Understanding Uterine Myoma

In my practice, I frequently encounter patients who come to me with concerns of heavy menstrual bleeding, painful periods, and sometimes even a feeling of a mass in the lower abdomen. Very often, these symptoms lead us to a diagnosis of uterine myoma, also known as fibroids. If you are experiencing this, know that you are not alone, and this condition is very common among women in our community.

Uterine myomas are non-cancerous (benign) tumors that grow from the muscle tissue of the uterus. They are incredibly common, and it is estimated that up to 70-80% of women will develop fibroids by the age of 50. For Filipinas, the prevalence is notably high. Studies suggest that Filipino women have a 2 to 3 times higher risk of developing fibroids compared to Caucasian women, often presenting at a younger age and with more significant symptoms. The exact reason for this is multifactorial, involving both genetic predisposition and environmental factors.

What are the Risk Factors?

While the exact cause of myomas is unknown, several factors can increase a woman’s risk:

  • Age: Risk increases during the reproductive years (30s and 40s) and decreases after menopause.
  • Family History: Having a mother or sister with fibroids increases your risk.
  • Race: As mentioned, women of African, and notably, Asian descent, including Filipinas, have a higher predisposition.
  • Hormonal Factors: Estrogen and progesterone promote the growth of fibroids. This is why they often shrink after menopause.
  • Early Menarche: Starting your period at an early age.
  • Obesity: Higher body weight is linked to an increased risk.
  • Diet: A diet high in red meat and ham has been associated with a higher risk, while a diet rich in green vegetables may be protective.

Common Signs and Symptoms

Many women with fibroids have no symptoms at all. However, for those who do, the most common complaints include:

  • Heavy Menstrual Bleeding (Menorrhagia): This is often the most troubling symptom, which can lead to anemia, causing fatigue and weakness.
  • Dysmenorrhea: Painful periods that can be severe and crampy.
  • Pelvic Pressure and Mass: A feeling of fullness or a palpable mass in the lower abdomen (hypogastric mass), which may also cause bloating.
  • Pelvic Pain or Pressure: This can be constant or intermittent.
  • Urinary Symptoms: Frequent urination or difficulty emptying the bladder if the fibroid presses on the bladder.

How is it Diagnosed?

When you present with symptoms like heavy bleeding and a palpable mass, the diagnostic process typically involves:

  1. Pelvic Examination: This allows me to assess the size, shape, and contour of your uterus.
  2. Transvaginal Ultrasound: This is the primary imaging tool. It uses sound waves to create a picture of the uterus, confirming the presence, size, number, and location of the fibroids.
  3. Additional Imaging: In complex cases, an MRI (Magnetic Resonance Imaging) may be requested for a more detailed view, which is crucial for planning surgical management.

Potential Complications

If left unmanaged, symptomatic fibroids can lead to:

  • Severe Anemia: Due to chronic heavy blood loss.
  • Impaired Quality of Life: Chronic pain and bleeding can affect daily activities, work, and intimate relationships.
  • Pregnancy Complications: Depending on their size and location, fibroids can sometimes cause infertility, miscarriage, or preterm labor.

Management Options

The good news is that there are many effective treatment options. The best choice for you depends on your symptoms, the size and location of the fibroids, your age, and your desire for future pregnancy.

  1. Medical Management: For women with heavy bleeding and pain, we often start with medications.
    • Tranexamic Acid: Reduces menstrual blood flow.
    • NSAIDs (e.g., Mefenamic Acid): Help relieve dysmenorrhea.
    • Hormonal Therapies: Progestin-only pills, injectable contraceptives, hormonal IUD (Mirena) or GnRH can significantly reduce bleeding and pain.
  2. Minimally Invasive Procedures:
    • Uterine Artery Embolization (UAE): Blocks the blood supply to the fibroids, causing them to shrink.
    • MRI-guided Focused Ultrasound: Uses ultrasound waves to destroy fibroid tissue.
  3. Surgical Management:
    • Myomectomy: This is the surgical removal of fibroids while preserving the uterus. It is the preferred option for women who wish to have children in the future.
    • Hysterectomy: This is the complete removal of the uterus and is the only definitive cure for fibroids. It is considered when symptoms are severe, and childbearing is complete.

A diagnosis of uterine myoma can be overwhelming, but please be assured that it is a manageable condition. As your gynecologist, my role is to walk with you through this journey, explaining all options in the context of your personal life and goals. We will work together to create a management plan that addresses your symptoms and improves your quality of life. Do not hesitate to ask any questions—your understanding and comfort are top priorities to reclaim the quality of your life.