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Also known as uterine fibroids, they are benign tumors of the smooth muscle of the uterus.
The most common tumor found in the female reproductive system, uterine fibroids is seen in 20-25% of all women and is estimated to occur in 40% of women who menstruate for more than 50 years.
In addition, subserosal myomas occur twice as often in black women as in white or Asian women. Subserosal myomas can occur between menarche and menopause but are more common in women 35 to 49. Usually, they resolve after menopause.
Uterine fibroids can be classified by their location as follows:
- Submucosal fibroids are the least common in the submucosa and near the endometrial cavity. They are associated with heavy and prolonged menstrual periods and an increase in spontaneous abortions; Submucosal fibroids can be pedunculated and prolapse on the cervix.
- Intramural myomas grow inside the uterine wall; its growth may be associated with symptoms related to mass, such as abdominal distension due to assembly or urinary frequency due to compression of the bladder.
- Subserosal myomas develop in the outer portion of the uterus; they can be pedunculated, potentially grow in the abdomen or the ligaments of the uterus, and are associated with bladder compression and abdominal distension.
What are subserous myomas?
A subserous myoma is the most common benign (noncancerous) tumor in a woman’s uterus (uterus). Subserosal myomas are smooth muscle tumors found in the wall of the uterus. They can develop inside the uterine wall or adhere to it.
They can grow as a single tumor or in groups. Uterine fibroids can cause excessive menstrual bleeding, pelvic pain, and frequent urination.
These growths occur in up to 50% of all women and are one of the leading causes of hysterectomy (removal of the uterus) in the United States. It is estimated that 600,000 hysterectomies are performed in the USA. UU Annually, and at least one-third of these procedures are for fibroids.
Newer and less invasive medications and surgical treatments are now available to help control the growth of fibroids.
Fibroids start in the muscle tissues of the uterus. They can grow in the uterine cavity (submucosa), in the thickness of the uterine wall (intramuscular), or on the surface of the uterus (subserosal) in the abdominal cavity. Some may occur as pedunculated masses (fibroids growing on a stem outside the uterus).
Although these tumors are called fibroids, they are misleading because they consist of muscle tissue, not fibrous tissue. The medical term is leiomyoma, a type of myoma or mesenchymal tumor.
Causes
The exact reasons why some women develop subserous myoma are unknown. Subserosal fibroids tend to be hereditary and affected women often have a family history of fibroids. Women of African descent are two or three times more likely to develop subserous fibroids than women of other races.
Subserosal myomas grow in response to stimulation by the hormone estrogen, naturally produced in the body. These growths can appear as early as age 20 but shrink after menopause when the body stops producing large amounts of estrogen.
Subserosal myomas can be small and not cause problems, or they can also grow and weigh several pounds. Fibroids usually tend to grow slowly.
The following factors have been associated with the presence of subserosal myomas:
- Being overweight, obesity.
- Never having given birth to a child (called nulliparity)
- Start of the menstrual period before ten years
- African-American heritage (occurring 3-9 times more often than in Caucasian women)
What are the symptoms of subserous myomas?
Most subserosal myomas, even large ones, do not produce symptoms. These masses are often found during a regular pelvic exam.
When women experience symptoms, the most common are the following:
- An increase in menstrual bleeding, known as menorrhagia, sometimes with blood clots;
- Pressure on the bladder, which can cause frequent urination and a sense of urgency to urinate, and, on rare occasions, the inability to urinate;
- Pressure on the rectum, which produces constipation;
- Pelvic pressure, “feeling of fullness” in the lower abdomen, lower abdominal pain;
- Increase the size around the waist and change the abdominal contour (some women may
- Need to increase the size of your clothes but not due to a significant weight gain);
- Infertility, which is defined as the inability to get pregnant after one year of trying to get pregnant; I
- A health professional discovered a pelvic mass during a physical examination.
If a woman has any questions about her uterine health, she should seek medical assistance as soon as possible. If a woman has any of the following, she should notify her health professional:
- Irregular or heavy menstrual cycle, bleeding between periods
- Pelvic or abdominal pain
- Fever or night sweats
- Increase in abdominal circumference
- Concerns about pregnancy or the inability to get pregnant
If a woman has any of the following signs or symptoms, she should contact a health professional immediately or go to the emergency department.
