Definition: Myoma is a benign growth of smooth muscle in the wall of the uterus.

Description: A Myoma is a solid tumor made of fibrous tissue; hence it is often called a fibroid tumor. Myomas vary in size and number, are most often slow- growing and usually cause no symptoms. Myomas that do not produce symptoms do not need to be treated. Approximately 25% of myomas will cause symptoms and need medical treatment. Myomas may grow a single nodule or in a clusters and many range in size from 1mm to more than 20cm in diameter. Myomas are the most frequently diagnosed tumor of the female pelvis and the most common reason for a woman to have a hysterectomy. Although they are often referred to as tumors, they are not cancerous. The cause of myoma has not actually been determined, but most myomas develop in woman during their reproductive years. Myomas do not develop before the body begins producing estrogen. Myomas tend to grow very quickly during pregnancy when the body is producing extra estrogen. Once menopause has begun, myomas generally stop growing and can begin to shrink due to the loss of estrogen. About Uterine Fibroids Uterine fibroids (also referred to as myoma, leimyoma, leiomyomata, and fibromyoma) are benign (non-cancerous) tumors that grow within the muscle tissue of the uterus. Between 2050% of woman of childbearing age have uterine fibroids. While many women do not experience any problems, symptoms can be severe enough to require treatment.

Fibrous ranges in size from very small (coined-shaped) to larger than a melon. A very large uterine fibroid can cause the uterus to expand to the size of a six or seven-month pregnancy. There can be either be one dominant fibroid or a cluster of many small fibroids. There are four primary types of uterine fibroids, classified primarily according to location in the uterus.

Figure 1.1

Subserosal uterine fibroids

These fibroids develop in the outer portion of the uterus and continue to grow outward.

The most common type of fibroid. These develop within the uterine Intramural uterine fibroids wall and expand making the uterus fell larger than normal(which may cause bulk symptoms).

These fibroid develop just under the lining of the uterine cavity. Submucosal uterine fibroid These are the fibroids that can have the most effect on heavy menstrual bleeding and the ones that can cause problems with infertility and miscarriage.

Pedunculated

Fibrous that grows on a small stalk that connects them to the inner or outer wall of the uterus.

Etiology The cause of fibroids is incompletely understood. It is known that each tumor result from an original single muscle cell. Each individual uterine myoma is monoclonal. Cytogenetic analysis has demonstrated multiple chromosomal abnormalities. Pathologists have two different theories as to the cell of origin of this smooth muscle tumor. One hypothesis proposes that the cell of origin is from persistent, small, embryonic cell rests, whereas the other theories proposes that myomas originate from the smooth muscle of blood vessels. However, their development seems to be associated with the female hormone, estrogen. Fibroids appear during childbearing years when a womans estrogen levels are high. Myoma has no known cause. Doctors believe that it is cause by hormones that it became hardened due to misuse. Ladies should exercise daily to burn this hormone. Risk Factors

A number of factors increase the risk of developing a fibroid. Not all people with risk factors will develop a fibroid. Risk factors include: African American ethnicity High weight of obesity No history of giving birth

Symptoms You may experience fibrous symptoms daily or only occasionally. Any of these symptoms can be severe: Abdominal, pelvic, or lower back pain that can be severe. Abdominal pressure. Abdominal swelling, distension or bloating. Heavy bleeding during menstrual period (menorrhagia) Longer than normal menstrual periods Pain during sexual intercourse Urgent need to urinate Vaginal bleeding between menstrual periods

Treatment Treatment for fibroids(myoma) begins with seeking medical care from your health care provider. To determine whether you have fibroids, your health care provider will ask you to undergo diagnostic testing.

Some women with fibroids never have any symptoms. When symptoms do occur, however, you may be asked to undergo a pelvic examination and an abdominal ultrasound to determine the size and location of the fibroid. If it is deemed medically necessary, such as when the fibroid continuous to grow and you experience pain or abdominal bleeding, you health care provider will determine the most appropriate treatment for you based on your age and your symptoms and the characteristics of the fibroids. Option includes: Hormones to regulate the menstrual cycle or to reduce symptoms such as oral contraceptive pill Hysterectomy (removal of the uterus) Hysteroscopic removal of the uterine fibroids using a hysteroscope (instrument to visualize the endometrial cavity) Intrauterine device to release progestine within uterus to stop bleeding and pain Myomectomy (surgical removal of the fibroids) Pain control medications Uterine artery embolization (procedure that interrupts the blood supply to fibroids)

CASE STUDY

Our patient resides at Sta. Cruz Ballesteros, Cagayan. She is 49 years old, a teacher in profession and a mother of three children. She was diagnosed to have a Myoma when she was 33 years old. According to her, every time she has a menstrual period she experience pain, as days goes by her abdomen is getting bigger as if shes pregnant, his legs seems heavy and can hardly breath. As she experienced this kind of symptoms she urgently goes to consult a doctor. The doctor recommended her to have an Ultrasound for further test and diagnosis. According to the result of the Ultrasound a 3cm in diameter tumor has grown within the right side of the uterine wall of her uterus, so the doctor advice and recommended her to take some pain reliever. For 7 years all she know that the tumor did not develop, but when she was 40 years old the tumor rapidly grow so she went to the doctor for further analysis and the doctor recommend her to undergo an operation. The process need to be done is called TAH-BSO or Total Abdominal Hysterectomy and Bilateral Salpingo-Oopherectomy, which means the removal of the uterus including cervix as well the tubes in the ovaries using incision in abdomen. The removed benign tumor is as big as a fully grown fetus. In Gods grace, the operation was successfully done. For good maintenance, she takes dolfenal for pain control, calcium and vitamin E. In terms of food, she seldom eats salty dishes and she only drinks distilled water. The doctor also recommends her not to perform heavy loads.

REFERNCES: Books Mishell, Stenchever, Droegemueller, Herbst- Comprehensive Gynecology, 5th Edition. Internet http://www.nichd.nih.gov/health/topics/uterine_fibroids.cfm http://www.nichd.nih.gov/medicneplus/ency/article/000914.htm.