Uterine leiomyomas (fibroids) are benign, hormone-sensitive uterine neoplasms. These tumors are classified as either submucosal (beneath the endometrium), intramural (within the muscular uterine wall of the uterus), or subserosal (beneath the peritoneum).
They seldom develop in the cervix, the lower part of the uterus. When they do, they are usually accompanied by myomas in the larger upper part of the uterus, which are also called fibroids.
The larger ones can cause blockage of the urinary tract or even protrude (prolapse) into the vagina.
Symptoms depend on the location, size, and number of myomas, and include menstrual abnormalities (menorrhagia), features of mass effects (e.g., back/abdominal/pelvic pain or bladder and bowel dysfunction), and infertility.
If left untreated, infections may develop, causing further blessing, pain and vaginal discharge.
Pelvic physical examination can detect lump in the abdomen (of the myomas are large enough) and the patient experiences feelings of pressure.
Ultrasound are used to confirm the diagnosis and to visualize and determine sizes.
If myomas are small and do not cause any symptoms, no
treatment is needed.
If they cause symptoms, they are surgically removed if possible (a procedure called myomectomy).
Myomectomy (excision of the subserosal or intramural fibroids only) is preferred for women planning future pregnancies. However, if myomas are large, removal of the entire uterus (hysterectomy) may be necessary. The procedure can be done by making a large incision in the abdomen (laparotomy) or by instruments inserted through one or more small incisions near the navel (laparoscopy), which is less invasive and is associated with less intra and post-operative complications.