The uterine myoma is a benign tumor that originates in the muscular layer of the uterine wall. This is the middle layer, which causes contractions during labor.

Although composed of the same smooth muscle fibers of the uterine wall (myometrium), it is much denser than normal myometrium.

Usually, the uterine fibroid has a round or semi-round shape.
Fibroids are most common in women between the ages of 35 and 50.

Usually myoma causes no problems. Many women do not know they have.
Fibroids vary in size and number, usually grow slowly and do not cause symptoms.
Myomas that produce symptoms should be treated. About 25% of myomas cause symptoms and need a treatment to heal.

Uterine fibroids may grow as a single or group nodule and the size may range from 1 mm to more than 20 cm in diameter.
Fibroids are the most common tumors of the female pelvis, the main reason that causes a woman to have a hysterectomy . This mass is benign, does not cause metastases.
There are four different types of uterine fibroids per position in the uterus.
The most frequent is intramural uterine myoma.

 

  • Subserous – this fibroid develops outside the uterus and continues to grow to the outside.
  • Intramural – this fibroid develops inside the uterine wall and expands causing a greater than normal uterine sensation.
  • Submucosal – develops under the outer wall of the uterine cavity.
    This type of uterine fibroid is what causes more consistent menstrual bleeding, and this is what can cause problems of infertility and miscarriage .
  • Pediculated myoma  the fibroid that grows on a small rod that connects it to the inner or outer wall of the uterus.

 

Causes of uterine fibroid

Doctors do not know the cause of uterine fibroids, but clinical research has found the following risk factors:

  • Genetic alterations. Many fibroids have genes that are different from normal uterus muscle cells. According to some studies fibroids have a genetic component and identical twins are more likely to have both myoma than heterozygous twins.
  • Hormones. Estrogen and progesterone, two hormones that stimulate the development of the external wall of the uterus during a menstrual cycle in preparation for pregnancy, appear to favor the growth of fibroids.
    Myoma contains more estrogen and progesterone receptors than   normal cells in the uterine musculature. Fibroids tend to decline after menopause due to a decrease in hormone production.
  • The others. Insulin-like growth factors are substances produced by the liver that can affect the growth of uterine fibroids.

 

What are the symptoms of uterine fibroid?

For most women fibroids do not cause any symptoms.

 

Symptoms according to location, size and number

Uterine submucous myoma . This myoma grows in the internal cavity of the uterus, can cause significant and prolapsed menstrual bleeding and sometimes a problem for women who want to become pregnant.

Subserous uterine
fibroid The subserous fibroid protrudes from the outside or the outside of the uterus, sometimes by pressing the bladder causes symptoms in the urinary tract.
If the myoma moves toward the back of the uterus it can push the rectum, causing a feeling of pressure on the spinal nerves, causing pain in the spine .

Intramural uterine myoma. Some fibroids grow inside the uterine muscular wall. If they become large enough to distort the shape of the uterus and cause prolonged menstrual periods with heavy bleeding, they can also cause pain and pressure.

At least 25% of women who have uterine fibroids have the following symptoms:

Myoma may also cause infertility (not being able to conceive) especially when it is located near the insertion of the fallopian tubes, sputum abortion (before 37 weeks of gestation) if it is inferior to the insertion of the placenta.

 

Diagnosis of uterine fibroid
During palpation inside the vagina or abdomen, the doctor may feel an abnormal form of the uterus.
The diagnostic tests are:

  • The  ultrasound . You can have an abdominal or transvaginal ultrasound (insertion of a catheter into the vagina) to see the inside.
  • Blood tests may be helpful to understand if the patient has anemia due to chronic blood loss and to exclude other problems, for example the thyroid.

If traditional ultrasound is not enough, your doctor may ask:

  • Magnetic Resonance Imaging
  • Hysterosonography . This is an ultrasound that uses a saline solution to expand the uterine cavity, so it is easier to identify a fibroid in the submucosa and in the endometrium.
  • Hysterosalpingography . It is an x-ray of the uterus and fallopian tubes with contrast medium.
  • Hysteroscopy . examination of the uterus and fallopian tubes by inserting a hysteroscope (a thin tool) attached to a chamber.

 

Treatment and drugs for uterine myoma

There is no single approach to uterine fibroid treatment, but there are many treatment options. If you feel the symptoms, you should talk to your doctor about the treatment options.

Watchful waiting
Many women with uterine fibroids have no signs or symptoms but only mild discomfort with which they can live.
Myomas are not cancerous. They rarely interfere with pregnancy.
They usually grow slowly and often tend to decline after menopause when levels of reproductive hormones fall.

Medications
Medications for uterine fibroids act on hormones that regulate the menstrual cycle, serving as a treatment for some symptoms such as abusing menstrual bleeding and pelvic pressure.
They do not eliminate the fibroids, but they can reduce them.

Medicaments include:
Gonadotrophin releasing hormone agonists.
These medicines (found under the tradename Lupron, Synarel and others) treat myomas by blocking the production of estrogen and progesterone, causing a temporary postmenopausal state. As a result, if you stop menstruating, shrink the fibroids and often improves anemia .
Your doctor may prescribe a gonadotropin-releasing hormone agonist to reduce the size of fibroids before scheduled surgery.
Many women feel very hot while using the medication.
Gonadotrophin releasing hormone agonists are usually used no more than three to six months because the symptoms return when they stop taking the medication and long-term use can cause bone loss.

