Uterine Myoma

 
Uterine myomas constitute a very frequent benign pathology. They may appear at the age of 20 without producing any symptom. Between a 10 and a 20 percent of the patients require some kind of treatment.

 
The tendency nowadays is to resort to minimum invasive techniques to remove or necrotize (destroy) myomas which produce very disturbing and severe symptoms.

Myomas are benign tumors of the uterus which are classified according to the location and size they adopt into submucous, intramural and subserous.

Submucous myomas have their base in the myometrium and they grow towards the uterine cavity (endometrium).

The intramural ones are completely located in the thickness of the uterine wall (myometrium)

Finally, the subserous ones grow towards the outside of the uterus, to the abdominal cavity.

Even though the exact reasons for these lesions are not clear, scientists believe they may be related to a genetic predisposition and hormonal influence. This could explain why they are more frequent in certain races or family groups.

Fibroids can grow fast during pregnancy but they recover their previous size after it. This happens due to the increase of estrogens during that period. On the other hand, they reduce their size during menopause due to estrogen level decrease.

The symptoms

Most of the myomas are asymptomatic, only 10 to 20 percent of women require treatment.

Myomas can appear in 20 year-old women with a slow evolution and generally symptoms become noticeable when reaching the age of 30 or 40.

According to the location, size and amount of fibroids, the patient can present the following symptoms:

• Lingering and abundant menstrual cycles sometimes associated with hemorrhages out of the cycle, which may even lead to anemia. This is the most frequent symptom related to fibroids.

• Intense menstrual pain, like cramps.

• Pelvic pain, distention due to the fibroid mass or to its weight which compresses the neighboring pelvic structures.

• Backache, flanks or even pain in the legs, due to the compression of nerve structures.

• Pain during sexual act.

• Pressure in the urinary system with an increase in the mictional frequency, including the necessity of getting up to urinate at night. In some cases myomas compress the ureters which connect the bladder with the kidneys, blocking the normal passage of the urine from the kidneys.

• Intestine compression provoking constipation or intestinal habits alterations.

• Abdominal distention faking an inexistent weight increase.

• Also, they may appear as recurrent abortions or infertility .

DIAGNOSTICc TEST
 

1.    Pelvic examination. During the examination the doctor will palpate to detect masses or changes in the uterus shape.

2.   Pelvic or transvaginal scan. Painless pelvis exploration with ultrasounds. Myoma is seen as a suggestive image of solid tumor.

3.    Hysteroscopy.

4.  Magnetic resonance or tomography: are also useful for the diagnosis and its relationship with neighboring organs.

 
PROGNOSIS AND COMPLICATIONS

Before menopause, myomas usually grow slowly. Their main complications are:

• Infertility due to problems in the egg implantation.

• Very serious bleeding which requires urgent surgery.

• Very abundant bleeding provoking anemia and jeopardizing the quality of life.

TREATMENT OF THE UTERINE MYOMA

Treatment will depend on the type of myoma, size, location, patient’s future wish of fertility and the surgeon’s skills to operate. It is also important to consider those women who want to keep their uterus.

If a woman presents myomas but not symptoms, most probably her doctor will adopt an expectant attitude controlling the uterus and the fibroids in each gynecological examination, monitoring the symptoms.

Surgery is the most common treatment for uterine myoma. Two kinds of surgery are often carried out:

1. Myomectomy. Extirpate only the myoma. It can be done in isolated and accessible tumors, with women who are in their fertile age. It is desirable because the matrix is kept.

2. Hysterectomy. It is an operation in which the whole uterus is removed. It is necessary when the myoma is multiple, not very accessible, or when uterus conservation is not indispensable (after menopause for example).

3. Uterine embolization. It is a new non-surgical treatment which leads to the retraction and diminution of myomas’ size. This procedure called uterine arterial embolization, was used for the first time in France in 1991 and spread to the United States, Canada and the United Kingdom. The procedure is carried out by interventional surgeon-radiologists and consists in the puncture of the femoral artery (where the groin is), and subsequent embolization (occlusion) of both uterine arteries, under radioscopic control, injecting gellified polyvinyl alcohol particles the size of a sand grain. These particles go in first place where the myomas are, adhering to them without being able to “travel” to any other part of the organism (myomas act as sponges, absorbing them). As a result of the flow restriction, myomas start reducing their size by necrosis (tissue’s death).

When patients consult about myomas, they are many times scan discoveries without presenting symptoms. In that case the attitude is expectant.

 
When they also present some of the symptoms described I suggest in general (depending on the importance of the symptom) to wait as much as possible before surgery, because, among other reasons, menopause helps to soothe the problem since the reduction in the level of estrogens (proper of this stage) also reduces the myomas’ size.

 
If the symptom is the infertility manifested through repeated abortions or embryo nesting impossibilities, surgery tends to be positive.

Homeopathic treatment can’t make a myoma disappear, but it can stop its growth.

 
Many times when reestablishing a person’s energetic equilibrium the symptoms decrease apart from improving the general welfare.

 
I believe it is a very valuable alternative before taking a more invasive decision.
 

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