Medicine for Africa - Medical Information Service

IBROMYOMA

Definition:
 
Fibroids, medically known as 'leiomyomas' or simply 'myomas' are tumorous growths composed of smooth muscle cells and admixed with fibrous cells. Smooth muscle is the kind of muscle that is not subject to control by the mind, but which functions 'automatically' (e.g. the intestinal tract is surrounded by smooth muscles which 'work' when filled, i.e. when food has to be propelled forward). Smooth muscle tumors (leiomyomas or myomas) are almost always benign tumors, with a very low chance of progress to a malignant variant (about 2-3%). Myomas are the most frequent type of tumorous growth in the pelvic area. Most often, they occur in the walls of the womb (uterus) in a woman (intramural myoma); in addition, they can occur underneath the peritoneal layer of the uterus (subserous myoma), where they grow in a mushroom like shape (pedunculated) at times and can become necrotic (the tissue dies) if twisted. Other myomas grow under the mucosal lining of the endometrial cavity within the uterus (submucous myoma) and can cause heavy menstrual irregularities and even infertility. Less frequently observed locations are in the walls of the cervix and subserous myomas which grow into the ligaments along the fallopian tube.
 
The growth of all myomas is subject to hormonal control, especially estrogen and progesterone, causing them to grow at certain times during a woman's period as well as during pregnancy, while their growth usually subsides and even regresses after menopause has been established. In addition to the uterus, small leiomyomas can occur in a large variety of places -- such as the walls of the intestinal tract or even the walls of larger vessels as well as in smooth muscle coats of other organs. However, these locations are rarely affected by myomas, and when they occur, they cause only occasionally adverse effects. Most of the time, they are found accidentally by a physician during routine examinations.
 

Symptoms:
 
Symptoms caused by myomas of the uterus are usually mild and depend on the precise location of the myoma. Intramural myomas (which occur within the muscle wall of the uterus) can become quite large, thereby interfering with the normal expansion of the uterus during pregnancy or decreasing the amount of space available for the offspring, and thus may create problems during delivery. Subserous myomas (myomas that grow underneath the peritoneal layer of the uterus) sometimes grow in a mushroom-like shape (pedunculated) and if so, they may become necrotic if twisted. Both myoma types, if sufficiently large, can cause pressure on the urinary bladder as well as on the colon. When they are pressing against the bladder, pressure can result in symptoms of urgency or in difficulties during urination with occasionally an increased risk of urinary tract infections. When the myomas press against the colon, symptoms of constipation may develop.
 
Submucous myomas (myomas that develop underneath the mucosa of the uterine cavity) often cause irregularities during the menstrual periods with heavier (hypermenorrhea) or longer lasting (menorrhagia) menstrual bleeding. They can also interfere with the normal imbedding of the fertilized embryo and cause subsequent abortions.
 
Myomas that have been present for a long time can degenerate into either soft necrotic tumors or become firm and hard (hyalinized) by the overgrowth of connective tissue fibers throughout the tumor. In such cases, even small sized tumors can cause pelvic pain and symptoms of fullness or an unpleasant feeling for the woman, and may need to be treated surgically.
 

Diagnosis:
 
Diagnosis can be made during a physical examination depending on the location of the myomas and if they have reached a certain size. Irregularities in menstrual pattern have to be diagnosed if they persist in order to rule out the chance of developing a malignancy or a premalignant tissue change. Sonography is one of the best ways to diagnose myomas because it can show the examining physician the size, numbers and location of most myomas present.
 

Therapy:
 
Therapy depends on the accompanying symptoms as well as the size of the tumors, their location, and the age of the patient. If the affected woman still wants to bear children, large myomas that could create problems during pregnancy should be removed. They can be removed (excised, shelled out) individually, either through a small abdominal-pelvic incision or via the vagina. The route of surgery depends again on the size and location of the myomas.
 
If the myomas are small and the woman is near her menopause and does not want to bear children anymore, there is usually no need for further treatment, since the myomas will stop growing and regress after the menopause. If they are large and cause symptoms, a hysterectomy might be the best treatment for the woman nearing her menopause.
 
Recent trials of a new way of treatment show promising results of getting the myomas to shrink in size by cutting off their blood supply through a minor surgical procedure. While this form of treatment may spare the woman in certain cases from having to have a hysterectomy, it is not yet widely accepted as the preferred treatment nor is it everywhere available.
 

Prevention:
 
There are no preventive measures that can hinder the development of fibroids/myomas since they are caused by chromosomal abnormalities. A genetic predisposition for the development of myomas is evident in the rather different chances of occurrence based on race, as they are much more common in Blacks than in Whites.

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