Urogenital disorders

II./4.2.: Symptoms

The uterus myomatosus gravis may cause various clinical symptoms depending on the size, location and number of the nodules, and on the secondary degenerative changes occurring inside them.

Menstrual disorder.

The most common symptom , which occurs mostly in case of intramural and submucosal nodules . The manifestations of menstrual disorder include: bleeding occurring on time, but prolonged (menorrhagia), pre- and postmenstrual bleeding, and bleeding independently of the cycle (metrorrhagia). These symptoms are significantly more frequent in myoma patients, than in the average population. A persistent menstrual disorder may lead to iron deficiency anemia, which may result in chronic fatigue and weakness.

Pain.

The larger nodules - because of their size - may cause abdominal discomfort. Compression of the surrounding nerves may cause pain radiating in the waist, back and the lower limbs. Multiple intramural myomas and large submucosal nodules may cause painful menstruation (dysmenorrhoea).

Pain associated with the myoma itself is rare and mainly occurs if necrosis develops inside the tumor due to lack of enough blood supply or if the necrotic area is infected. In such cases the pain is associated with fever and increase in white blood cell count.

Symptoms of acute abdominal catastrophe may occur due to the twisting of the subserosal nodule’s gelatinous handle. Contractures equivalent to labor pain may develop due to the squeezing of the gelatinous subserosal nodule through the cervical canal. Myoma located on the posterior wall or cervical nodules grooving in the vagina may cause cohabitative pain. In myoma patients pain during menstruation (60%)post menstruation pain (17%), as well as medium-term pain (30%), and difficulty in passing urine and stool (11%), or dyspareunia (24%) is significantly more frequent, than in those who have not been diagnosed with uterine tumor.

Compression symptoms…

Various compression symptoms may occur as a result of the compression and dislocation of surrounding tissues and organs - depending on the location and size of the tumor. The enlarged uterus and the larger subserosal nodules may trigger frequent urination and defecation stimulus by putting pressure on the urinary bladder and the rectum; due to the compression of the pelvic veins lower extremity edema, less commonly pelvic and/or lower extremity thrombosis and vascular occlusion may occur. The intraligamentary and cervical nodules may cause hydroureter and hydronephrosis by putting pressure on the ureter. Due to the compression of the urethra and the rectum, urinary retention and constipation may occur. Among all of the compression symptoms the most commonly occurring is pressure on the urinary bladder and abdominal/pelvic discomfort (33%).