- Menstrual bleeding soaked in more than three compresses per hour
- Severe or prolonged pelvic or abdominal pain
- Dizziness, lightheadedness, shortness of breath, or chest pain associated with vaginal bleeding
- Vaginal bleeding associated with pregnancy or possible pregnancy
Diagnosis
The patient’s doctor will discuss your medical history and perform a physical exam that includes a pelvic exam. Often, a doctor may feel an irregularly shaped uterus when subserosal myomas are present.
If more studies are indicated, the doctor may choose one of the following tests to help decide if the patient has subserous myomas and to exclude other potentially more serious causes of ongoing symptoms:
- An abdominal, transvaginal or pelvic ultrasound can help identify most subserosal myomas’ number, size, and shape. These tests use sound waves to give doctors an image of the pelvic area.
- An endometrial biopsy is done by taking a tissue sample from the uterus. A small instrument is passed through the cervical opening to “grab” small tissue samples inside the uterus. It can be done in a doctor’s office.
- A hysteroscopy is seen inside the uterus by passing a small fiber-optic chamber through the opening of the cervix.
- Hysterosalpingography involves the injection of a dye into the uterus and the fallopian tubes, which are then subjected to an x-ray to identify the anatomy of these structures.
- Laparoscopy is a surgical procedure. The surgeon will insert a tiny fiber-optic camera into the abdomen through small abdominal incisions to observe the internal organs directly.
What is the treatment for subserous myomas?
Treatment for subserosal fibroids depends on the symptoms, the size and location of subserosal myomas, age (how close the person is to menopause), the patient’s desire to have children, and the general health patient.
Are there home remedies?
There is no specific self-care available for subserous myomas. However, if a woman has abnormal or heavy menstrual bleeding, she should keep a diary of her menstrual cycle to provide the information to her health professional.
What is the medical treatment for subserous myomas?
In most cases, treatment is unnecessary, particularly if the woman has no symptoms, has small tumors, or has gone through menopause. Abnormal vaginal bleeding caused by subserosal myomas may require a surgical scraping of the uterine cavity in a procedure known as dilation and curettage (D & C).
Observation
A woman’s doctor can track the size and growth of subserous fibroids over time to make sure there are no cancer indicators. If the person does not have symptoms such as vaginal bleeding or pelvic pain, and if the fibroid is not increasing, no treatment may be needed.
However, some patients may require more frequent pelvic exams, such as every six months, to control changes with fibroids.
What are the medications used?
Patients can receive non-steroidal anti-inflammatory drugs, oral contraceptives (birth control pills), gonadotropin-releasing hormone agonists, or RU-486.
It has been shown that non-steroidal anti-inflammatory agents, such as ibuprofen (Advil is an example), relieve pelvic pain associated with subserosal myomas. Oral contraceptive pills are also commonly used in women with subserous myomas. They often decrease the perceived menstrual blood flow and help with pelvic pain.
Gonadotropin-releasing hormone (GnRH) agonists are drugs that act on the pituitary gland to decrease the amount of estrogen produced by the body. A decrease in estrogen causes subserosal myomas to fall in size.
This type of medication is often used before surgery to reduce the size of the subserous myoma, decrease the amount of blood lost during surgery, or improve preoperative blood counts. The size of the subserous myoma can be reduced by 50% in three months with this type of therapy. But subserosal fibroids can regrow once the treatment is stopped.
Long-term treatment with these medications is limited by the side effects of low estrogen levels (very similar to menopause), which include decreased bone density, osteoporosis, hot flushes, and vaginal dryness.
It has also been shown that the antihormonal drug RU-486 (mifepristone) reduces the size of the myoma by half. It has also been shown that this medication reduces pelvic pain, bladder pressure, and pain in the lower back.
Low doses of this medication can reduce the size of subserosal myomas in preparation for surgery to eliminate them.
It can also help some patients avoid surgery altogether by reducing subserosal myomas and the problems they are causing. Side effects related to low levels of estrogen, observed with GnRH analogs, may be less familiar. RU-486 can induce a miscarriage, so this medication should be used cautiously if a woman is trying to conceive.
The drug danazol (Danocrine) has been used to reduce bleeding in women with subserosal fibroids. This drug causes the cessation of menstruation but does not reduce the size of subserosal myomas.
