Fibroids

Myomas are muscle nodules that can sit inside or outside the uterus. It is common to have myoma without having any symptoms. You may need treatment if they grow quickly, grow large or sit in a place that gives you a lot of symptoms. You can be treated with drugs or by surgery.

Myoma is common, almost half of all who have a uterus get myoma. Myoma is also more common in those older than 40 years.

Symptoms of myoma

Myoma usually gives no symptoms at all. What symptoms you may have depends on the size of the myoma and where it is located.

Common symptoms of myoma:

  • You bleed a lot, for a long time and are in pain when you have menstruation.
  • You have a feeling of weight in the genital area.

Uncommon symptoms of myoma:

  • You have a stomach ache.
  • You are in pain with the wear joint.
  • You are often desperate.

If you have difficulty getting pregnant, it may be because you have myoma.

It is very uncommon, but sometimes the blood supply to the myometra can deteriorate rapidly. Then you suddenly get very sore in the lower abdomen.

When and where should I seek care?

Contact a health care provider or gynecologist if you have any of the following symptoms:

  • You have a lot of pain or bleed a lot when you have menstruation
  • You have weight or pressure feeling in the genital area.

Investigations

You are told how you feel and what symptoms you have. Then the doctor does a  gynecological examination and a vaginal ultrasound to see if you have myoma, how big they are and where they are sitting.

The vaginal ultrasound makes the doctor with an ultrasound rod to insert into the vagina. It does not hurt.

Treatment of myoma

Small myomas that do not cause symptoms usually do not need to be treated, but sometimes you may need to go on checks to see if myomas have become larger.

The treatment you receive depends on how large the myoma is, where they are and what symptoms you have. There are four types of treatment:

  • medicines to reduce menstruation and pain during menstruation
  • drugs to shrink myoma
  • embolization, that the blood supply to the myometra is stopped
  • Operation.

Drug treatment to reduce menstruation and pain during menstruation

You who have ample menstruation can try tranexamic acid to reduce menstruation. You can also try hormonal spirals or birth control pills if you have both ample menstruation and a lot of pain when you have menstruation.

Hormone spirals contain an artificial yellow body hormone called progestogen. The hormone spiral makes you bleed less or not at all.

Birth control pills contain hormones that prevent you from ovulating. The hormones make you bleed less and get less pain when you bleed.

Drug treatment to shrink myoma

There are two different drugs that are usually used to shrink myoma.

Treatment with ulipristal
One way to shrink myometry is to treat with the active substance ulipristal. It is found in the drug Esmya. Ulipristal can cause myoma to become smaller and you bleed less or not at all. For most, the myoma shrinks with this treatment, but not for everyone.

While you are eating the medicine, you usually do not bleed at all. After about six months, you get an evaluation and see if the myoma has shrunk. The medicine can be used for several years. 

Sometimes Esmya is the only treatment. Sometimes you can get Esmya printed for an operation.

You should not use Esmya if you have liver problems.

Treatment with GnRH agonists
The second way to shrink the myometrium is anti-hormonal treatment with the help of so-called GnRH agonists. Then you temporarily enter artificial menopause. You can get side effects such as sweating, flushes and mood changes.

Embolization – the blood supply to the myometrium is turned off

The myometrial may become smaller or disappear completely by so-called embolization. Embolization means that the blood supply to the myometrial is shut down so that the myometrial gets no oxygen. The myometry then shrinks.

The procedure is done by inserting a small tube through a blood vessel into the groin and injecting small particles into the blood vessel. The particles cause a plug to form so that the blood cannot reach. You are usually hospitalized for one to three days. Because the embolization can hurt you get a back anesthetic that stays for one to two days. For the first time after embolization, you may have pain treated with painkillers.

Embolization is only done in certain county councils and regions. This method is mainly used if you do not want or can be operated on. It can also be used if treatment with medicines does not work.

Operation

You may need surgery if any of the following is true of you:

  • You have very large myomas that cause symptoms.
  • You get new myoma and do not want children in the future.
  • You are trying to get pregnant and the myometrial prevents you from getting it.

Myoma can often be removed by a puncture surgery, a so-called laparoscopy. The doctor then operates using a camera and small instruments that are inserted through small holes in the abdominal wall. The myometre then takes them out through a cut on the stomach or through the vagina. 

Myomas located inside the uterus can be burned by inserting a thin instrument with a camera through the vagina. 

You can leave the hospital the same day or the day after, depending on how the operation is going and how much you are bleeding.

You must take medication to shrink the myometra before surgery

You may need to take medicines that make the myometrium as small as possible before surgery. The smaller the myometrium, the easier it is to remove. It also minimizes the risk of damaging the uterus.

The uterus may need to be removed

It is unusual, but sometimes you may need to remove the entire uterus. This is especially important if you have several large myomas or if the treatment with medicines does not work.

There are three different methods for this operation:

  • keyhole surgery
  • surgery through the stomach
  • operation through the vagina.

Which method works best depends on how large a myoma is and where it is located.

The operation of the uterus is also called a hysterectomy. In hysterectomy due to myoma, you have left your ovaries and continue to have your ovulation. This means that you have retained your hormone production but that you are not bleeding. If you have  PMS problems, you will also have these.

What does myoma depend on?

Several different factors such as hormones and heredity may contribute to the development of myoma. Myoma is due to a change in a gene in a muscle cell. The cell then begins to divide and forms a muscle node.

Myomas are usually round or semi-circular and the size can vary, from a larger ball of ball up to 30 centimeters. The fact that myomas become so large is very unusual. 

Pregnancy and myoma

Having myoma doesn’t have to affect either pregnancy or childbirth, but it can. It depends on how large the myometre is and where it sits. If you know that you have myoma and are trying to get pregnant, it may be helpful to discuss with a gynecologist how it can affect your pregnancy.

A myoma can make it difficult to get pregnant, especially if the myoma is inside the uterus. It can also cause miscarriage. Then it is usually operated away. It is usually possible to get pregnant after an operation.

Menopause and myoma

When you get into menopause and stop getting menstruation, the levels of the hormones, estrogen and yellow body hormone, that control when you get menstruation in the body decrease. Then the myoma also usually becomes smaller or disappears completely.

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