A uterine myoma is a benign tumor formed by a series of muscle cells that form part of the wall of the uterus. In this case, these are very common tumors in women of childbearing age.
Although it has been studied, the factor that triggers its formation is still unknown, but it is influenced by female sex hormones. Thus, fibroids grow during pregnancy and also during the reproductive stage, although they diminish with menopause.
The presence or not of symptoms of the disease will vary depending on its size and the place where the myoma is located.
Types of uterine fibroids
Depending on the location of the fibroids in the uterus, four types of fibroids can be distinguished:
- Submucous: their size increases growing towards the uterine cavity.
- Subserosal: these fibroids grow from the outer covering of the uterus into the pelvis.
- Intramural: Intramural uterine fibroids are located on the inside of the uterine wall.
- Pedunculated: this type of myoma is attached to the outer or inner surface of the uterus, usually by a stalk or peduncle.
Diagnosis of uterine fibroids
Diagnosis of myoma is usually made with a medical history and a gynecological examination. Abdominal palpation and vaginal examination can detect the size, shape and consistency of the uterus, to which the complete number of fibroids can be added.
In turn, there are various complementary tests that can be used to determine the status of the myoma:
- Vaginal ultrasound
- Magnetic resonance
- Hysteroscopy
Symptoms of uterine fibroids
A large number of fibroids may go unnoticed as they are completely asymptomatic. In this case, they are usually detected and diagnosed during routine gynecological check-ups. The most common signs and symptoms of uterine fibroids are:
- Bleeding disturbances. Bleeding is irregular, between cycles, prolonged or excessive during menstruation….
- Pain in the lower abdomen or pelvic area.
- Urinary discomfort due to bladder compression. There are difficulties in initiating urination and a very frequent need to urinate.
- Intestinal discomfort, e.g. constipation.
- Discomfort during sexual intercourse.
- Infertility
In cases of gestation, the myoma usually increases in size, although it does not normally hinder the development of the fetus. However, complications can sometimes occur:
- Premature delivery
- Abdominal pain
- Cesarean delivery in case the myoma blocks the birth canal or alters the position of the fetus.
- Alterations in the uterus
- Heavy postpartum bleeding
Treatment of uterine fibroids
Today there are several ways to treat uterine fibroids, and the specialist in gynecology will use the most appropriate therapy for each treatment. In the event that the presence of a myoma is detected but it is asymptomatic, periodic medical check-ups should be performed. There are two types of treatment, medical and surgical.
- Medical treatment
- GnRH analogs: they slow down the production of hormones by the ovaries, and therefore the size of the myoma can be reduced. Their use is temporary, and their period of use cannot exceed three or four months.
- Ulipristal acetate: they modify the activity of progesterone, the female sex hormone. Its objective is to reduce the size of the myoma before surgery, thus reducing the hemorrhages it causes and anemia. Its duration is three months.
- Surgical treatment
- Myomectomy: the myoma(s) is removed while maintaining and preserving the uterus. Myomectomy is indicated in women who want to preserve their fertility.
- Hysterectomy: consists of the removal of the uterus, either laparoscopically, vaginally or through the abdomen.
- Embolization of the myoma: the blood vessels surrounding the myoma are closed, which causes the death of the surrounding tissue and decreases its size.