Blessed Angelique Marie B.

Mira BSN

Father Saturnino Urios University OB-GYNE Exposure

RESOURCE MANUAL

Uterine Fibroids (Myoma)

Definition: Uterine fibroids are non-cancerous tumors that grow from the muscle layers of the
womb. These benign growths of smooth muscle can vary from the size of a bean to being as large
as a melon. They are also known as leiomyomas and myomas. Fibroids affect around 30 percent of
all women by the age of 35 years, and from 20 to 80 percent by the age of 50 years. They usually
develop between the ages of 16 to 50 years. These the reproductive years during
which estrogen levels are higher.

There are four types of fibroid:

Intramural: This is the most common type. An intramural fibroid is embedded in the muscular
wall of the womb.

Subserosal fibroids: These extend beyond the wall of the womb and grow within the
surrounding outer uterine tissue layer. They can develop into pedunculated fibroids, where the
fibroid has a stalk and can become quite large.

Submucosal fibroids: This type can push into the cavity of the womb. It is usually found in the
muscle beneath the inner lining of the wall.

Cervical fibroids: Cervical fibroids take root in the neck of the womb, known as the cervix.
The classification of a fibroid depends on its location in the womb.

Risk Factors Include:

 Age
 Family History
 Time since last birth
 Nulliparity
 Premenopausal women
 Hypertension
 Intake of food additives and soybean
 African-Americans are 2-3 times more likely to present with symptomatic uterine
fibroids and typically will do so at a younger age than the rest of the population of
women with uterine fibroids.
 Average age range for fibroids to become symptomatic is 35-50.
 Asian women have a lower incidence of symptomatic uterine fibroids.
 Obesity is associated with the presence of uterine fibroids. (Of course, which came first --
the weight or the fibroids -- is still an unanswered question.)
 Consumption of beef, red meat (other than beef), and ham has been associated with the
presence of uterine fibroids.

Causes:
It remains unclear exactly what causes fibroids. They may be related to estrogen levels.
During the reproductive years, estrogen and progesterone levels are higher.
When estrogen levels are high, especially during pregnancy, fibroids tend to swell. They are
also more likely to develop when a woman is taking birth control pills that contain estrogen.
Low estrogen levels can cause fibroids may shrink, such during and after menopause.
Genetic factors are thought to impact the development of fibroids. Having a close relative with
fibroids increases the chance of developing them.
There is also evidence that red meat, alcohol, and caffeine could increase the risk of fibroids, and
that an increased intake of fruit and vegetables might reduce it.
Being overweight or obese increases the risk of fibroids.
Childbearing lowers the risk of developing fibroids. The risk reduces each time a woman gives
birth.

Signs and Symptoms:

Around 1 in 3 women with fibroids will experience symptoms.

These may include: heavy, painful periods, also known as menorrhagia, anemia from heavy
periods, lower backache or leg pain, constipation, discomfort in the lower abdomen, especially
in the case of large fibroids, frequent urination, pain during intercourse, known as dyspareunia
Other possible symptoms include: labor problems, pregnancy problems, fertility problems,
repeated miscarriages
If fibroids are large, there may also be weight gain and swelling in the lower abdomen.
Once a fibroid develops, it can continue to grow until menopause. As estrogen levels fall
after menopause, the fibroid will usually shrink.

Nursing management:

 Administer iron and BT as ordered

 Encourage verbalization of feelings
 Monitor inputs and outputs as well as the characteristics of urine
 Monitor active fluid loss from wound drainage, tubes, diarrhea, bleeding and
vomiting.
 Monitor temperature
 Encourage patient to drink prescribed fluid amounts
 Monitor serum electrolytes and urine osmolality and report abnormal values.
 Determine the client’s normal voiding pattern and note the variations
 Encourage clients to increase fluid intake
 Check all the urine, note the presence of stones and send output to a laboratory for
analysis
 Investigate complaints of a full bladder: suprapubic palpation to distention. Note the
decrease in urine output, edema periorbital / dependent
 Observations of changes in mental status, behavior or level of consciousness
 Supervise laboratory tests, samples of electrolytes, BUN creatinine
 Take a urine for culture and sensitivity
 Note the catheter patency was settled (when using catheter)
 Assess nutritional status, including weight, history of weight loss and serum
albumin.
 Encourage intake of protein and calorie-rich foods.
 Irrigation with acidic or alkaline solution as indicated
 Offer emotional help
 Help develop effective coping strategies
 Refer for counseling
 Tell patient to report increase in symptoms
 Explain effects of operation
 Encourage regular follow up visits
Medical Management

 Ultrasound-identify size and location of myoma

 Dilatation and Curretage,
 Cytology-rule out cancer
 Blood Studies-show anemia
 Submucosal Hysterosalphingography-detect submucosal myoma
 MRI-fibroid imaging
 Laparoscopy-visualize subserous biomyomas on the uterine surface
 Diagnostic Hysteroscopy-view endocervical canal and lower uterine segment
TREATMENT
 GnRH antagonist (Lupron) therapy-create hypoestrogenic environmentand try to
shink tumors Pelvic examination q 4-6 months to monitor the growth of small
biomyomas that produce no symptoms

Prevention:
There is no known treatment that prevents uterine fibroids. But getting regular exercise may
help. According to one study, the more exercise women have, the less likely they are to get uterine
fibroids. Studies have shown that preventing or treating high blood pressure helps to lower the
risk of developing fibroids. According to research from the Harvard Medical School and Harvard
School of Public Health, there’s a strong and independent association between blood pressure and
risk for fibroids in premenopausal women

Preventing fibroids from coming back after treatment

It is common for fibroids to grow back after treatment. The only treatment that absolutely
prevents regrowth of fibroids is removal of the entire uterus, called hysterectomy. After hysterectomy,
you cannot get pregnant. While many women report an improved quality of life after hysterectomy,
there are also possible long-term side effects to think about

Reference:
https://www.medicalnewstoday.com/articles/151405.php
https://www.medscape.com/viewarticle/886395
http://nursingfile.com/nursing-care-plan/nursing-interventions/nursing-interventions-for-
myoma.html
https://www.slideshare.net/reynel89/myoma-nursing-medical-surgical-managements
https://www.webmd.com/women/uterine-fibroids/uterine-fibroids-prevention
https://draxe.com/fibroids/