The diagnostic picture of uterine myomas could, in some cases, be problematic, not only for the effects that are found at the body level, but also for the identification of the symptoms. In fact, in about half of the cases, myoma of the uterus is asymptomatic ; around one out of three myomas, on the other hand, involves abnormal bleeding during menstruation (particularly abundant) or in the remaining part of the month. Rarely, a uterine myoma can cause abdominal pain , radiating to the back (especially if it is pedunculated), dyspareunia ( pain during intercourse or shortly after), and dysmenorrhea ( painful menstruation). In some cases, then, uterine myomas can increase the frequency of urination ( pollakiuria ).
Symptoms And Risks
In most cases, uterine myomas are asymptomatic , so the woman is unaware of the presence of these benign neoplasms: statistics reveal that about 50% of uterine myomas do not cause symptoms, so the detection of the tumor is a consequence of a fortuitous event. The finding of many fibroids is, in fact, casual, and the finding can be confirmed by an ultrasound scan or by a simple pelvic exam during a gynecological visit .
However, the volume, morphology and location of the uterine myoma are factors that heavily affect the symptoms which most commonly consist of: abnormal uterine bleeding, pelvic pain and pressure, urinary and bowel symptoms, and pregnancy complications.
Symptoms: How Does A Uterine Myoma Manifest Itself?
Symptoms that may indicate uterine myoma include:
- Dysmenorrhea : abdominal menstrual pain (typical of submucosal fibroids);
- Metrorrhagia : unexpected bleeding in the intermenstrual period (common condition in submucosal and intramural uterine myomas );
- Polymenorrhea : bleeding at irregular and frequent intervals before 24 days (condition that could be confused with an advance of the menstrual cycle );
- Menorrhagia : abnormal, longer and profuse menstrual bleeding.
- Anemia : effect of excessive bleeding, consequently it is often associated with metrorrhagia and menorrhagia;
- Abdominal swelling or heaviness in the lower part of the abdomen : typical sensation caused by large-caliber myomas, especially located near the bladder ;
- Sacral and lumbar pain : typical symptom of highly evolved and voluminous myomas;
- Difficulty urinating and the need to urinate often : myomas attached to the bladder tend to compress it, stimulating it;
- Constipation : determined by myomas near the rectum;
- Pain during intercourse usually caused by pedunculated fibroids.
Sessile and pedunculated fibroids
The symptoms caused by uterine myomas mainly depend on the location: in fact, subserous sessile fibroids usually do not cause symptoms of any kind, unlike the pedunculated ones , which cause acute pain in the pelvic area, especially if they are twisted on the stalk.
When To Worry
The following symptoms should prompt you to consult your gynecologist as soon as possible:
- Pelvic pain that does not go away
- Excessively heavy, prolonged or painful menstruation
- Spotting or bleeding between cycles
- Difficulty emptying the bladder
- Unexplained low red blood cell count (anaemia)
Contact your doctor immediately if you experience severe vaginal bleeding or severe pelvic pain that comes on suddenly.
The transformation of a myoma into a malignant tumor is a very rare occurrence, although it is the most feared. In fact, it affects 0.2% of cases, so it is judged to be statistically insignificant.
Effects On Fertility
Uterine Myoma: Can It Affect Fertility?
In benign forms, it is rare for uterine myomas to cause serious consequences for fertility: this event, however, can occur if the fibroma registers a rapid evolution and an excessive increase in volume, to the point of obstructing the fallopian tubes . Again, the implantation of the egg could be hindered if the myoma expands to the point of occupying the entire organ.
In some cases, uterine fibroids in pregnant women can increase in size or hinder delivery due to alterations in uterine contractions.
How Is A Uterine Myoma Treated?
The therapy of symptomatic uterine myomas is chosen on the basis of the location and size of the formation, the general health conditions of the patient and her desire for fertility.
In fact, in the majority of asymptomatic and small uterine fibroids, the gynecologist recommends only periodic visits , generally once or twice a year; for large fibroids, which cause problematic symptoms or, in any case, in the event that the patient complains of “annoying” symptoms, the doctor could instead recommend drug treatment or surgical removal.
The drugs that can be administered not only to resolve the symptoms, but also to reduce the myoma itself, are generally progestogens or oral contraceptives .
Surgery – eg. myomectomy , hysterectomy – is another option for the management of fibroids, treatment reserved only for women with severe symptoms (eg the fibroid covers the entire uterus or the tumor is very painful).