Myomas (also called fibroids or fibroids) are the most common pelvic tumors in women. They are noncancerous monoclonal tumors arising from the smooth muscle cells and fibroblasts of the myometrium. They occur in women of reproductive age and, when symptomatic, typically present with symptoms of abnormal uterine bleeding and/or pelvic pain/pressure. Myomas can also have reproductive effects (e.g. infertility, adverse pregnancy outcomes).
Myomas are defined according to their location within the uterus:
Intramural myomas (FIGO type 3, 4, 5) - This myoma Types are located within the uterine wall. They can grow large enough to disrupt the uterine cavity or the outer surface of the uterus. Some myomas may be transmural and extend from the outer surface to the inner surface.
Submucosal myomas (FIGO type 0, 1, 2) - These myomas are derived from myometrial cells just under the endometrium (inner lining of the uterus). Submucosal myomas protrude into the inner cavity of the uterus.
Subserosal myomas (FIGO types 6, 7) - These leiomyomas arise from the myometrium on the outer surface of the uterus. They may have a broad or stalked base and be intraligamentary (that is, they lie between the folds of the broad ligament).
Cervical myomas (FIGO type 8) - These leiomyomas are located in the cervix rather than in the uterus itself, and sometimes they protrude into the vagina.
How Common Are Myomas?
Uterine myomas are the most common pelvic tumor in women. Although it is difficult to determine their true frequency, there are studies showing that they are seen in at least half of women. An ultrasound screening study of women ages 18 to 30 found a prevalence of 26 percent in Black women and 7 percent in White women. The incidence of fibroids increases with age during the reproductive years. Fibroids have not been identified in prepubescent girls, but they sometimes occur in adolescents. Most, but not all, patients experience shrinkage of fibroids after menopause.
Why Do Fibroids Occur?
Race – Myoma incidence rates are typically two to two in Black women than in White women. was found three times more. Most of the data on breeds is from the United States, but a bush in South Africa Studies have also shown similar differences in fibroid prevalence between Black and non-Black women.
The etiology of the increased incidence of fibroids in Black women is unknown. Differences in genetic factors, diet, lifestyle, psychosocial stress, and environmental exposure between Black and White women are thought to contribute to this disparity
The natural history of leiomyomas also varies by race. Most white women with a symptomatic fibroid are in their 30s or 40s; However, Black women develop symptoms on average four to six years younger and may even present with disease in their 20s
Hormones: Why fibroids form is partly related to the female hormones estrogen and progesterone.
Giving birth – It is a known fact that giving birth reduces the occurrence of myomas.
Entering early puberty – Early menstruation (<10 years) is associated with an increased risk of developing myomas. Puberty is associated with rising estrogen levels, which plausibly leads to both increased fibroid growth and premature fusion of long bone epiphyses, resulting in short stature.
Using Birth Control Pills – Birth control pills have an effect on fibroids. has been shown to have no effect.
What are the Symptoms of Myomas?
Most myomas are small and do not cause any complaints, but many patients with myomas have problems that interfere with some aspects of their lives and require treatment. There are significant problems. These symptoms are related to the number, size and location of the tumors. Myomas can occur as single or multiple tumors and can range in size from microscopic to tens of centimeters. The size of a uterus with a myoma is measured by the size of the gestational week, for example, a myoma the size of a 20-week pregnancy can be mentioned.
Myoma symptoms are divided into three categories:
Heavy or prolonged menstruation. bleeding
Complaints related to the mass such as pressure, pressure and pain in the groin.
Conditions related to fertility (i.e. infertility or pregnancy complications)
Abnormal uterine bleeding among patients with myoma-related complaints �) and painful menstruation are the most common symptoms, occurring in approximately 26 to 29 percent of all women.
Heavy or prolonged menstrual bleeding – Heavy and/or prolonged menstrual bleeding is the typical pattern of bleeding in fibroids and is the most common. It is a common symptom of myoma. Excessive bleeding due to fibroids may be responsible for problems such as anemia, social embarrassment and loss of productivity in the workforce.
The presence and degree of uterine bleeding is largely determined by the location of the myoma; size is of secondary importance.
Submucosal fibroids that protrude into the uterus and into the uterine cavity are most often associated with significantly heavy menstrual bleeding. Severe anemia may occur in these patients.
Intramural myomas are often associated with heavy or prolonged menstrual bleeding, but subserosal fibroids are not considered a significant risk for heavy menstrual bleeding.
Myomas near the cervix. It may be associated with very heavy bleeding.
The mechanism of heavy menstrual bleeding in patients with myomas is not clear, but it may be caused by the increase in blood vessels in the uterus and the decrease in the contraction force of the uterus in patients with myomas.
