Women who are in their 30s and 40s, and those who are overweight, are more likely to develop fibromyomas. The tumors vary in size, and can be too small to be visible or large enough to occupy all of the uterus. Although the cause of the tumors is not known, a fibromyoma is more likely to grow when estrogen levels are higher. For this reason, a fibromyoma may slowly enlarge while a woman is still having periods, but may shrink after menopause, when estrogen levels fall.
A fibromyoma of the uterus may develop inside the muscular walls of the womb, in which case it is called an intramural fibromyoma. Submucosal fibroids grow beneath the womb’s inner lining, while what are known as subserous fibromyomas arise from the outside of the uterus and may become huge. Occasionally a pedunculated fibromyoma, a type of fibroid which grows on the end of a stalk, may develop from the outer uterus wall.
Fibromyoma of the Uterus Risk Factors
pregnancyafter the age of 30
• Age over 45
Recently research has proven that fibromyoma can occur in young women below the age of 30 years.
Fibromyoma of the Uterus Symptoms
Abnormal vaginal bleeding:
•Heavy menstrual periods
• Irregular menstrual periods
• Vaginal bleeding after menopause
• Irregular vaginal bleeding:
• Vaginal spotting
• Abnormal vaginal discharge
• Lower abdominal pain
• Pelvic pain
• Chronic pelvic pain
• Abdominal tenderness:
• Right lower abdominal tenderness
• Left lower abdominal tenderness
• Lower abdominal tenderness
• Abdominal swelling
• Pain During Intercourse
• Painful menstrual periods
• Back pain:
• Lower back pain
• Chronic back pain
• Difficulty urinating
• Increased urinary frequency
• Increased urinary urgency
• Urinary incontinence
Fibromyoma of the Uterus Evaluation
The evaluation of uterine fibroids begins with a history and physical exam, including a pelvic exam.
Physical findings in a woman with uterine fibroids may include:
* Vaginal bleeding
* Enlarged uterus during pelvic exam
* Lower abdominal tenderness
Tests that may be used to evaluate uterine fibroids include:
* Uterine biopsy
* PAP smear
* Pelvic ultrasound
* CT scan of the pelvis
* MRI scan of the pelvis
Less commonly performed tests that may be used to evaluate uterine fibroids include:
* Pelvic angiogram
· diagnosis of fibromyomas is usually made using an investigation such as an ultrasound scan. Fibromyoma treatment is only necessary if symptoms are troublesome. A drug known as GnRHa, or gonadotropin releasing hormone agonist, may help shrink the tumors, but it is not generally taken long term due to side effects such as osteoporosis, where bones become fragile.
Fibromyoma of the Uterus Treatment
Most women who have uterine fibroids have few if any symptoms. Small uterine fibroids may not require treatment if they do not cause symptoms. Treatment for large uterine fibroids may include hormone therapy, surgery to remove the fibroids, or hysterectomy. Fibroids that cause heavy vaginal bleeding can lead to significant anemia that may require treatment.
Treatment options for uterine fibroids include:
* Hormone therapy for uterine fibroids:
o Gonadotropin-releasing hormone agonists cause menstruation to stop, causing fibroids to shrink.
* Androgens (Danazol):
o Can relieve fibroid symptoms
o Stops menstruation and can shrink fibroids
o May cause side effects such as weight gain, depression, anxiety, acne, headaches, and excessive body hair.
* Birth control pills and progestins:
o May improve fibroid symptoms
* Progestin-releasing intrauterine device (IUD):
o Can improve fibroid symptoms, but does not shrink them or make them go away.
* Myomectomy for uterine fibroids:
o Removal of the fibroids from the wall of the uterus
* Hysterectomy for uterine fibroids:
o Surgical removal of the uterus
Non-surgical procedures such as UAE, or uterine artery embolization, reduce the size of fibromyomas by removing their blood supply. Endometrial ablation removes the womb lining and cuts away fibroids close to the surface of the uterus. For large fibroids, an operation such as a hysterectomy may be required, where the whole womb is removed. If women wish to have children later, an alternative method called a myomectomy may be carried out, where fibroids are extracted through the cervix, or through an incision in the uterus, sometimes using keyhole surgery techniques.