Myomas

Myomas, also called uterine fibroids, are benign tumors arising from the smooth muscle of the uterus (the myometrium). They are the most common benign tumor of the female reproductive tract and typically occur during reproductive years. Most fibroids are noncancerous, and malignant transformation is rare. Fibroids can be submucosal, intramural, or subserosal, and they may grow singly or in multiple nodules. They can also undergo degenerative changes such as hyaline or calcific degeneration.

Many fibroids cause no symptoms. When present, common features include heavy or prolonged menstrual bleeding, pelvic pressure or pain, frequent urination, constipation, or enlargement of the abdomen. They can contribute to infertility or pregnancy complications in some cases. Risk factors include age, African descent, family history, obesity, early menarche, and nulliparity.

Diagnosis usually begins with a pelvic exam and transvaginal ultrasound. MRI may be used for complex cases or preoperative planning. Blood tests can assess anemia if bleeding is heavy.

Treatment is individualized. Asymptomatic fibroids are often observed. For symptomatic fibroids, options include medical therapy to control bleeding and symptoms (eg, tranexamic acid, NSAIDs, hormonal therapies), and procedures to remove or shrink fibroids (myomectomy, uterine artery embolization, MRI-guided focused ultrasound). Hysterectomy remains a definitive option for those who have completed childbearing or prefer it.

Prognosis is generally favorable; recurrence can occur after treatment, and the choice of therapy depends on symptoms, size, location, age, and fertility goals.