of the uterus can cause pelvic pain or pressure. This discomfort may be chronic or intermittent and can range from mild to severe.
3. Urinary symptoms: Myomas that press against the bladder can lead to increased frequency of urination or difficulty emptying the bladder completely. In some cases, this can result in urinary tract infections.
4. Bowel symptoms: Myomas located near the re**um can cause bowel-related symptoms such as constipation, difficulty passing stool, or increased pressure on the re**um.
5. Reproductive issues: Depending on their size and location, myomas can interfere with fertility. They may obstruct the fallopian tubes, interfere with the implantation of a fertilized egg, or cause recurrent miscarriages.
6. Pregnancy complications: Myomas can increase the risk of various pregnancy complications, including pain, preterm labor, placental abruption (separation of the placenta from the uterine wall), and breech presentation.
7. Enlarged abdomen: In some cases, large myomas can cause the abdomen to appear distended or enlarged, leading to a noticeable bulge.
HOW TO DIAGNOSE MYOMA UTERI
1. Medical History: Your doctor will start by taking a detailed medical history, including any symptoms you may be experiencing, such as heavy or prolonged menstrual bleeding, pelvic pain, or pressure.
2. Physical Examination: A pelvic examination will be performed to check for abnormalities in the uterus, such as an enlarged or irregularly shaped uterus.
3. Imaging Tests: Your doctor may order imaging tests to visualize the uterus and confirm the presence of fibroids. Common imaging modalities include:
- Ultrasound: Transabdominal or transva**nal ultrasound uses sound waves to create images of the uterus and can help identify the size, location, and number of fibroids.
- Magnetic Resonance Imaging (MRI): MRI scans provide more detailed images of the uterus and can help evaluate the characteristics of fibroids, such as their size, location, and blood supply. This information can be valuable for treatment planning.
- Hysterosonography: This involves injecting fluid into the uterus before performing an ultrasound to enhance the accuracy of imaging.
4. Other Tests: In some cases, additional tests may be necessary to rule out other conditions or gather more information. These may include:
Hysteroscopy: A thin, lighted device called a hysteroscope is inserted through the va**na and cervix into the uterus. This allows the doctor to directly visualize the uterine cavity and any fibroids present.
– Endometrial Biopsy: If abnormal uterine bleeding is a concern, a small sample of the uterine lining may be collected for analysis to rule out other causes.
– Blood Tests: Blood tests may be performed to evaluate hormone levels, which can help determine the potential hormonal influence on fibroid growth.
TREATMENT OF MYOMA UTERI
The treatment for myoma uteri (uterine fibroids) can vary depending on the size of the fibroids, their location, the symptoms they’re causing, and the patient’s overall health and future fertility plans. Here are some of the most commonly used treatments:
1. **Watchful Waiting**: If the myomas are small and causing no symptoms, your doctor might recommend watchful waiting. This means you’ll have regular check-ups to monitor the fibroids but no specific treatment.
2. **Medications**: Medications can be used to regulate your menstrual cycle, treat symptoms such as heavy menstrual bleeding and pelvic pressure, or even help to shrink fibroids. They won’t eliminate fibroids, but they can make them smaller and reduce symptoms. These might include:
– Gonadotropin-releasing hormone (GnRH) agonists, like Lupron, which can temporarily stop menstruation and shrink fibroids.
– Progestin-releasing intrauterine device (IUD) to help regulate bleeding.
– Nonsteroidal anti-inflammatory drugs (NSAIDs) for pain related to the fibroids.
– Tranexamic acid or oral contraceptives to help control heavy menstrual bleeding.
3. **Non-Invasive Procedures**: Certain procedures can destroy uterine fibroids without actually removing them through surgery. These might include:
– MRI-guided focused ultrasound surgery (FUS): During FUS, high-frequency, high-energy ultrasound is used to target and destroy the fibroids.
4. **Minimally Invasive Procedures**: These procedures involve small incisions or special access routes to reach the fibroids and treat them. Examples include:
– Uterine artery embolization: Small particles are injected into the arteries supplying the uterus, cutting off the blood supply to fibroids, causing them to shrink and die.
– Radiofrequency ablation: A needle is inserted into the fibroids to heat up and destroy small areas of fibroid tissue.
– Laparoscopic or robotic myomectomy: The fibroids are removed surgically through small incisions in the abdomen.
– Hysteroscopic myomectomy: This is used for fibroids that are inside the uterine cavity; the fibroids are removed through the cervix, so no incisions are needed.
5. **Traditional Surgical Procedures**: These are more invasive procedures that might be used if other treatments don’t work or if the fibroids are large. They include:
– Abdominal myomectomy: If you have multiple fibroids, very large fibroids or very deep fibroids, your doctor may use an open abdominal surgical procedure to remove the fibroids.
– Hysterectomy: This is the removal of the uterus. This is the only certain way to cure uterine fibroids. This is typically a last-resort treatment if the fibroids are causing severe symptoms and other treatments have failed or are not an option.
The best treatment option depends on a variety of factors, including whether the woman wants to maintain her fertility, the size and location of the fibroids, the woman’s age, and whether she has any other health issues. The woman’s personal preferences and lifestyle factors should also be taken into account. It’s important to discuss all options.
