Uterine Myoma
Description
Uterine myomas (also: uterine leiomyomas, uterine fibroids) are an accumulation of numerous benign, nodular growths or tumors, consisting of muscle and connective tissue, that may form in or on the uterus. They are distinguished by their size, shape and location, which are also determining factors for any symptoms and complaints. Uterine myomas are common in women of childbearing age, but usually develop between the ages of 35 and 50. Myomas develop and grow under the influence of female hormones. After menopause there is hardly any growth of tumors, because the female hormone levels decrease. A rare malignant form of myoma is called leiomyosarcoma.
Symptoms
Myosas often develop asymptomatically, however they can also cause a variety of ailments. Typical symptoms are severe or prolonged menstrual bleeding, accompanied by violent, spasmodic pain. Further indications of myomas can be a sensation of pressure or of a foreign body in the abdomen, unpleasant feelings during intercourse and bleeding between menstrual periods.
Causes and Risks
The background and triggering factors that cause myomas to occur are not precisely understood. However, it is clear that they are stimulated by female sex hormones, under whose influence the tumors will grow. Familial predisposition may also play a deciding role in the formation of myomas.
If uterine myomas cause stronger and longer menstrual periods or bleeding between periods, the increased blood loss can lead to anemia. Sometimes myomas bring problems during pregnancies: the influence of altered hormone levels may cause them to greatly increase in size, and if they grow excessively can possibly trigger premature labor or an abnormal positioning of the child.
Examination and Diagnosis
After discussion with the gynecologist, having already found indications of uterine myomas, there will usually be palpation and ultrasound examinations. Larger myomas can be detected using palpation, but smaller nodules and a more accurate diagnosis of their situation and size will require vaginal ultrasound. With myomas on the inside of the uterus, an endoscopic inspection of the uterus may be necessary. Under certain circumstances a laparoscopy may be required for investigation of myomas on the outside and in the wall of the uterus, during which procedure both smaller and larger nodules can immediately be removed.
Treatment
Treatment of myomas usually occurs only when they bring discomfort, impair fertility or cause problems before or during pregnancy. The determining factor in the choice of treatment is whether the patient still wants to have children. Drug treatment and surgical or non-surgical methods all have their advantages and disadvantages, and should be adapted to the individual needs of the patient. The therapeutic measures can be aimed at reducing menstrual bleeding or relieving pain and cramps. Especially worth mentioning here are hormonal treatments as well as surgery to remove the myomas or the uterus.
If the nodules grow directly under the endometrium, a hysteroscopy will often be considered. If the myomas are located on the outside or in the wall of the uterus, they can be removed laparoscopically. The advantage here is that during surgery, tissue samples are taken and then examined for malignant cells.
Course and Prognosis
It is estimated that about 40-80 percent of women have uterine myomas. This may also include very small myomas that go unnoticed. It is difficult to make a prognosis as to how myomas will develop in individual cases: they vary in size and growth. In some women the growths and the discomfort caused thereby remain almost unchanged without treatment. But in others they may increase in size, and the symptoms may worsen or else subside completely on their own. During menopause however, the myomas degenerate, and as a result the symptoms usually disappear.