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Myomas – Also (Wrongly) Known as Fibroids

Thursday, November 7th, 2013

As widely used as the term “fibroids” is, it is, in fact, a misnomer. “Myoma or myomas”  is the proper name for these tumors of the uterine muscle.

Myomas can be many different sizes and are typically hard and rubbery. They grow slowly and can occur at any time in any woman. 25 percent of all women have myomas, while 50 percent of black women do. Fortunately, many of these myomas are small and require no treatment. There can be just one or dozens in one uterus, and each one can be smaller than a pea or as large as a cantaloupe – or anywhere in between.

If your doctor tells you that you have a myoma, there are some questions you should be prepared to ask. You’ll want to know how big it is, how many of them there are, and where in the uterus they are located. Furthermore, you’ll want to discuss any symptoms it may be causing. A diagnosis of myomas often leads to hysterectomy, but sometimes this is an unnecessary overreaction, so talk to your doctor about possible other treatments, or whether treatment is needed at all.

For example, at menopause, myomas often shrink. This is because they are largely dependent on estrogen, so when estrogen output dwindles, myomas shrivel. They may not disappear completely, but if they are small enough and not causing symptoms, then there is often no reason to treat them.

However, some myomas can cause troublesome symptoms such as pain, irregular heavy bleeding, frequent urination, or problems with defecation caused by pressure on the colon. Another problem with myomas is that they can be hard to distinguish from ovarian cysts and tumors. Because they are slow-growing, though, it’s usually fine to monitor their growth through repeated examinations. If they stay the same size over time, this is a good sign. However, a growing myoma is a concern that requires some type of follow-up, usually exploratory surgery.

If a myoma needs to be removed, there are still different options for women and their doctors to explore. A myomectomy isolates and removes each myoma, while a hysterectomy removes the entire uterus. A woman who wants to preserve her ability to have children may opt for a myomectomy, but she should realize that this operation is difficult and complications are likely, so if she is older or certain that she does not want to have more children, then a hysterectomy is a much safer, simpler option.

There are new alternative treatments for myomas that are not recommended for women who still want to have children, because their newness calls into question the wisdom of recommending them; you can find more information about these treatments in my book, Inside Information for Women. But the fact remains that hysterectomy is the safe, rational course of action for myomas in women who do not want any more kids. Therefore, if you are symptomatic, menopausal and/or have completed your family, your  gynecologist may offer the definitive treatment of hysterectomy.

– Yvonne S. Thornton, M. D., M. P. H.