Uterine Fibroids (Myomas)

Uterine fibroids are benign tumors of the uterus. “Benign” means that they are not cancer. They are swellings that happen in the muscle area of the uterus. And these swellings can be anywhere in that muscle. And the size can vary also. And that will decide the symptoms and the complaints you might have.

So “myo” is “muscle”, “oma” is “swelling”, that’s why a myoma is a muscle swelling and fibroid is; the fibres of the muscle will have some swelling in them.

Who gets them? About 80-90% of the women by the age of 50 will have had myomas. Some women will never notice them and other might have life-threatening situations because of them.

The causes are not known of why we have or develop these myomas, but we are assuming that oestrogen has a major role in affecting them, so their growth. So the more oestrogen you have (the female hormone), the more chances of growing a bigger size of those myomas.

Genetics play an important role. Number 1 role is that you might inherit it from your mother or a related woman in the family on your mother’s side. So if your mother, your aunt or your sister have had it, you probably will develop it. Another reason is weight gain. If you are overweight you might develop it, because this will increase the oestrogen in the blood.

Women who have had their menarche very early (started menstruating very early in their lives), we expect that they might be having a higher chance of developing myomas.

The symptoms and the complaints due to myomas will depend on the size and the location of the tumors. So let’s see, on this painting of Dr. Netter, how this will happen. So you might have a tumor or a myoma in the middle of the uterus, in the middle layer and you might not notice much.

Another one might block the fallopian tube and then will affect the fertility.

Another one might fill in the area of the uterus and then affect also the growth of your baby if you are pregnant – or the position of the baby. It might even block the exit of the baby and then we’ll have to do a caesarean section to get the baby out.

One might also even stick out of the vagina and we can see it outside the uterus.

Here’s another one that is actually coming outside of the uterus and then twisting around itself and might be life-threatening to the patient.

The size, as you can see, varies from some millimetres and some can grow to as big as a watermelon or football.

As you can see here, also the baby’s growth is affected by this tumor, also the position.

This tumor has been developing gangrene, and then we have a major life-threatening situation for the lady.

This lady’s tumor is totally blocking her uterus and then she might be not able to get pregnant.

And this lady’s myoma is sticking out of her abdominal wall, and then it looks very disturbing of course, and also could threaten her life.

Here we can see that the myomas can also grow to affect the colon, if they press on the colon, and the rectum might even block it and in the end you will develop constipation and severe pain, abdominal pain.

You can also have back pain due to the weight of the uterus pulling on the ligaments hanging on the backbones, and then you’ll have a lot of pain.

Another problem that, if it’s very heavy, it might press on the urinary bladder and then you will be having the urge to urinate more often.

Yet another problem is that if they’re very big and filling this area sexual intercourse will be very painful.

And another problem they cause is that they’re cosmetically not pretty if they grow very big. You will develop a big belly any people might think you’re pregnant, but you’re not. It’s that myoma.

They also suck a lot of blood out of your system. So when you are having your menstruation you’ll be bleeding a lot. That’s another problem. And the result of this: you will have prolonged menstruation periods and heavy ones. And that will make you loose a lot of iron from your body, and you will have, in the end, iron deficiency anaemia. So most women who have big myomas also suffer at the end from iron-deficiency anaemia.

So, how can we help? How can we solve the problem? We need to first diagnose it. So I would suggest that all women who have had family history of myomas to seek medical help to diagnose it using ultra-sound. So, pelvic ultra-sound is #1 way to diagnose it. You will go to the gynaecologist and he will or she will have a probe either into the vagina or trans-abdominal and will look at your abdomen from inside and diagnose it.

How do we treat the myomas? Many doctors will just observe you and watch and wait. So they will ask you to come back every six months to check if the myoma has grown and then decide on what to do with it.

And if you have problems the doctor will prescribe medications. The medications are usually hormones, so birth control pills or other hormones. You might also have an (Intrauterine device) IUD inserted into the uterus. They will also try to correct your iron. You might take iron tablets or injections, and that will help a lot in feeling better and correcting your shortness of breath, being tired and so on.

The alternative to medication or medical treatment is surgical treatment. We have two options. Either to remove the uterus as a whole – they will not remove the ovaries, only the uterus. And this is the perfect solution if you want to permanently get rid of the myomas.  They will never grow back. But of course that’s when you are maybe older and have decided not to have children anymore. Because you will not be able to have children after hysterectomy. The other option is to have myomectomy. “Myomectomy” means: cutting only the myomas. So they will remove only the myomas. Either through open abdominal surgery or endoscopy or through the vagina. This will be decided between you and your doctor.

The latest development in the field of surgery or minor procedures or treating the myomas is UAE. Uterine Artery Embolization. It’s a procedure that cuts off the flow to a uterine fibroid causing it to shrink. It’s not a surgical procedure, it’s a minimally invasive procedure during which a thin tube that’s called a “catheter” is inserted into an artery in the growing and is guided using x-ray cameras. Once it’s there the doctor injects very small particles through the tube. The particles will clog the blood vessels that feed the fibroids. That causes them to shrink over time and die out in the end.

Not all women are candidates for every procedure. Some women are not allowed to undergo certain surgeries, and that’s why you’ll have to decide with your doctor.

If you have problems with your myomas please seek medical help because it affects your life-style and life quality a lot. So don’t hesitate to seek medical help.

I wish you the best of health. Thank you.

Alyaa Gad