Miomas

Miomas, also called uterine fibroids, are benign tumors composed of smooth muscle and connective tissue that develop within the walls of the uterus. They are the most common pelvic tumors in women of reproductive age. The growth is linked to hormonal factors, particularly estrogen and progesterone. They can vary in size from microscopic to several centimeters and may be solitary or multiple. They typically grow during reproductive years and often shrink after menopause.

They are classified by location: intramural (within the muscular wall), submosal (protruding into the cavity), subserosal (on the outer surface), pedunculated (on a stalk). Symptoms depend on size and location and can include heavy or prolonged menstrual bleeding, painful periods, pelvic pressure or fullness, frequent urination, constipation, and in some cases infertility or pregnancy complications. Many fibroids are asymptomatic and found incidentally.

Diagnosis typically begins with a pelvic exam and imaging, usually transvaginal ultrasound; MRI may be used for complex cases. Other tests may assess anemia or uterine factors. Risk factors include age, early onset of menstruation, family history, obesity, and certain ethnicity (higher prevalence in people of African descent).

Management ranges from watchful waiting to medical and surgical options, depending on symptoms, age, desire for fertility, and fibroid characteristics. Medical treatments include GnRH agonists to shrink fibroids temporarily, tranexamic acid for heavy bleeding, and hormonal contraception to regulate cycles. Procedures include myomectomy to remove fibroids while preserving the uterus, hysterectomy for definitive treatment, uterine artery embolization, and focused ultrasound ablation. The prognosis is generally good, but fibroids can recur after treatment and they are not associated with uterine cancer.