UTERINE MYOMAS

Uterine myomas also called fibroids are tumors that grow from the wall of the uterus. The wall of the uterus is made of muscle tissue, so a fibroid is a tumor made of muscle tissue. The fibroids start off very small, actually from one cell, and generally grow slowly over years before they cause any problems. Most fibroids are benign; malignant fibroids are rare. The cause of fibroids is unknown, although it is known that fibroids have a tendency to run in families. Fibroids are very common, with an estimated 50% of women having them. Fibroids can be diagnosed by pelvic examination or by ultrasound. Fibroids do not have to be removed unless they are causing symptoms such as heavy periods, irregular bleeding, or severe cramps with periods. Also, sometimes the size alone causes enough discomfort so that removal is necessary. Once women go through menopause, fibroids do not usually cause any further problems.

These tumors can grow very large, sometimes growing as large as a melon. The typical Myoma, however, is around the size of an egg. When the Myoma penetrates the entire wall of the uterus, it is referred to as uterus myomatosus. In certain very rare cases (less than 1/2 of 1% of the time) the tumors can become malignant. When this happens, it is known as sarcoma.

There are four primary types of uterine fibroids, classified primarily according to location in the uterus:

Subserosal uterine fibroids

These fibroids develop in the outer portion of the uterus and continue to grow outward. The most common type of fibroid. These develop within

Intramural uterine fibroids

the uterine wall and expand making the uterus feel larger than normal (which may cause "bulk symptoms"). These fibroids develop just under the lining of the uterine

Submucosal uterine fibroids

cavity. These are the fibroids that have the most effect on heavy menstrual bleeding and the ones that can cause problems with infertility and miscarriage. Fibroids that grow on a small

Pedunculated

stalk that connects them to the inner or outer wall of the uterus.

SIGNS AND SYMPTOMS: Cramping with periods. Heavy flow or clots with periods. Hyper menorrhea

Lower abdominal pain Lumbago Dymenorrhea Irregular vaginal bleeding Dizziness Anemia. Very heavy and prolonged menstrual periods Pain in the back of the legs Pelvic pain or pressure Pain during sexual intercourse Pressure on the bladder which leads to a constant need to urinate, incontinence, or the inability to empty the bladder Pressure on the bowel which can lead to constipation and/or bloating. An enlarged abdomen which may be mistaken for weight gain or pregnancy Discomfort, such as pressure, as well as being unable to lie on your stomach and being unable to button your clothing easily, caused by the mass of the fibroids. Other, less common symptoms include irregular bleeding and urinary frequency caused by the pressure on the bladder from the fibroids. If your periods are very heavy, you may become anemic and an iron supplement may be recommended.

When the Myoma pushes on the intestines or the bladder, it can result in constipation, pain of the bladder, or a constant need to urinate. If the tumor pushes on the nerves in the spinal cord, it can result in pain of the back or the legs.

The causes of uterine Myoma are not fully understood. Some research suggests that Uterine Myoma is less common in women who have had at least two children. For at least one form of uterine Myoma, there seems to be a genetic predisposition.

Uterine Myoma often goes undetected. Ultrasounds, CT Scans, or MRIs may be necessary to fully diagnose uterine Myoma. If you have symptoms of Uterine Myoma, your

health care provider will help you determine the best way to diagnose the problem.

TREATMENT:

If fibroids become symptomatic enough, they can be removed surgically. The most common surgical approach is to perform an abdominal myomectomy. An incision is made in the lower abdomen into the abdominal cavity, and the fibroids are removed from the uterus and the uterus stitched closed. If the uterus is no longer necessary (the woman is finished having her family) and the woman desires her uterus removed, a hysterectomy (removal of the uterus) can be performed. (A hysterectomy is removal of the uterus and cervix, not removal of the ovaries. Therefore, a woman who has a hysterectomy does not necessarily go through menopause.) If a submucous fibroid is diagnosed, then the removal of the fibroid can be performed through the cervix. This is called a hysteroscopic myomectomy. Because the instrument goes through the cervix, there is no cutting. It is usually a same-day procedure, which means you come in on the day of the procedure and go home the same day, with a minimal recovery period. If you are very anemic or the fibroids are very large, you may be treated before surgery with a medication called Depot Lupron. This medication puts you into a temporary menopause, thus decreasing your estrogen levels and causing the fibroids to shrink. Unfortunately, this medication does not shrink the fibroids permanently, so it can not be used as a permanent solution.

Once it is diagnosed, Uterine Myoma can be treated through hormonal and/or herbal treatments. Hormonal treatment typically do not cure the Uterine Myoma. Rather, they give a temporary relief of the symptoms of Uterine Myoma. In addition, these hormones may have certain side effects. If these hormone treatments do not work, surgery is typically an option. Surgical options include the surgical removal of the Myoma tumors (known as an enucleation) or a complete hysterectomy. Recent advances in laser surgery may make this an option also. If this is the case, the surgery can become much less invasive, and can be done laparoscopically.

The DOs Keep your follow-up appointments so that your doctor can check your fibroids regularly. Take your iron supplement if one has been recommended. This will prevent anemia. It is also helpful to eat a diet rich in iron in addition to the iron supplement. If your period cramps are uncomfortable, overthe-counter ibuprofen can be very effective in relieving the cramps. Over-the-counter ibuprofen comes in 200-milligram tablets. You can start with 2 tablets every 4 hours. However, if this does not relieve the cramps enough, you can take 3 tablets (600 milligrams) every 6 hours or 4 tablets (800 milligrams) every 8 hours. You should always take ibuprofen with some food on your stomach to avoid stomach irritation. (Obviously, you should not take ibuprofen if you have an allergy to it, have been told you should not take it or any aspirin-like products, or have a history of ulcer or gastritis.) The DONTs If you take birth control pills, you and your doctor may want to consider another birth control method because the estrogen in the birth control pills sometimes stimulate the fibroids to grow more quickly. When to Call Your Doctor If periods become heavier, either heavier flow or more or larger clots. If you have irregular periods/bleeding. If the ibuprofen does not relieve enough of the cramps. If you feel that the fibroids are suddenly larger, or the mass causes discomfort.