3. DEFINITION
Myoma of uterus (fibromyomas ,leiomyoma ,fibroma ,fibroids ) are the
commonest benign neoplasm arising from uterus. They are commonly
seen in women of reproductive phase.
They are slow growing tumors and takes 3-5 years to be clinically
palpable unlike ovarian tumors. Small fibroids are palpable only on
vaginal examination, but once uterus is enlarged it is palpable per
abdomen.They tent to be multiple in numbers. Size may vary from
peanut size to size of a head of a newborn.
All fibroids begin in myometrium but some may grow more towards
endometrial cavity.
4. CLASSIFICATION
The tumor may grow symmetrically , remaining within the myometrial wall it is called
intramural or interstitial.
If the tumor grows outwards towards the peritoneal surface , it shows itself as a
bossy growth and is called subserous.
Further extrusion outwards with the development of a pedicle makes it a
pedunclated fibroid. In rare cases such tumor gets attached to a vascular organ and is
cut off from its utrine origin(parasitic fibroid)
Uterine contractions may force the myoma towards the cavity where it is covered
only by a thin endometrium ,it is called submucous myoma. This myoma may force
itself downwards toward the vagina by a pedicle and it is called submucous
myomatous polyp.
The distribution of myoma in the body of the uterus is broadly classified as:
intramural , submucous, subserous.
5. The majory of myomas arise in the uterus but they may also arise from
the round ligament, the utero-ovarian and utero-sacral ligaments, the
vagina and the vulva. Tumors can therefore be classified as uterine and
extrauterine-the uterine myomas are further divided into those that arise
from the body and those that arise from the cervix.
Subserous and cervical myomas contain more fibrous tissue and less of
muscle as compared to other varieties of uterine myomas.
6.
7. SYMPTOMS
Heavy menstrual bleeding
Menstrual periods lasting more than a week
Pelvic pressure or pain
Frequent urination
Difficulty emptying the bladder
Constipation
Backache or leg pains
8. MANAGEMENT
MEDICATIONS:
GnRH agonists : blocks the production of estrogen and progesterone, putting a
temporary menopause like state. GnRH agonists include leuprolide, goserelin and
triptorelin.
Progestin-releasing intrauterine device(IUD): it relieve heavy bleeding caused by
fibroids.
Tranexamic acid: to ease heavy menstrual periods.
Other medications:oral contraceptives can help control menstrual bleeding, but they
don’t reduce fibroid size. NSAIDs relieving pain related to fibroids, but they don’t
reduce bleeding caused by fibroids.
