About the Disease

Myoma is the usual term for benign tumors called uterine leiomyomas, also known as fibromas or fibroids. They correspond to 95% of all benign tumors of the female genital tract, and affect up to one third of all women of childbearing age, being the major cause of hysterectomies (surgery to remove the uterus).

They are basically formed by smooth muscle cells (the same cells that make up the uterine muscle) and connective tissue (responsible for the support and nutrition of other cells). And they affect both the body of the uterus and the region of the cervix.

Some risk factors have already been well established in the literature – family history is one of them: women with relatives who have the disease are more likely to develop it. Black women are up to 3 times more likely to develop the disease, as well as those who are of childbearing age. It is rarely found in patients who have not yet entered puberty, and has reduced incidence in women who are already in the climacteric. Some other studies have risk factors such as early menarche (first menstruation before age 10), hypertension and alcohol consumption.

There are some factors that seemingly protect women from developing new myomas, among them the main one is the use of the oral contraceptives. However studies show that diets rich in vegetables can decrease the chance of developing this tumor.

These tumors are said to be monoclonal, that is, each myoma grows from a single cell, which duplicates multiple times and presents itself as a tumor. For this reason, the patient can have several myomas at the same time and all of them differ from each other, as well as have individual characteristics. Its development involves several hormones, enzymes and even genetic mutations; however, the main hormone that modulates the growth of this tumor is estrogen, since myoma cells have a high number of receptors for this hormone, which makes them more responsive than others.

As much as it is a very common disease, up to half of women who have this type of tumor do not develop any symptoms. The clinical manifestation that most takes a patient with uterine fibroids to the office is abnormal uterine bleeding, which is characterized by abnormally intense menstrual flow, increased menstrual period and even bleeding between menstrual periods. Symptoms such as pelvic pain (lower abdomen) and pain during intercourse may appear.

When the fibroid is very large in volume, a palpable mass may appear in the abdomen, urinary and intestinal alterations, such as recurrent urinary infections, increased urination, a feeling of not completely emptying the bladder, constipation, among others.

It is known that the myoma itself does not interfere with ovulation, but it is associated with infertility in up to 10% of cases, no matter how much this topic is contested in the literature, nor that sometimes other factors can coexist, the myoma can be the responsible one for infertility.

To diagnose myoma, a good interview and physical examination can be able to make the diagnosis or at least suspect this hypothesis. A very simple, low-invasive and very accessible exam is ultrasound, either through the abdomen or vaginally, in the hands of an experienced examiner who can make the diagnosis by demonstrating the size, location and number of nodules. The best exam for visualization and measurement of leiomyomas is – no doubt – nuclear magnetic resonance, which can differentiate even from other pathologies, such as adenomyosis, but it has very high cost and difficult accessibility.

Endoscopic exams in uterine fibroids have specific indications: video-hysteroscopy, which is one of the main exams for complaints of abnormal uterine bleeding. In this exam a very thin optic is introduced through the external orifice of the cervical canal (of the cervix) and there is a view of the uterine cavity. In some types of fibroids it can make the diagnosis and even the treatment at the same surgical time. Videolaparascopy, on the other hand, is used in women with infertility to be clarified and the fibroid may be an incidental finding when this optic is introduced through the navel allowing to view the peritoneal cavity.

When fibroids are asymptomatic, or little symptomatic in patients in perimenopause, an expectant approach can be chosen, in which the patient would not be treated immediately, but rather periodically followed-up with ultrasound examinations every six months. When considering clinical treatment, medication in this case, the treatment of some related symptoms is considered, such as irregular bleeding or even the reduction of the tumor to facilitate the subsequent surgical process, with drugs containing hormones which interfere with the physiological hormonal production.

Surgical treatment is the modality that solves this disease de facto, since it aims the complete extraction of the tumor and not only the reduction of size or symptom control. Hysterectomy – complete removal of the uterus – is the most radical and widely performed method for the treatment of fibroids in the world, it is indicated for patients with already constituted and very symptomatic offspring. It is possible to perform myomectomy, in which only the fibroid is removed, thus preserving the uterus and fertility in women who still wish to become pregnant and the fibroid is the cause of infertility and / or repeated abortions. It can be done by laparatomic (open surgery) or laparoscopic pathways (by videolaparoscopy). The choice depends on the surgeon’s experience, size and quantity of leiomyomas, etc.

In cases of submucosal fibroids they can be removed by hysteroscopy, with some exceptions. Endometrial ablation can be performed aswell , in which there is destruction of the endometrium and thus the improvement of bleeding symptoms, however it is an alternative modality for some selected cases.

There are also treatment alternatives, such as myolysis, uterine artery occlusion, uterine artery embolization and focused ultrasound guided by nuclear magnetic resonance (ExAblate 2000).

There is no way to talk about the best treatment, each patient must be individualized and presented with possible treatment alternatives according to their clinical case.

As to the frequent doubt about the possible transformation of the myoma into a malignant tumor, it should be clarified that fibroids are tumors that can degenerate, which means undergo changes in their cellular structures, but this transformation is rarely malignant. It is known as sarcomatous degeneration and occurs in only 0.5% of cases, mainly in women after menopause.

Schedule an Appointment

The Crispi Institute is qualified for the diagnosis and treatment of highly complex gynecological diseases.