The progesterone-releasing intrauterine device (IUD)
A progesterone-releasing device may relieve severe hemorrhage caused by fibroids.
An IUD only relieves symptoms, but does not restrict or eliminate fibroids.

Other medicines
Your doctor may recommend other medications, such as the birth control pill or progestin that may help control menstrual bleeding, but do not reduce myoma size.
Medications NSAIDs (NSAIDs) are nonhormonal drugs can be effective in relieving pain but does not reduce bleeding caused by fibroids. Your doctor may also recommend vitamins and iron in case of heavy menstrual bleeding and anemia.
Ablation of the uterine myoma by focused ultrasound is a non-invasive treatment option that preserves the uterus, there is no incision and is performed during a day hospital.
This therapy is performed within an MRI using a high energy ultrasonic transducer.
The pictures give the doctor the exact location of the uterine fibroid. When the exact location of myoma is found the ultrasound transducer sends sound waves into the fibroid to heat and destroy small areas of fibroid tissue.
Recent technology, researchers do not know much about long-term safety and effectiveness.
But so far, the data collected show that uterine fibroid ablation by ultrasound is safe and effective.

 

When to operate? When to remove the myoma?

If a woman has severe bleeding, cramps, menstrual pain, infertility, and bladder or bowel disorders, they should consider surgery.

Minimally Invasive Procedures
Some interventions can destroy uterine fibroids without removing them by surgery:

Embolization of the uterine artery
Injecting small particles (embolic agents) into the arteries that supply blood to the uterus, disrupts blood flow to the myoma that then dies (necrosis coagulative).
This technique may be effective in restricting fibroid and relieving symptoms.
Complications can occur if the blood supply to the ovaries or other organs is compromised.

Miolysis
In this laparoscopic procedure, an electric current or laser beam destroys the uterine fibroids and narrows the blood vessels that irrigate it.
A similar procedure called “cryocoagulation myolysis” freezes fibroids.
Myolysis is not often practiced.

Laparoscopic or robotic
myomectomy In a myomectomy, the surgeon removes the fibroid, leaving the uterus in place.
If the fibroids are small and small, we can opt for a laparoscopic or robotic procedure where a long, narrow instrument is inserted through small incisions in the abdomen to remove the myoma from the uterus.
The doctor sees the abdominal area on a monitor connected to a small camera that is located on one of the surgical instruments.
Robotic myomectomy gives the surgeon an enlarged three-dimensional view of the uterus, so it is more accurate than other techniques.
For this laparoscopic surgery, the woman is under total anesthesia , the patient must spend one night in the hospital and the recovery time is about 3-4 weeks.

Hysteroscopic Myomectomy
This procedure may be an option if fibroids are contained within the uterus (submucous). The surgeon removes fibroids using instruments inserted through the vagina and cervix.
This operation is performed in hospital-day and after a few hours of observation in the hospital, you can go home.
Recovery time is 3-4 days rest on the wing.

Endometrial ablation and resection of submucous myoma
This treatment is performed with a special instrument in the uterus that uses heat, microwave energy, hot water or electricity to destroy the inner wall of the uterus that can stop menstruation or decrease flow.
Generally, endometrial ablation is effective in stopping abnormal bleeding.
The submucosal fibroids can be removed at the time of hysteroscopy for endometrial ablation, but this does not affect fibroids outside the inner wall of the uterus.

 

Traditional surgical procedure

Options for traditional surgical procedure are:


Abdominal Myomectomy

If you have several fibroids, very large (> 4cm) and deep fibroids, your doctor may perform an open abdominal operation (laparotomy) to remove fibroids.
Many women think that hysterectomy is the only option, but they can do an abdominal myomectomy.

It is necessary to remember that the uterine fibroid may become a malignant tumor, but it is very rare, so the surgery is only for the symptoms and if the doctor does not suspect a cancer in the uterus.

Hysterectomy
This operation involves the removal of the uterus and remains the only permanent solution for uterine fibroids.
The problem is that hysterectomy is a surgery that eliminates any possibility of having children.
If you choose to remove the ovaries, hysterectomy causes menopause, so you have to evaluate whether to begin hormone replacement therapy.
Menopause causes hormonal and metabolic disorders, for example, a weight gain, you should carefully consider this option.
Most women with uterine fibroids may choose to keep their ovaries.
Abdominal hysterectomy is done under general anesthesia, most women remain 3-4 nights in the hospital and the recovery time is about 6-7 weeks.

Fever after surgery is normal in the first few days, but in case of high fever and other symptoms it is necessary to seek the surgeon.

 

What are the risks and complications of hysterectomy?

As each operation, the risks of abdominal hysterectomy and complications, are as follows:

Do not substitute hormonal and psychological successive complications due to premature menopause.
After surgery, sexual intercourse may continue normally, in fact, one should not feel pain caused by myoma.

 

The risk of developing new fibroids (recurrence)

For all operations except hysterectomy, some small tumors that the doctor does not remove during surgery may grow and cause a relapse.
New fibroids can give symptoms in this case should be treated.

Natural Remedies for Uterine Fibroids
There is no natural homeopathic treatment or herbal remedy to cure fibroids, but there are some products that can reduce symptoms.

The diet and nutrition can help reduce the size of this benign tumor, but there are still no research on the subject.

Preventive Measures
Unfortunately, since the cause of cancer is not fully known, there is no way to prevent the onset of uterine fibroids.
If a woman falls into one of the risk-increasing categories, she should make regular checks for fibroids by her doctor.

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