FIBROID/MYOMA
Fibroid / myoma
Fibroid / myoma (also known as: leiomyoma uteri, benign uterine tumour) is a benign tumour of the myometrium and the most frequent tumour of the female body.
Leiomyoma uteri is an encapsulated benign tumor capable of almost infinite growth, which may be located in the womb in three ways.
The subserous form is located under the peritoneal lining of the womb, on the surface of the womb, the intramural form is found withing the wall of the womb, whereas the submucous form is under the endometrium. The subserous form may be peduncular, receive blood flow from the peritoneum, and also detach from the wall of the womb. The tumour is mostly found in grops.
Based on current knowledge, hormonal causes play a primary role in the development of fibroids. This is supported by the fact that in the late menopause, after the removal of the ovaries, or by pharmaceutical induction of artificial menopause (by GnRH analogue medication, although this is set back due to side effects), fibroids will regress. Regarding its background, several theories came out. Among them, the most probable is that regularly missed ovulation and luteal phase with intact follicular maturation (“folliculus persistens”) leads to a hormonal background that contributes to the development of fibroids. In such cases only follicular hormones stimulating cell division (estrogens) will be produced in the body, without progesterone. This way, the cell division stimulating effect of estrogens will predominate uncontrollably on the myometrium, endometrium and breasts. This may explain the fact that with fibroids, other conditions with increased cell division, such as endometrial hyperplasia and cancer, fibrocystic disorder of the breasts (mastopathy) are much more frequent. This is indicated by the fact that the patient will suffer from bleeding disorders and infertility even in the case of a smaller fibroid. Anti-fibroid effect of progesterone is supported by the fact that fibroids will regress during pregnancy and their size will decrease with progesterone therapy. (It shall be noted here that only natural progesterone has a fibroid decreasing effect, and this will unfortunately depend on the size of the fibroid. Synthetic (pharmaceutical) progesterone rather exhibits a fibroid increasing effect.)
What are the likely symptoms?
8-10% of patients with fibroids have no symptoms. Some of the complaints are the consequence of hormonal imbalance inducing fibroid. These may include:
- Prolonged, clumpy, painful periods (hypermenorrhea, dysmenorrhea)
- Missed period
- Increasing breast distension when approaching period Repeated early abortions or infertility
Other symptoms may be caused by the space-occupying effect of the tumour:
- Urine flow obstacles
- Urination complaints (frequent urination urge, incomplete bladder emptying, etc.)
- Defecation difficulties
- Repeated urinary tract infections (for example cystitis, pyelonephritis)
Furthermore, especially with submucous fibroids, late abortion, premature birth, premature detachment of the placenta, placentar insufficiency are more frequent. As obstetrical complication, insufficient contractions, inability of contraction of the womb after delivery (uterine atony), which may also result in life-threatening blood loss.
Evaluation
Transvaginal sonography plays the leading role in the evaluation of fibroids, it can adequately assess the exact location, thereby judging its role regarding complaints, and number, size and blood supply of nodules.
All these data are required for choosing the correct treatment.
Therapy
In the treatment of fibroids, surgery is performed unduly frequent. However, surgery is required:
- enormous fibroid (of the size of a man’s fist)
- suspected malignant change (myometrial sarcoma) (less than 1% of all cases)
- tumour causing compression of surrounding organs
- otherwise not treatable symptoms, especially irregular and strong bleedings and pain.
Surgery
- Surgery may consist of complete removal of the womb (total hysterectomy) with leaving or removing ovaries.
- It may be an amputation ot the womb above the vagina (Chrobak operation). In 1-2% of cases, stump carcinoma may be considered here.
- Womb preserving surgery: If only one well accessible tumour is detected and it is important to preserve fertility, isolated removal of the tumour (enucleation) is an option.
There is no fibroid/myoma without estrogen dominance!
Hormonal evaluation is always inevitable, regardless wether a fibroid should be operated or not. One reason is that the fibroid will recur without restoring the hormone system, the other reason is that hormonal changes in the background of fibroids will also affect breasts and ovaries. Cycle disturbance inducing fibroids may lead to fibrocystic breast disease and ovarian disorders, which may evolve to cancer in 2-5% of cases. The removal of the womb will therefore not make the restoring of the hormonal balance and attending cancer screening examinations unnecessary.
Prior to applied therapy, determination of progesterone/estrogen rate and, depending on the result, further gynecological and endocrinological hormone evaluation is elemental. The time point of hormone evaluation depends on the cycle of the given person, and it will never be determined based on the reference range seen on the laboratory report, whether a hormone normal or abnormal is, we always have to look at their proportion and the influence upon each other.
You may receive information about these methods and application possibilities in person – based on previous appointment (+36 70/23 89 689).
You may read about important information regarding products containing natural progesterone at www.womenscream.com
