Uterine Myoma Definition, Reason, Symptoms, Treatment & Prevention
Understanding
Uterine myoma or myoma is a condition of mass growth inside the uterus or outside the uterus that is not malignant.
Usually, myomas are located in the uterine wall, and their shape protrudes towards the endometrial cavity or the surface of the uterus.
In addition, the number and size of myomas may vary. Occasionally, one or more masses may be found.
As many as 20 percent of myoma cases appear at childbearing age, which are usually found accidentally during routine checks.
Others, 40-50 percent of asymptomatic myoma cases are found in women aged 35 years.
Symptoms
Usually, uterine myoma disease does not cause symptoms that are easily recognized by the sufferer.
However, for some women, the characteristics and signs of myoma (uterine myoma) are as follows:
- Menstruation in large quantities
- The stomach feels full and enlarged
- Chronic pelvic pain that is prolonged and does not go away. Pain can appear during menstruation, after sex, or when there is pressure on the pelvis
This pain occurs due to the twisting of the stem of the myoma, dilation of the cervix due to the pressure of the myoma, or cell death from the myoma.
- Urinary disorders. Occurs due to the large size of the myoma then pressing on the urinary tract, causing frequent urinary frequency
- This symptom occurs because the size of the myoma presses on the lower part of the large intestine, which makes it difficult to defecate
- Mioma discharge through the cervix. Usually accompanied by symptoms of severe pain causing injury, and there is a possibility of infection
- Accumulation of fluid in the abdominal cavity
Reason
Experts do not know the exact cause of uterine fibroids.
However, research and clinical experience show the following factors as triggers for the cause of myoma in women.
1. Genetic Changes
Many uterine myoma masses contain different gene changes than normal uterine muscle cells.
2. Hormones
Progesterone and estrogen are two hormones that play a role in stimulating the development of the lining of the uterus during each menstrual cycle. These two hormones also seem to promote the growth of this disorder.
Uterine myomas contain more progesterone and estrogen receptors than normal uterine muscle cells.
Mioma tends to shrink after menopause due to decreased hormone production.
3. Other Growth Factors
Substances that help the body maintain tissue, such as insulin-like growth factors, can influence the growth of this disorder.
4. Extracellular Matrix (ECM)
ECM is a compound that makes cells stick together in the uterus. The ECM will increase in this disorder and make it more fibrous.
The ECM also stores growth factors and causes biological changes within the cell itself.
On the other hand, experts believe that uterine fibroids develop from stem cells in the smooth muscle tissue of the uterus (myometrium).
One cell divides repeatedly and in the end creates a spongy mass that is different from the surrounding tissue.
Uterine myoma growth patterns vary. Some grow slowly or quickly, stay the same size, or some can shrink on their own.
Risk Factors
There are several known risk factors for the appearance of uterine fibroids, including:
Ras
All women of reproductive age of any race can develop uterine fibroids. However, black women are more likely to have this disorder than women of other racial groups.
In addition, black women can have uterine fibroids at an earlier age.
They also tend to get more or larger myomas, along with more severe symptoms.
Descendants
If your mother or sister has this disorder, you are at higher risk.
another factor
Starting menstruation at an early age, being overweight, lacking vitamin D, having a history of a diet high in red meat and lower in green vegetables, fruit and milk; and drinking alcohol, seem to increase the risk of developing uterine fibroids.
Diagnosis
In diagnosing uterine myoma, the obstetrician and gynecologist will first conduct a medical interview (anamnesis).
Anamnesis is done to find out whether the patient often complains of a feeling of heaviness and a lump in the lower abdomen, and has menstrual disorders accompanied by pain.
After that, the doctor will carry out a physical examination. Physical examination by bimanual will reveal a mass or lump in the uterus.
Generally, these masses are located in the midline or slightly to the side, which when felt are lumps.
After that, the doctor can carry out supporting examinations to support the final results.
Here are some supporting examinations to diagnose uterine myoma.
1. Ultrasound (Ultrasound)
The doctor can use sound waves (ultrasound) to get an image of the uterus.
This method is used to confirm the diagnosis as well as map and also measure the mass in the uterus.
The doctor or medical worker uses an ultrasound device over the patient’s abdomen (transabdominal) or also places it in the vagina (transvaginal) to get an image of the uterus.
2. Laboratory Tests
If there is abnormal menstrual bleeding, the doctor may order other tests to find out a potential cause, such as a complete blood count (CBC).
3. Magnetic Resonance Imaging (MRI)
An MRI imaging test can show in more detail the location and size of the myoma. This method can also be done to identify the type of tumor and help determine the right choice of therapy.
MRI is often applied to women with a larger uterus, or to women approaching menopause (perimenopause).
