Hi Dr. D.
Tanong po ako ulit, tungkol sa myoma, pag meron po bang myoma bawal bang mag buntis? mga more than 3 ung myoma? ano po bang mangyayari pag nagbuntis n meron kang myoma?
A myoma is the most common abnormal growth in the uterus.
It occurs in 1 out of every 5 women. Even I have a myoma. My mother and her 5 sisters also had myomas and they all had them surgically removed.
A myoma or fibroid is due to uncontrolled proliferation or growth of muscle cells within the uterus. This rarely leads to cancer. Half of the cases slowly enlarge, 25% shrink on their own and the other 25% stays the same size all throughout a woman’s life.
It is influenced by the hormone estrogen which is why myomas may disappear altogether once a patient reaches menopause.
Due to estrogen stimulation, fibroids may enlarge during pregnancy but most doctors would choose to leave them alone because removal during pregnancy would cause catastrophic bleeding and they will decrease in size after pregnancy anyway.
Most myomas have no symptoms. Some may present with pain in the “puson” or hypogastric area and a few will have symptoms of strong vaginal bleeding.
Several theories are still undergoing research as to the cause of myomas.
One study relates it to chromosomal or genetic abnormalities which could explain why it is common among female relatives.
Another theory is a diet rich in red meat and fat. This could be supported by the fact that fat and cholesterol convert to estrogen thus increasing the incidence and the size of myomas.
There is no known drug to make the myoma disappear completely.
Some hormones called GNRH (example: Luprolex by Takeda) may be injected. This drug is beneficial for patients who have profuse bleeding or pain but cannot undergo surgery at the moment. Prior to surgery the patient has to secure medical clearance from her cardiologist. Conditions like anemia, diabetes, heart disease or clotting problems need to be corrected before you can schedule the patient for surgery. Even some maintenance drugs have to be stopped for 1-3 months before it can be safe to perform the operation. This is where GNRH is very helpful. GNRH or Luprolex can treat the pain and the bleeding may be controlled while the patient is preparing herself for surgery.
Surgery is the only absolute method to remove the mass. This is reserved for patients who have severe pain, strong bleeding and those who are trying to get pregnant. But take note that the myoma may decrease once the patient is in her menopause years. So it might be worthwhile to wait a few years if you are in your late 40′s. You may also choose to receive GNRH injections while waiting. The GNRH can shrink the myoma as you wait for menopause. This saves you and your health insurance the great expense, the surgical risk, as well as the inconvenience of having the surgical procedure done.
Two types of surgeries are advised.
Total hysterectomy is removal of the entire uterus. This is done for women who have completed their family size and those who have multiple, large myomas.
The other surgery is a myomectomy. This entails removal only of the myoma and leaving behind the uterus so that the woman can still try to get pregnant.
For you, B.F., it is best to do a vaginal ultrasound first and see the sizes and locations of your three myomas. As long as they are not blocking the fallopian tubes and the cervical opening, you can still get pregnant. You can even attempt to undergo a normal delivery.
I had a patient with a 3 cm. myoma. When she got pregnant, it grew to 5 cms. Fortunately, the myoma was high up in the uterus and the baby was lower, closer to the cervical opening. My patient had a normal birth with no complications. Six months after the delivery, on repeat ultrasound, the myoma was only 2 cms and it has remained the same size for the past 5 years.
Do not think of surgery right away.
Diet and exercise should be your first line of management as long as there is no bleeding.
Lessen your intake of fried foods, beef, chicken and dairy. Fat and cholesterol convert to estrogen.
Soy products like tofu, tokwa and soymilk also contain plant estrogens. If you avoid these foods and lose weight too, you will notice a decrease or even disappearance of your myoma.