Danazol is an androgenic (male) hormone drug that can cause serious side effects such as weight gain, muscle cramps, decreased breast size, acne, hirsutism (improper hair growth), oily skin, mood swings, depression, dropped of high-density lipoproteins (HDL or “good cholesterol”) and increased levels of liver enzymes.
Another new medication may be helpful in the treatment of some uterine fibroids. It is a progesterone receptor modulator called EllaOne. It is used as an emergency contraceptive medication, but it was found to reduce subserosal myomas and reduce bleeding associated with subserosal myomas.
What is the surgery for subserous myomas?
Surgery options for treatment have risks and benefits. Be sure to discuss these risks and help the doctor. Some treatment options may not be suitable for a woman due to the characteristics of subserous myomas or other health factors.
Myomectomy is the surgical removal of fibroids only. This can be achieved by hysteroscopy, laparoscopy, or, less frequently, an open procedure (an incision in the abdomen). The surgical approach depends on the size and location of the fibroid.
It has been shown that pretreatment with GnRH analogs decreases blood loss and operative time in women who undergo myomectomy. It has also been demonstrated that myomectomy has a lower probability of injury to the bowel, bladder, or ureter than hysterectomy. In this procedure, the uterus is left intact, and the patient can become pregnant.
Hysterectomy is the surgical removal of the uterus (and subserosal myomas). It is the surgical procedure most commonly performed in treating subserosal myomas and is considered a cure. Depending on the size of the fibroid, hysterectomy can be done with incisions through the vagina or abdomen. In some cases, the procedure can be performed laparoscopically.
The use of GnRH agonists can reduce the size of the fibroid to allow less invasive surgical techniques. In previous experience, there has been less blood loss with hysterectomy than with myomectomy.
Hysterectomy with removal of the fallopian tubes and ovaries (called salpingo-oophorectomy) may be indicated if there is a suspicion of cancer or ovarian masses.
Embolizing the uterine artery or coagulation of the arterial blood supply to the fibroid is an innovative approach that has shown promising results.
This procedure is done by inserting a catheter (small tube) into an artery of the leg (the femoral artery), using a special X-ray video to track the arterial blood supply to the uterus, and then solidifying the street with a small plastic sponge. Or gelatin particles the size of sand grains.
This material blocks the flow of blood to the fibroid and reduces it. This method may be a good option for women if other methods have not worked, do not want surgery, or are not good candidates for surgery. A specialist known as an interventional radiologist performs this procedure.
A newer procedure has also proved promising: focused ultrasound guided by magnetic resonance. In this procedure, MRI is used to drive an ultrasound beam that heats subserosal myomas and helps heat and destroy small areas of fibroid tissue.
Is there another therapy available?
Constipation and hemorrhoids are other symptoms caused by the growing pressure of subserosal myomas. Some women can avoid these problems and relieve symptoms by eating more whole grains, bran, and fruits and drinking lots of water. The natural products of laxatives can also help; A woman should discuss these symptoms and treatments with her health professional.
What is the follow-up of fibroids?
All patients should follow the instructions of their health professional. A health professional may choose to do more frequent pelvic exams, such as every six months, to determine if a fibroid is growing.
Patients should be informed about treatment options. Patients may need to decide depending on their treatment progression and their fibroid symptoms; Your health care providers can help you get information about any treatment option.
Can you avoid this type of tumor?
Women should avoid weight gain after 18 years and maintain an average body weight compared to height. Bodyweight tends to increase the production of estrogen, which aggravates the growth of subserosal myomas.
Exercise can help women control weight and decrease the production of hormones that stimulate subserosal myomas’ growth.
It has not been shown that tobacco use is related to an increase in subserous myomas. But quitting smoking will improve women’s overall health and well-being who have subserous fibroids.
Routine health visits with a health professional can allow early detection of subserosal myomas.
What is the prognosis?
The success of the treatment and the future result depends on the severity of the fibroids or subserosal myomas before the treatment and the treatment chosen. Subserosal myomas can affect fertility, but this depends on the size and location of the subserosal myomas. Many women with subserous myomas are over 35 years old.
This and other factors such as decreased egg quality and decreased ovulation contribute to their inability to get pregnant.
