Uterine myoma

Many women have been frequently asking me: “I have been told that I have uterine fibroid (myoma). Do I need to have an operation?” I think the reason for this is that with the emphasis on the importance of early diagnosis of cervical cancer, more women are regularly getting checkups for gynecological cancers, leading to findings of even small uterine myomas that would have gone unnoticed in the past.

Uterine myoma is a benign tumor of the muscles in the uterus. It is a common gynecological condition found in approximately 40-60 percent of women aged 35 years and above. It usually occurs between the ages of 30 and 45 years old. Most patients tend to think of a “lump in the uterus” as a malignancy like “cancer,” and are often shocked. However, once the diagnosis has been made, there is no need to worry excessively.

Most do not give rise to any symptoms and are often incidental findings when people visit the hospital for other reasons. Approximately one-third of the patients with uterine myoma experience symptoms, such as excessive menstruation, irregular uterine bleeding and other abnormal uterine bleeding. When the tumor is large, a lump may be felt in the lower abdomen, and can lead to pressure or pain in the area. It may also be a cause of infertility, and can cause miscarriages and anemia. Most regress in size after menopause and it is uncommon to develop new myomas after menopause. However, in rare cases it can be proven as true malignancies, so it is recommended to be removed by surgery in particular when the size of the myoma increases after menopause.

The treatment depends on the age of the patient, the possibility of future pregnancies, symptoms and the size of the myoma. Smaller, asymptomatic myomas can be checked up on every 3 to 6 months to decide on the future treatment plan. There have been recent efforts using various hormone medications to prevent bleeding or reduce the size of the myoma, but such effects are temporary and cessation of treatment may lead to a regrowth of the myoma.

There is no need to rush into surgery, but a hysterectomy may be performed when the symptoms are significant, or if the patient does not want to get pregnant in the future. If the myoma is believed to be the cause of infertility, or if the patient is a young female who wants pregnancies in the future, myomectomy is done. In this case, it is important to note that other myomas may develop again in other areas of uterus after surgery sometimes.

Patients who need to undergo a hysterectomy worry about losing their female functions, unexplainable fatigue, or weight gain after surgery. However, the uterus does not play any significant role in the body if the patient has no plans to become pregnant in the future. The actually important reproductive organs are the ovaries, which produce female hormones. Therefore, patients will be able to carry on with their normal daily life even without a uterus.

By Kim Byoung-gie

The author is a doctor at Department of Obstetrics and Gynecology at Samsung Medical Center and a professor of Sungkyunkwan University School of Medicine. ― Ed.