Introduction
The diagnostic picture of uterine myomas - or uterine fibroids - could, in some cases, be problematic, not only for the effects that are found at the level of the organism, but also for the detection of symptoms. In most cases, the uterine myomas are in fact asymptomatic, so the woman does not notice the presence of these benign neoplases: the statistics show that 50% of uterine myomas do not involve symptoms, so the detection of the tumor is a consequence of a fortuitous event. The finding of many fibroids is, in fact, random, and the assessment can be confirmed by an ultrasound scan or by a simple gynecological inspection.
However, the volume, morphology and location of the uterine myoma are factors that heavily affect symptomatology.
Recurrent symptoms
Symptoms that may be signs of uterine myoma can be summarized as:
- Dysmenorrhea: abdominal menstrual pain. Typical symptom of submucosal fibroids, a consequence of the continuous contractions of the uterus as an act of defense of the organ, in an attempt to "eliminate" the fibroids;
- Metrorrhagia : unexpected bleeding in the intermenstrual period (common condition in submucosal and intramural uterine myomas);
- Polimenorrhea : bleeding at irregular intervals and frequent before 24 days (a condition that could be confused with an advance of the menstrual cycle);
- Menorrhagia : abnormal menstrual bleeding, longer and more abundant;
- Anemia : effect of excessive bleeding, consequently it is often associated with metrorrhagia and menorrhagia;
- Abdominal swelling;
- Perception of heaviness in the lower part of the abdomen: typical sensation caused by large-caliber myomas, located mainly near the bladder;
- Sacral and lumbar pains : typical symptom of highly developed and voluminous myomas;
- Difficulty urinating and need to urinate often : myomas attached to the bladder tend to compress it, stimulating it;
- Constipation : determined by myomas near the rectum;
- Pain in general and discomfort during intercourse, usually generated by pedunculated fibroids.
Effects on fertility
Sometimes, albeit rarely, the pain caused by uterine fibroids is a wake-up call for malignant evolution. However, in benign forms, it is rare for uterine myomas to cause serious consequences for fertility: this sad event, however, can occur if the fibroma registers a rapid evolution and an excessive volume increase, to the point of obstructing the tubes of Fallopian. Furthermore, 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.
Sessile and pedunculated fibroids
The symptoms caused by uterine myomas depend mainly on the location: in fact, sessile subserosal fibroids usually do not involve symptoms of any kind, unlike pedunculated ones, which cause acute pain in the pelvic area, especially if they are twisted. peduncle. However, pedosiered suboserous myomas may be a signal of Meigs syndrome (characterized by pleural effusion, ascites and benign ovarian neoplasms).
Therapy
The therapy must be chosen based on the age of the patient, her health conditions and the location of the myoma. In fact, in most asymptomatic and small uterine fibroids, the gynecologist only recommends periodic visits, usually once or twice a year; for fibroids of considerable size, which cause a problematic symptomatology or, in any case, if the patient complains of "annoying" symptoms, the doctor may instead recommend a pharmacological treatment or surgical excision.
The drugs that can be administered for the resolution not only of the symptoms, but also of the myoma itself, are generally progestogens: the hormonal treatment, however, could cause serious undesirable effects, whose symptoms can be very similar to those of menopause: among these, mood modulations and hot flushes stand out.
Surgery is another option for the resolution of fibroids, a treatment reserved only for women who have severe symptoms (eg the fibroid covers the entire uterus or the neoplasm is very painful). Surgical excision is not recommended in pregnant women with myoma, since the operation could generate complications and bleeding.
To conclude, the symptoms caused by myomas should not be underestimated, although in most cases they remain benign forms. We have seen that many uterine fibroids do not cause symptoms, therefore a periodic gynecological check is also essential to ascertain the possible presence of uterine myomas.