4. Hysterosonography
Hysterosonography using sterile normal saline fluid. This method is useful for obtaining images of submucosal uterine myomas and fibroid layers.
5. Histerosalpingografi
A hysterosalpingography examination uses a dye that is used to highlight the uterine cavity and fallopian tubes on X-ray images.
Doctors may recommend it if infertility is a concern. The test will help the doctor determine if a patient’s fallopian tubes are open or blocked.
The hysterosalpingography method may also show some submucosal myomas.
6. Hysteroscopy
For this examination, the doctor inserts an instrument similar to a small lighted telescope called a hysteroscope through the cervix into the uterus.
Then, the doctor injects a saline solution into the uterus, thereby expanding the uterine cavity. The doctor can also examine the uterine wall and also the opening of the fallopian tubes.
Treatment
Initial treatment of uterine myoma can be done according to the symptoms felt, such as giving anti-pain in the form of paracetamol.
In addition, there are several treatment options for uterine fibroids performed by obstetricians and gynecologists, namely:
- USG
Physical examination and ultrasound should be repeated every 6-8 weeks to see the growth of myomas, including their size and number.
If growth is stable, the patient will usually be observed every 3 – 4 months.
- Hormonal Therapy
Hormonal treatment can be taken using progestin preparations or gonadotropin-releasing hormone (GnRH).
This preparation will produce a hypoestrogenic effect which has satisfactory results for myoma therapy.
- Progestin-Release Intrauterine Device (IUD).
A progestin-releasing IUD can ease heavy bleeding caused by uterine fibroids.
The IUD actually only relieves symptoms, prevents pregnancy, and does not reduce the mass of uterine myomas or eliminate them.
- Assam Tranexamat
These non-hormonal drugs are used to relieve heavy menstrual periods or in patients with heavy bleeding.
- Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
NSAIDs may be effective in relieving pain associated with uterine myomas. However, these drugs do not reduce bleeding.
Your doctor may also advise you to take vitamins and iron if you have heavy menstrual bleeding and anemia.
- Myomectomy
Another way to treat uterine fibroids is through myomectomy, which is an operation to remove myoma.
Myectomy will be considered if the patient is young and wants to have children. However, the possibility of myoma growing again after myomectomy is around 20-25 percent.
After surgery, women are usually advised to postpone pregnancy for about 4-6 months, because the uterus is still in a fragile state.
Unfortunately, sometimes there are complications from the operation, namely the risk of bleeding.
- Hysterectomy
The hysterectomy method will be considered in patients with persistent pain, recurrent myomas (even after surgery), and do not want more children.
- Uterine Artery Embolization
The uterine artery embolization procedure uses small particles (embolic agents) that are injected into the arteries that supply blood to the uterus.
This method will cut off blood flow to uterine myomas, which cause lumps or masses until they eventually shrink and die.
- Radiofrequency Ablation
In a radiofrequency ablation procedure, radiofrequency energy destroys the masses of uterine fibroids, while shrinking the blood vessels that “feed” them.
This can be done during a laparoscopic or transcervical procedure, a similar procedure called cryo myolysis to freeze uterine myomas.
- Laparoscopic or Robotic Myomectomy
In a myomectomy, the surgeon removes uterine fibroid tissue, leaving the uterus in place.
If the myoma tissue is small in number, the patient and doctor may choose a laparoscopic or robotic procedure.
This method uses a flat instrument inserted through a small incision in the abdominal area to remove the mass from the uterus.
Larger uterine myoma masses can be removed with smaller incisions, then broken into several parts or morcellation.
This method can be done in a surgical bag, or by expanding an incision to remove the mass.
Prevention
Little scientific evidence is available on how to prevent uterine fibroids.
However, living a healthy lifestyle might minimize you from getting these health problems, such as:
- Maintain a healthy weight
- Consume healthy and balanced food, multiply fruits and vegetables
- Exercise regularly
- Several studies have also shown that the use of hormonal contraception may be associated with a lower risk of uterine fibroids.
Complications
Although uterine myomas are usually harmless, they can cause complications, one of which is a decrease in red blood cells, which can lead to fatigue and excessive blood loss.
Uterine myomas usually do not interfere with pregnancy, although submucosal fibroids may develop. This condition can cause infertility or miscarriage.
Uterine myomas can also increase the risk of pregnancy complications, such as placental abruption, stunted fetal growth, and premature birth.
When to See a Doctor?
If you experience some of these things, you should immediately consult an obstetrician and gynecologist:
- Menstruation that doesn’t stop and is painful
- Abdominal and pelvic pain that is severe and does not improve
- Menstruation is long and painful
- Heavy bleeding in large quantities that occurs suddenly
- Problems with frequent urination that are getting worse