Myomas are benign “tumors” that originate from the muscle of the uterus. They vary in position and also in size. They can be located inside or outside of the uterus and sometimes their size exceeds 15 cm occupying most of the space in the abdominal cavity.
Myomas are very common. A woman from the white race has 83% risk of having a myoma, whereas a woman from the black race has 92% risk respectively.
How are myomas classified in respect to their position?
Myomas can grow in various locations inside and outside of the uterus. In relation to where they go they can be classified in the following categories:
- Subserous: This type of myoma grows on the outer surface of the uterus and beneath the external cover of the uterus which is called serosa. They can grow and become extremely big. They usually cause symptoms of pressure to adjacent organs like the bladder (increased urinary frequency) or the bowel (constipation).
- Intramural: this myoma protrudes inside the cavity of the uterus and most of the times causes heavy bleeding.
- Penduculated: This type of myoma is hanging from the uterus with a «string» which is responsible for the blood supply. They can either grow inside the abdominal cavity or protrude through the cervix and into the vagina.
Myomas are oestrogen -dependent. This means that during the reproductive age (when the body is full of oestrogen) myomas usually grow in size. During menopause when production of oestrogen falls, myomas shrink or even disappear (the later depends on the premenopausal size).
What are the most common symptoms?
Most of the times myomas don’t cause any symptoms at all. One third of women who have myomas will experience some symptoms or a combination of these.
The most common symptoms are the following:
- “Heavy” periods
- pain anywhere in the abdomen with or without reflection to another part of the body (this usually happens when the myoma is degenerated and calcified)
- Increased urinary frequency
- pain during sex
How are myomas being diagnosed?
The gynaecology surgeon is expected to get the full medical history from the patient so that the symptoms are completely understood. This includes not only the type of symptoms but also the degree to which her everyday routine is affected. Large myomas can be palpated either vaginally or even abdominal especially in thin patients. Most of the times, however, myomas are incidentally discovered during a routine checkup.
The initial approach, especially in myomas that cause heavy bleeding, is to obtain a full blood count in order to establish if there is a significant fall of haemoglobin. This is crucial especially in cases where heavy bleeding comes with weakness or easy fatigue.
It is of the utmost importance to topographically locate the myomas and evaluate their size. This can be achieved both with transvaginal ultrasound and MRI.
How can myomas be treated?
Treatment of myomas should always be individualised in each patient. Crucial factors that play an important role in choosing the best treatment are their size, their location, the symptoms they produce, as well as the woman’s age and desire for future pregnancy.
When surgical intervention is chosen, laparoscopy and hysteroscopy are the preferred methods instead of the classic open approach.
Dr Kyriakopoulos has a great experience in surgical treatment of myomas as he has performed laparoscopically a big number of such procedures with impressive high rates of pregnancy consecutively. He applies new and pioneering surgical techniques for faster healing of the uterus, minimising at the same time scar tissue formation, so that this noble fertility organ stays in perfect functional condition and capable to carry out a future pregnancy.