Mass effect. Associated complaints- Myomatous uterus has an enlarged and irregular shape and can cause some specific complaints due to the pressure of fibroids in certain places. These complaints and symptoms include groin pain or pressure, urinary tract or bowel obstruction, or vascular compression.
Press or pain in the groin – In general, a feeling of pressure in the groin is common in patients with fibroids, but is less common than abnormal bleeding.
Back pain can sometimes be related to the presence of fibroids, but other possible causes should be considered.
Urinary tract or bowel problems – The urinary tract or intestines can be compressed by fibroids, depending on their size and location . Symptoms and findings include the following:
Urinary tract complaints - Complaints such as inability to urinate completely, very frequent urination and rarely pressure on the kidney tract may occur due to myomas growing on the bladder in the front of the uterus.
Intestinal complaints - Myomas that put pressure on the anus can cause constipation.
Painful periods – Painful periods are a complaint expressed by many patients with fibroids. In many patients, this pain appears to be associated with heavy menstrual flow and/or passage of clot.
Painful sexual intercourse – It is controversial whether patients with myomas are more likely to experience painful intercourse than those without fibroids
Infertility or pregnancy-related complications – Leiomyomas that disrupt the uterine cavity (intramural with a submucosal or intracavitary component) are thought to cause difficulty conceiving and an increased risk of miscarriage. Additionally, leiomyomas have also been associated with adverse pregnancy outcomes.
Myoma prolapse – Rarely, a submucosal leiomyoma prolapses from the cervix and presents with a mass, bleeding, and possible ulceration or infection.
Diagnostic Methods of Myomas
Clinical diagnosis of uterine myomas is made based on pelvic examination and pelvic ultrasound findings. Characteristic complaints further support the clinical diagnosis, although most patients are asymptomatic.
Pelvic examination findings typically include the presence of an enlarged, mobile uterus with an irregular contour on palpation; However, small submucosal or intramural fibroids will not produce a visibly enlarged uterus or an irregular contour. The most common complaints are heavy or prolonged menstrual bleeding, and fibroids may be associated with pelvic pain, infertility, or other symptoms. Typically, clinical diagnosis is confirmed by pelvic ultrasound.
Complaints about fibroids - The most common symptoms of uterine fibroids are heavy or prolonged menstrual bleeding, pelvic pain. or pressure and infertility. The duration, severity, and impact on quality of life of all conditions should be evaluated.
It is important to evaluate the severity of heavy or prolonged menstrual bleeding. A bleeding history is taken and the volume and duration of bleeding are revealed. If there is a possibility that the patient is pregnant, a pregnancy test should be performed. Additionally, depending on the bleeding pattern and risk factors, the clinician may evaluate the risk of endometrial hyperplasia or cancer and whether endometrial sampling is performed.
For patients with groin pain or pressure, the location, severity and characteristics of the pain should be evaluated. Pain related to fibroids is unlikely to have an acute onset, except in rare cases of fibroid torsion and degeneration. Additionally, while some patients with fibroids experience painful periods, the pain associated with fibroids may also not be cyclical. Menstrual-related pain may also indicate adenomyosis, endometriosis, or primary painful menstruation.
Patients may be presented with other potential pain or lumps, such as painful sexual intercourse, inability to urinate, or constipation. You should be asked about symptoms related to fibroids.
The patient should be asked about infertility, recurrent miscarriage or pregnancy complications that may be related to fibroids.
Physical examination – The physical examination includes an abdominal and pelvic examination. Patients with severe menstrual bleeding may become anemic.
Abdominal examination should include palpation for a pelvic-abdominal mass. The uterus with large fibroids can be palpated abdominally. The uterine fundus level should be noted.
A comprehensive pelvic examination is performed. Size, contour, and mobility should be noted during the bimanual pelvic examination. An enlarged, mobile uterus with an irregular contour is suggestive of a fibroid uterus. These findings are useful to track changes in the uterus over time and to aid in surgical planning (e.g., transverse or vertical incision, vaginal surgery, or abdominal approach).
Rarely, a vaginal examination may reveal a fibroid protruding from the cervix into the vagina. . Prolapsed fibroids should be removed and differentiated from a large endocervical or endometrial polyp by the intact consistency of the tissue and evaluation of pathology.
Laboratory testing – Laboratory tests have no role in diagnosing fibroids, but the following may include other associated conditions: It is important in the evaluation of:
Pregnancy – If the patient is pregnant, a pregnancy test should be performed in urine or blood
Anemia – For those with anemia, clinicians should consider bleeding disorders. It should also take into account accompanying etiologies, including.