Myoma: affects 50% of women and deserves attention

Virtually everyone has heard about fibroids, but not everyone knows for sure what they are, what are the causes and symptoms they can cause, or how they should be treated.

The most common symptoms of these nodules are abnormal uterine bleeding, pain, infertility, miscarriage, among others. But it is worth noting that in many women they are asymptomatic.

Lilian Freitas de Oliveira Carneiro (CRM-MG 31517), an oncologist at Oncomed BH, highlights that uterine myomatosis is a disease with a high incidence. “It affects about 50% of women between the ages of 30 and 50,” she says.

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“It occurs three to nine times more in black women. They have fibroids at younger ages and are more likely to have more or larger fibroids,” adds Lilian.

Other risk factors for uterine fibroids, according to the oncologist, are:

• Heredity: history of the disease in the family (mother or sister).
• Obesity – weight gain: Being overweight can lead to hormonal dysfunction due to the increased number of fat cells.

What are uterine fibroids?

Fibroids are benign tumors that develop in the uterus and often appear during childbearing years. “The scientific name is uterine leiomyoma (leio=smooth; myo=muscle; oma=benign tumor). Fibroids develop from the smooth muscle tissue of the uterus (myometrium) that grows into or out of the uterus. A cell divides repeatedly and wildly until it forms a different mass from nearby tissues. The fibroid can change the shape of the organ as it develops”, explains Lilian.

Fabiane Sabbag, gynecologist and obstetrician at Hospital e Maternidade São Luiz Itaim, points out that the origin of fibroids is unknown. “But it is known that its growth occurs by hormonal induction, mainly by estrogen”, she says.

types of fibroids

Lilian explains that fibroids are classified according to their location on the wall of the uterus:

Submucous: appear inside the uterus, in the deepest part of the organ. “They are less common, but can lead to profuse bleeding and anemia, as they lead to intense and prolonged menstrual periods”, says the oncologist.

Intramural: grows inside the uterine wall and expands, causing the uterus to increase in size. “They are the most common types of fibroids and usually cause heavy menstrual flow, pelvic pain or a feeling of heaviness and cramps”, explains the doctor.

Subserous: arising on the outside of the uterus, usually growing outwards. “They don’t usually affect menstrual flow. The main symptom is perceived discomfort when they start to compress other organs of the pelvis, such as the intestine”, says Lilian.

Pediculated: can be confused with ovarian tumors. “They are connected to the uterus only by a tissue called a pedicle. Usually asymptomatic, the growth of the myoma over time can predispose to torsion of its pedicle, causing acute pain, which can lead to the need for urgent surgery for its removal”, explains Lilian.

Intracavitary fibroids: They are located entirely within the uterine cavity. “They usually cause bleeding between periods and often cause cramping,” says the doctor.

Symptoms

Lilian explains that despite being a very prevalent problem, many women with uterine fibroids are asymptomatic. That is, the disease often causes no symptoms. But, the main and most common symptoms produced by myoma, according to the doctor, are:

• Excessive menstrual bleeding;
• Heavy irregular menstruation and prolonged menstrual periods – seven days or more of menstrual bleeding – which can lead to anemia
• Atypical monthly bleeding (between periods), sometimes with clots;
• Feeling of pressure or pelvic pain – cramping;
• Abdominal pain;
• Urinary incontinence / frequent urination;
• Difficulty emptying the bladder;
• Irregular functioning of the intestine – “constipation”;
• Pain during sexual intercourse.

Fabiane points out that each case is different, and everything depends especially on the location of the myoma. “If it’s internal, it can cause irregular bleeding, sometimes very heavy; colic… If it is on the outside, and if it grows too much, it can cause pain, compress organs. But in many cases the fibroid is asymptomatic,” he recalls.

“Sometimes the fibroid is small and doesn’t even bother the woman. The important thing is that she doesn’t despair… But, yes, look for your doctor, who will analyze: where is the myoma? How many? Which size? And, thus, it will indicate the best way to treat the problem”, comments the gynecologist.

Diagnosis

Lilian explains that the diagnosis is usually made in a gynecological consultation, taking into account the complaints presented by the patient and also through the local physical examination. “Gynecological examination reveals the alteration, enlargement of the uterus or alteration of its relief. Transvaginal ultrasound is the exam indicated to confirm the diagnosis. It reveals the number of fibroids, the location and size of each one,” she says.

treatments

Fabiane points out that the patient’s treatment will depend on the location, size and number of fibroids. “It could be clinical or surgical,” she says.

“These factors can also determine whether the fibroid will make a possible pregnancy difficult or increase the risk of miscarriage, as well as bring pain or cause premature labor”, adds the gynecologist.

