SYMPTOMS

Myomas are non-cancerous (benign) tumours (growths) derived from the uterine muscle cells. These tumours develop when the muscle cells become extremely sensitive to normal estrogen levels and start dividing very rapidly.

Myomas are usually not solitary. More than one muscle fibre may be affected and therefore multiple myomas are usually present. They may differ in size with the result that very small myomas may not be seen at the time of surgery and for this reason myomas may recur following an operation.

Myomas may or may not be symptomatic. Symptoms that may be caused by myomas include: pelvic pain, excessive bleeding or bleeding in between menstrual periods, infertility and miscarriages. The localisation of the myomas in the uterus play an important role in causing symptoms. The ones directly below the uterine lining are the most important and can also be most easily missed by internal gynaecological examination by your doctor. They prevent pregnancy or cause miscarriages by taking up valuable space in or beneath the cavity of the uterus. This limits the blood supply to the foetus which does not grow or dies. A myoma may therefore mimic the function of an intra-uterine contraceptive device ("loop").

DIAGNOSIS

1. The history of the symptoms of abnormal bleeding, pain, infertility and pregnancy loss may make your doctor suspicious of the presence of myomas.

2. Uterine myomas can usually but not always be felt by gynaecological examination.

3. Ultrasound diagnosis is very accurate. Intra-vaginal (internal) ultrasound scans are much more accurate than the external ultrasound scanning done through a full bladder.

TREATMENT

Not all fibroids need to be removed. Whether they need to be removed or not will depend on the position, size and growth rate as determined by regular follow-up evaluations.

1. "Open surgery"
   This has been the traditional way of removing myomas. Hospitalisation and a long period of time away from work has made this approach unfavoured.

2. Laparoscopic surgery
   Most myomas can be removed very effectively through so called key whole surgery where the tumours are cut up in small pieces inside the pelvis and removed laparoscopically. The patient goes home the same day and back to work one week after surgery.

3. Hysteroscopic surgery
   During a very light anaesthetic a hysteroscope is passed through the cervix of the uterus. Under direct vision the myomas are cut away. This technique is only applicable to myomas being present inside the uterine cavity or directly below the uterine lining. This procedure is practically pain free and patients go back to work within a few days.