Myomas, (also called fibroids) are benign tumours of the myometrium, meaning the muscular tissue of the uterus. They range in size and they can rarely evolve in malignant tumors. Chances of myoma developing into a malignant growth (sarcoma) are less than 1%. Fibroids are the most common type of female reproductive organ tumour and can be found in 50% of female population.
As for their types, there are intramural fibroids (developing within the uterine wall), subserosal myomas (in the outer portion of the uterus) and submucosal myomas (developing just under the lining of the uterine cavity).
Removal of intramural and subserosal fibroids can be done laparoscopically, while submcosal fibroids are removed through hysteroscopy.
Two more types of myoma can develop around the uterus: pedunculated myoma and intraligamentous myoma. The former grow on a small stalk that connects them to the inner or outer wall of the uterus, and the latter develop on the ligaments attached to the uterus.
Most women having uterine myoma do not experience any problems. Symptoms are mainly related to the size and location in the uterus. Common symptoms are:
- Uterine bleeding (metrorrhagia)
- Very heavy and prolonged menstrual periods
- Abdominal pain
- Pain in nearby organs (the bowel, or the urinary bladder) due to pressure exerted by the myoma
- Urinary frequency
- Pain during sexual intercourse
Clinical gynaecologic testing, a transvaginal ultrasound and a magnetic resonance imaging (MRI) session will detect any uterine myoma. More specifically, an MRI defines the depiction of the different size, shape, texture and location of the fibroids, an ultrasound detects fibroids that are bigger than 2cm, while clinical gynaecologic testing can identify the presence of larger fibroids.
Uterine fibroids can be treated either by medication or by surgical removal. The method of treatment depends on their size and number, on the woman’s age and her wish to become pregnant or not.
Medication includes Gn-RH agonist administration which aims at reducing uterine bleeding and bringing fibroids to their initial size. After menopause, fibroids shrink due to estrogen deficiency.
Surgical removal (myomectomy) is necessary when fibroids:
- proliferate rapidly
- cause infertility
- are the cause of miscarriage
- cause pelvic pain
Laparoscopy and robotic surgery are techniques that enable the surgeon to remove myomas safely and effectively. After the procedure, recovery time needed and post-operative pain are minimal, and the aesthetic result is perfect. Thus, the patient can soon return to her daily routine.