Uterine Myoma - Causes, Symptoms and Treatment

The uterine myoma, also called leiomyoma, is a tumor that originates from the muscular tissue of the uterus. Myoma is a benign tumor of the uterus, that is, a lesion that is not cancer and presents no risk of malignant transformation.

Uterine myoma
Uterine myoma

What is fibroid?

The uterus is an organ most composed of muscles. Myoma is an abnormal growth of an area of this musculature, usually forming a round shaped tumor. Myoma is composed of exactly the same tissue of the uterus, being only a denser lesion.

There are four types of myoma, classified according to their location in the uterus. Follow the explanations with the illustration below:

1. Mucoma submucosa: tumors that grow just below the myometrium, the layer that covers the inner wall of the uterus. The submucosal myoma extends into the uterine cavity, being able, when large, to occupy much of it.

2. Subsyroid myoma: tumors that grow just below the serosa, the layer that covers the outside in the uterus. Subseradic fibroids give the uterus a nodular appearance

3. Myoma pedicle: they are subserosal tumors that grow and end up highlighting the uterus, getting trapped by a thin cord, called the pedicle. The pedicled myoma may grow into the uterine cavity or out of the uterus.

4. Intramural myoma: these are tumors that grow inside the muscular wall of the uterus. When large, they may distort the external wall such as subservient fibroids and / or the internal wall such as submucosal myomas.

Causes and risk factors of leiomyoma

Myoma is a disease of women of reproductive age and is related to the hormones estrogen and progesterone. Fibroids do not appear before puberty and are uncommon in adolescents.

It is not well known what causes fibroids, which are probably the result of genetic, hormonal, vascular and external influences.

If the causes have not yet been elucidated, some risk factors are already well known:
  • Family history: women whose mothers or sisters have fibroids are more at risk of having them.
  • Black race: Myoma occurs in all ethnic groups, but Afro-descendant women have a higher incidence. In addition, in this group, fibroids usually appear earlier, around the age of 20 years.
  • Pregnancy: Women who have never been pregnant or who have their first pregnancy later are at increased risk of developing fibroids.
  • Age of menarche: The earlier the age of first menstruation, the greater the risk of fibroids.
  • Contraceptives: The pill usually decreases the risk of myoma and is also one of the treatment options: However, when girls start taking it very early, before age 16, there seems to be an increase in risk.
  • Alcoholic beverages: consumption of beverages, particularly beer, increases the risk of fibroids.
  • Hypertension: hypertensive women are at higher risk of having fibroids.


Myoma may be a single tumor or several tumors; may be tiny or have several centimeters in diameter; can cause symptoms or be completely asymptomatic, going undetected for a long time.

Most leiomyomas are small and asymptomatic. When myoma causes symptoms, they usually fall into one of three categories:
  • Vaginal bleeding
  • Pelvic pain
  • Reproductive problems

Vaginal bleeding is the most common symptom of myoma (s), typically presenting as a bulging menstruation and/or lasting for several days. Vaginal bleeding that occurs outside the menstrual periods is not usually caused by fibroids. The submucous myomas are the ones that most often present with bleeding.

Pain or a feeling of heaviness in the pelvis is a common symptom of subservient fibroids . Depending on the location, there may be other symptoms, such as difficulty urinating in the case of myomas that compress the bladder, constipation in the myomas near the rectum and pain during sexual intercourse in fibroids located in the most anterior regions of the uterus.

Myoma does not interfere with ovulation, but depending on its size and location, it may disrupt an eventual pregnancy. Large, multiple fibroids that cause deformity of the uterine cavity, more commonly intramural and submucosal, may increase the risk of complications during pregnancy, such as abortions, bleeding, rupture of the uterus, and problems with childbirth. The risk of complications increases when the placenta is implanted on a myoma. The subservient fibroids do not usually marry problems during pregnancy.

The diagnosis of fibroids is usually made through gynecological examination and ultrasound.

Myoma is a possible cause of secondary dysmenorrhea.


Women with small, asymptomatic fibroids do not need treatment. In fact, up to 40% of fibroids regress spontaneously over a period of three years.

In women with symptoms, initial treatment is usually done with drugs, trying to reduce bleeding and decrease fibroid size. Options include GnRH analog medicines, which induce a temporary menopause, inhibiting ovarian estrogen production, oral contraceptives, and progesterone-releasing IUDs.

The surgery for fibroid becomes an option when:
  • Symptoms do not respond to drug treatment.
  • There is intention to get pregnant and fibroids can interfere with pregnancy.
  • There is doubt whether the tumors are actually fibroids or some malignant lesion.

Myomectomy is surgery in which only the leiomyoma is removed, keeping the rest of the uterus intact. Depending on the type of myoma, myomectomy can be done by laparoscopy, abdominal incision or hysteroscopy. In up to 1/4 of the cases, the myoma grows back after some time.

Embolization of the uterine artery is another option, performed by placing a catheter inside the uterine artery, responsible for the vascularization of the myoma, followed by the injection of agents that lead to the formation of thrombi causing interruption of blood flow. Myoma ischemia causes it to "wilt" and disappear within a few weeks.

Hysterectomy, which is complete withdrawal from the uterus, is the treatment option for older women or those who no longer wish to have children.

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