Lilian emphasizes that the treatment must be individualized and consider factors such as symptoms, age, plans to have children, the desire to preserve the uterus.

“In women with uterine fibroids, but asymptomatic, or with only mild symptoms, medical follow-up, without necessarily using any medication or undergoing surgery, may be the best option”, says Lilian.

Other treatment options, according to Lilian, are:

Hysterectomy: Surgery used to remove the uterus. However, it is not suitable for women who still want to have children or want to keep the uterus.

Myomectomy: Surgery to remove the fibroid, preserving the uterus. It is indicated for women who wish to preserve their fertility or for those who have infertility caused by myoma.

Embolization: A procedure in which a substance is injected to block the tumor from feeding. There is improvement of complaints and reduction of fibroids. It is not considered a completely safe option for women who still want to have children.

Focused ultrasound guided by magnetic resonance: the ultrasound waves are directed to a specific region of the tumor, where the temperature rises up to 90ºC, destroying the tissue. Studies are being carried out to assess for which cases the method is effective.

Medications: will not kill tumors, but use is advised to reduce symptoms. They can be hormone-based, anti-inflammatory or antifibrinolytic.

Causes and prevention

Fabiane points out that the origin of a fibroid is unknown. “But it is known that its growth occurs by hormonal induction, mainly by estrogen”, she recalls.

Lilian explains that the appearance of a fibroid can occur after menarche (first menstruation) and last until menopause. “It is already known that hormonal factors – progesterone and estrogen, hormones that stimulate the endometrium during each menstrual cycle – influence its development,” she adds.

“In menopause, when there is a drop in the production of estrogen hormones, the myoma usually decreases in size and even disappears”, says Lilian. “During pregnancy, on the contrary, its tendency is to increase.”

Also according to Lilian, there is no way to prevent fibroids.

Thus, the best recommendation is that women make regular visits to the gynecologist so that they are always attentive to their health. And, in the case of emergence of this or other diseases, everything tends to be resolved in the best possible way.

As weight gain is considered a risk factor, keeping yourself at the right weight is also interesting (not least because it prevents many other health problems).

7 questions about fibroids clarified

1. After treatment, can fibroids come back?

Lilian points out that the definitive treatment of myoma is done with surgery. “When you choose drug treatment, this can happen. In fact, there is no medicine that will make it go away. Some drugs can stop its growth or even temporarily reduce its size. But as they cause strong side effects and cannot be used for more than three to four months, the fibroid grows back when treatment is stopped,” she clarifies.

2. After treatment, will my period be normal and regular?

Fabiane explains that myoma should not change menstruation, unless it is inside the uterus. “In this case, removing the fibroid, menstruation will return to normal. That is, if menstruation was altered due to myoma, it will return to normal.”

“And if the woman did not have her menstruation altered, it will not change”, adds the gynecologist.

3. Can anyone who has or had a fibroid get pregnant?

Fabiane explains that if the fibroid was interfering with fertility, treating the problem, the woman will probably be able to get pregnant.

4. Can myoma become cancer?

Fabiane explains that no. “Malignant transformation is very rare. What can happen is that the woman already has a malignant tumor and it is mistaken for a fibroid. A fibroid may even grow, but it will always be a fibroid,” she says.

5. If my mother or grandmother had fibroids, should I be concerned?

According to Fabiane, yes, as it may have more tendency.

It is worth remembering that heredity (history of the disease in the family) is considered a risk factor.

6. What tests should I do to detect this problem and maintain preventive care?

It is worth remembering that the diagnosis of tumor is carried out in consultation with the gynecologist, taking into account the patient’s complaints and physical examination (which evaluates whether the uterus has increased size).

Fabiane explains that, in general, ultrasound is performed first. If further delving is required, an MRI of the pelvis may be ordered. If suspected, hysteroscopy (to see inside the uterus) is done.

The general recommendation is that, regardless of symptoms, women do gynecological follow-up to keep an eye on the emergence of this or other diseases.

7. If the woman becomes pregnant and has fibroids, are she and the baby at risk?

Each case is unique and must be analyzed individually. “If the woman has many fibroids, she can have a premature labor and there is a greater risk of miscarriage. It’s a risky prenatal care, but if it’s a well-accompanied pregnancy, if the woman follows all the guidelines, it’s probably going to be okay”, highlights Fabiane.

It is worth mentioning that the treatment depends on the location, size and number of fibroids. Such factors can also determine whether the fibroid will make a possible pregnancy difficult or increase the risk of miscarriage, as well as bring pain or cause premature labor.

Finally, it is worth noting: although myoma is a typically female problem with a high incidence, its presence is not always a cause for concern. It often doesn’t even cause symptoms. O…