A myoma is a non-cancerous growth of smooth muscle tissue that can develop in or around the uterus. Also known as uterine fibroids or leiomyomas, myomas are the most common benign tumors found in a woman’s uterus, particularly during her childbearing years. They rarely develop into malignancy.
Factors Influencing Myoma Development
The exact cause of myoma formation remains unclear, but several factors influence their development. Hormones, specifically estrogen and progesterone, play a significant role. Myomas tend to grow in response to elevated levels of these hormones, often shrinking after menopause when hormone production wanes. Myoma cells often contain more estrogen and progesterone receptors than normal uterine muscle cells, contributing to their growth.
Genetic predisposition, such as a family history, triples the risk of developing myomas. Myomas are frequently observed in multiple family members, indicating a hereditary component. Other influencing factors include ethnicity, as African American women experience a higher incidence, earlier onset, and often more severe symptoms. Early menstruation can increase lifetime estrogen exposure, raising the risk. Obesity is also linked to increased incidence, possibly due to fat tissue producing and storing estrogen. Dietary habits, including high consumption of red meat and processed foods, and low vegetable intake, may also contribute to the risk.
Recognizing the Signs and Symptoms
Myomas can cause various symptoms, though some individuals experience no noticeable signs. Symptoms often depend on the myoma’s size, location, and number.
Common menstrual changes include heavy or prolonged menstrual bleeding, known as menorrhagia. Periods may last longer than seven days and require frequent sanitary protection changes. Bleeding can also occur between menstrual cycles.
Myomas can lead to pelvic pressure and pain. This may manifest as a constant fullness, lower back pain, or leg pains. Pain during sexual intercourse can also occur, particularly if myomas are near the cervix.
Pressure on adjacent organs can cause bowel and bladder issues. Individuals may experience frequent urination or difficulty emptying the bladder, which can increase the risk of urinary tract infections. Myomas pressing on the rectum can lead to constipation or rectal pressure.
The Diagnostic Process
Myoma identification typically begins with a routine pelvic examination. During this exam, a healthcare provider might feel uterine irregularities, enlargement, or an abnormal shape, suggesting growths. However, smaller or asymptomatic myomas may not be detected solely by physical examination.
Imaging tests are the primary method for confirming myoma diagnosis and assessing characteristics. Ultrasound is the most common initial imaging technique. Both abdominal and transvaginal ultrasounds use sound waves to create images, assessing size, location, and number.
For more detailed imaging or complex cases, other diagnostic tools may be used. Magnetic Resonance Imaging (MRI) provides a comprehensive view of the uterus and myomas, useful for distinguishing them from other growths and for treatment planning. Procedures like hysteroscopy (inserting a small camera into the uterus) or sonohysterography (injecting saline to enhance ultrasound clarity) are used to visualize myomas inside the uterine cavity, especially submucosal types causing significant bleeding. The diagnostic process aims to confirm the benign nature of the growth and differentiate it from rare malignant growths, such as leiomyosarcomas.
Management and Treatment Pathways
Management and treatment of myomas depend on the presence and severity of symptoms, the myoma’s size and location, and the individual’s desire for future fertility. For individuals with asymptomatic myomas or those experiencing mild symptoms, watchful waiting is often the initial approach. This involves monitoring the myomas over time, as many do not grow or cause problems, and they often shrink after menopause.
Medications can help manage symptoms, particularly heavy bleeding and pain. Hormonal therapies, such as Gonadotropin-releasing hormone (GnRH) agonists, reduce estrogen and progesterone levels, leading to a decrease in myoma size by about 30-35% and improved bleeding. These are generally used for short periods, often to prepare for surgery or as a bridge to menopause, due to potential side effects like bone mineral density loss. Levonorgestrel-releasing intrauterine systems (IUDs) can also reduce heavy menstrual bleeding.
Non-invasive and minimally invasive procedures offer alternatives to traditional surgery. Uterine Artery Embolization (UAE) blocks the blood supply to myomas, causing them to shrink and die. Radiofrequency ablation uses heat or electric current to destroy myoma tissue, reducing its volume. MRI-guided focused ultrasound (FUS) uses high-frequency ultrasound waves to heat and destroy myoma tissue while preserving the uterus.
Surgical options provide definitive solutions. Myomectomy surgically removes myomas while preserving the uterus, an option for individuals who wish to retain fertility. This can be performed through various approaches, including open abdominal surgery, laparoscopy, or hysteroscopy, depending on myoma size and location. Hysterectomy, the surgical removal of the uterus, is a permanent solution for myomas, often recommended for individuals with severe symptoms who do not desire future pregnancies.