Uterine Myoma: Causes, Symptoms, Diagnosis and Treatment

This type of myomas represents the most benign form (non-cancerous form) of tumors that originate in the uterus.

These fibroids or uterine fibroids often appear during the fertile years and are not associated with cancer risk in the uterus and are unlikely to develop into malignant tumors.

They are composed of smooth muscles, like the uterine walls (myometrium), but they are much denser than the normal myometrium.

The uterine fibroids are usually round and range from the size of seedlings, undetectable by the human eye, to masses of very large size that can distort and cause an increase in the uterus, another feature is that they can grow in groups or alone.

Many women have uterine fibroids at some point, but they are unaware of it because of the absence of symptoms, which can usually be discovered incidentally during routine pelvic exams or prenatal ultrasounds.

Uterine fibroids are often described based on their location inside the uterus.

Subserosal myomas are found under the serous or lining membrane located on the outside of the uterus.

These often appear localized on the outer surface of the uterus or may be attached to the outer surface by a peduncle.

The so-called submucosal myomas are located inside the uterine cavity, under the inner lining of the uterus.

And finally the intramural myomas are confined within the muscular wall of the uterus.

Causes

The exact causes of the appearance of uterine fibroids are unknown.

It is suggested that women develop these tumors due to genetic abnormalities, alterations of growth factor, abnormalities in the vascular system (blood vessels) and tissue response to injury play a role in the development of fibroids.

Family or genetic history is an important factor, since usually there is a history in the case of the development of uterine fibroids in women within the family.

Apparently the race seems to be associated with the appearance of fibroids.

Thus women of African descent are two to three times more likely to develop fibroids than women of other race descent.

There are other factors that have been associated with the risk of developing uterine fibroids, which include: not having given birth to a child (nulliparity), having before the age of ten the first menstrual period (menarche), consumption of alcoholic beverages (beer), high blood pressure and uterine infections.

Hormones such as estrogen tend to stimulate the development of fibroids, during the first trimester of pregnancy, about a third of uterine fibroids will increase in size and subsequently reduce after birth.

In general, fibroids tend to be reduced when menopause occurs, but when postmenopausal hormone therapy is being administered there may be persistent symptoms.

These tumors are quite common and occur in about 70% to 80% of women when they reach the age of 50 years.

Symptoms of uterine fibroids

Many women with uterine fibroids have mild symptoms or no symptoms and never require treatment. Approximately 1 in 3 women with fibroids experience symptoms, and when these occur, they include:

  • Menorrhagia. Pain and menstrual bleeding.
  • Anemia due to abundant periods of bleeding.
  • Back pain or lower leg pain.
  • Constipation.
  • Discomfort in the lower abdomen, especially in the case of large uterine fibroids.
  • Frequent urination
  • Urinary incontinence
  • Pain during intercourse, known as dyspareunia.
  • Fertility problems
  • Repeated miscarriages.

If the uterine fibroids are large, an increase in weight and swelling may occur in the lower abdomen.

Once the myoma develops, it can continue to grow until it reaches menopause.

And as estrogen levels decrease after the onset of menopause, the fibroid usually shrinks.

Diagnosis

As symptoms are often not observed, they are usually diagnosed during routine medical examinations.

Relying on diagnostic tests, fibroids can be detected and other conditions can be ruled out.

The diagnosis of uterine fibroids is made through a pelvic exam and ultrasound is the most common, simple and economical way to obtain images of the pelvis, to differentiate it from other conditions.

The images obtained by magnetic resonance and computed tomography support the diagnosis of myomas. Sometimes, when you want to determine if a fibroid is present in the uterine cavity (endometrial cavity), it is done through a histerosonogram (HSG).

In this procedure, ultrasound is used to inject contrast fluid into the uterus through the cervix.

The fluid contained within the endometrial cavity helps to project any tissue concentration that is inside, as is the case with submucosal fibroids.

Treatment of uterine fibroids

Medications such as:

  • Non-steroidal anti-inflammatory drugs (FANE): (mefenamic and ibuprofen).
  • Birth control pills: help regulate the ovulation cycle, and can help reduce the amount of pain or bleeding during periods.
  • Intrauterine system of levonorgestrel: this plastic device is placed inside the uterus, and releases a hormone called levonorgestrel.

Severe fibroids do not respond to treatment options and surgery is necessary, such as:

  • Hysterectomy.
  • Myomectomy
  • Endometrial ablation.

Uterine artery embolization (UAE), more specifically embolization of the uterine fibroid (UEF):

  • Percutaneous laser ablation guided by MRI.
  • Focused ultrasound surgery guided by MRI.