uterine myomas

7/29/2019 Uterine Myomas

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UTERINE MYOMASUterine myomas also called fibroids are tumors that grow from the wall of the uterus.

The wall of the uterus is made of muscle tissue, so a fibroid is a tumor made of muscle tissue.

The fibroids start off very small, actually from one cell, and generally grow slowly over years

before they cause any problems. Most fibroids are benign; malignant fibroids are rare. The cause

of fibroids is unknown, although it is known that fibroids have a tendency to run in families.

Fibroids are very common, with an estimated 50% of women having them. Fibroids can be

diagnosed by pelvic examination or by ultrasound. Fibroids do not have to be removed unless

they are causing symptoms such as heavy periods, irregular bleeding, or severe cramps with

periods. Also, sometimes the size alone causes enough discomfort so that removal is necessary.

Once women go through menopause, fibroids do not usually cause any further problems.

These tumors can grow very large, sometimes growing as large as a melon. The typical

Myoma, however, is around the size of an egg. When the Myoma penetrates the entire wall of

the uterus, it is referred to as uterus myomatosus. In certain very rare cases (less than 1/2 of 1%

of the time) the tumors can become malignant. When this happens, it is known as sarcoma.


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There are four primary types of uterine fibroids, classified primarily according to location in the

uterus:

Subserosal uterine

fibroids

These fibroids develop in the

outer portion of the uterus and

continue to grow outward.

Intramural uterine fibroids

The most common type of

fibroid. These develop within

the uterine wall and expand

making the uterus feel larger

than normal (which may cause

"bulk symptoms").

Submucosal uterine

fibroids

These fibroids develop just

under the lining of the uterine

cavity. These are the fibroids

that have the most effect on

heavy menstrual bleeding and

the ones that can cause problems

with infertility and miscarriage.

Pedunculated

Fibroids that grow on a small

stalk that connects them to the

inner or outer wall of the uterus.

SIGNS AND SYMPTOMS:

Cramping with periods. Heavy flow or clots with periods. Hyper menorrhea


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Lower abdominal pain Lumbago Dymenorrhea Irregular vaginal bleeding Dizziness Anemia. Very heavy and prolonged menstrual periods Pain in the back of the legs Pelvic pain or pressure Pain during sexual intercourse Pressure on the bladder which leads to a constant need to urinate, incontinence, or the

inability to empty the bladder

Pressure on the bowel which can lead to constipation and/or bloating. An enlarged abdomen which may be mistaken for weight gain or pregnancy Discomfort, such as pressure, as well as being unable to lie on your stomach and being

unable to button your clothing easily, caused by the mass of the fibroids. Other, less

common symptoms include irregular bleeding and urinary frequency caused by the

pressure on the bladder from the fibroids. If your periods are very heavy, you may

become anemic and an iron supplement may be recommended.

When the Myoma pushes on the intestines or the bladder, it can result in constipation, pain of

the bladder, or a constant need to urinate. If the tumor pushes on the nerves in the spinal cord, it

can result in pain of the back or the legs.

The causes of uterine Myoma are not fully understood. Some research suggests that Uterine

Myoma is less common in women who have had at least two children. For at least one form ofuterine Myoma, there seems to be a genetic predisposition.

Uterine Myoma often goes undetected. Ultrasounds, CT Scans, or MRIs may be

necessary to fully diagnose uterine Myoma. If you have symptoms of Uterine Myoma, your


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health care provider will help you determine the best way to diagnose the problem.

TREATMENT:

If fibroids become symptomatic enough, they can be removed surgically. The most

common surgical approach is to perform an abdominal myomectomy. An incision is made in

the lower abdomen into the abdominal cavity, and the fibroids are removed from the uterus and

the uterus stitched closed. If the uterus is no longer necessary (the woman is finished having her

family) and the woman desires her uterus removed, a hysterectomy (removal of the uterus) can

be performed. (A hysterectomy is removal of the uterus and cervix, not removal of the ovaries.

Therefore, a woman who has a hysterectomy does not necessarily go through menopause.) If a

submucous fibroid is diagnosed, then the removal of the fibroid can be performed through the

cervix. This is called a hysteroscopic myomectomy. Because the instrument goes through the

cervix, there is no cutting. It is usually a same-day procedure, which means you come in on the

day of the procedure and go home the same day, with a minimal recovery period. If you are very

anemic or the fibroids are very large, you may be treated before surgery with a medication called

Depot Lupron. This medication puts you into a temporary menopause, thus decreasing your

estrogen levels and causing the fibroids to shrink. Unfortunately, this medication does not shrink

the fibroids permanently, so it can not be used as a permanent solution.

Once it is diagnosed, Uterine Myoma can be treated through hormonal and/or herbal

treatments. Hormonal treatment typically do not cure the Uterine Myoma. Rather, they give a

temporary relief of the symptoms of Uterine Myoma. In addition, these hormones may have

certain side effects. If these hormone treatments do not work, surgery is typically an option.

Surgical options include the surgical removal of the Myoma tumors (known as an enucleation) or

a complete hysterectomy. Recent advances in laser surgery may make this an option also. If this

is the case, the surgery can become much less invasive, and can be done laparoscopically.


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The DOs

Keep your follow-up appointments so that your doctor can check your fibroids regularly.

Take your iron supplement if one has been recommended. This will prevent anemia. It is also

helpful to eat a diet rich in iron in addition to the iron supplement.

If your period cramps are uncomfortable, overthe-counter ibuprofen can be very effective in

relieving the cramps. Over-the-counter ibuprofen comes in 200-milligram tablets. You can start

with 2 tablets every 4 hours. However, if this does not relieve the cramps enough, you can take 3

tablets (600 milligrams) every 6 hours or 4 tablets (800 milligrams) every 8 hours. You should

always take ibuprofen with some food on your stomach to avoid stomach irritation. (Obviously,

you should not take ibuprofen if you have an

allergy to it, have been told you should not take it or any aspirin-like products, or have a history

of ulcer or gastritis.)

The DONTs

If you take birth control pills, you and your doctor may want to consider another birth control

method because the estrogen in the birth control pills sometimes stimulate the fibroids to grow

more quickly.

When to Call Your Doctor

If periods become heavier, either heavier flow or more or larger clots.

If you have irregular periods/bleeding.

If the ibuprofen does not relieve enough of the cramps.

If you feel that the fibroids are suddenly larger, or the mass causes discomfort.

uterine myomas

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