Myomas, also called uterine fibroids, are very common benign tumors of the uterus. They are made of muscle and fibrous tissue and can grow inside the uterine cavity, in the wall or on the outer surface of the uterus.
Most myomas are not dangerous, but they can cause heavy periods, pelvic pain, pressure symptoms and, in some cases, fertility difficulties or complications during pregnancy.
In Lisbon, Dra. Joana Faria sees women with myomas in Portuguese, English, French, and Spanish. The aim is to understand your symptoms, confirm the diagnosis and discuss treatment options that make sense for your life and your plans.
This page focuses on myomas. For an overview of other benign pelvic conditions you can also read the page on reproductive tract diseases and the specific pages on adenomyosis, uterine polyps and endometriosis.
What it is
Myomas are benign growths that develop from the muscle of the uterus. They are very frequent during the reproductive years and tend to shrink after menopause.
Doctors often describe myomas according to where they are located:
- Submucous myomas grow just under the lining of the uterus and protrude into the uterine cavity. Even small ones can cause heavy bleeding and infertility.
- Intramural myomas are inside the muscular wall of the uterus. They can make the uterus larger and heavier and may cause pain or heavy periods.
- Subserous myomas grow on the outer surface of the uterus. They tend to cause pressure or a feeling of a mass more than bleeding problems.
Many women have more than one myoma and of different types at the same time. Some myomas stay stable for years, while others can grow, especially during reproductive age and pregnancy.
Main symptoms and when to worry
Most myomas are silent and are only found by chance during an ultrasound. When symptoms are present, they often include:
- Very heavy or prolonged periods, sometimes with clots.
- Bleeding between periods or after sexual intercourse.
- Pelvic pain or cramps, especially during menstruation.
- A feeling of pressure or fullness in the lower abdomen.
- Need to urinate more often or difficulty emptying the bladder, when myomas press on it.
- Constipation or a feeling of pressure in the rectum.
- Increase in abdominal size that is not explained by weight gain.
Myomas can also be associated with:
- Difficulty getting pregnant or repeated miscarriages, especially when they deform the uterine cavity.
- Complications during pregnancy, such as pain, abnormal position of the baby or increased risk of caesarean section.
You should consider a gynecology consultation if you notice heavy bleeding, changes in your cycle, pelvic pain or a new mass in the lower abdomen. You should seek urgent care if you have sudden intense pelvic pain, especially on one side, pain with fever and malaise or very heavy bleeding with dizziness or fainting.
Diagnosis: exams and what to expect
Diagnosing myomas usually combines what you feel with what imaging exams show. For most women, a detailed consultation and a high quality ultrasound are enough to define a first plan.
During the evaluation, you can expect:
- Clinical history
Discussion about your periods, pain, pregnancies, fertility plans, previous surgeries and any treatments already tried. - Gynecologic examination
Assessment of the vulva, vagina and cervix and bimanual palpation of the uterus to evaluate its size, shape and mobility. - Transvaginal or abdominal pelvic ultrasound
Key exam to identify myomas, count them and describe their size, location and relation with the uterine cavity. - Saline infusion sonography or hysteroscopy
In some cases, these exams are used to look directly at the uterine cavity and confirm the impact of myomas on it. - Pelvic MRI
Sometimes used when there are many myomas, when the uterus is very large or when surgery is being planned. - Blood tests
Evaluation of anaemia, iron stores and sometimes hormones if there are cycle alterations.
Not every woman needs all these tests. Dra. Joana Faria will tailor the workup to your situation and will explain each step so that you know why it is being done.
Treatment options and realistic expectations
Treatment for myomas is not the same for all women. It depends on your symptoms, the size and number of myomas, your age and your plans regarding pregnancy and menopause.
The main options are:
- Watchful waiting
If myomas are small and do not cause significant symptoms, it may be safe to simply monitor them with periodic ultrasound. The advantage is avoiding unnecessary treatment. The limit is the need to reassess if symptoms appear or change. - Medical treatment
Hormonal contraception, hormone releasing intrauterine devices and other hormonal medicines can reduce bleeding and cramps and may stabilise the size of some myomas. They are less invasive than surgery but require adherence and can have side effects that need monitoring. - Targeted surgery
Myomectomy is surgery that removes myomas while preserving the uterus. It can be done by hysteroscopy (through the cervix), laparoscopy (keyhole surgery) or laparotomy (classical abdominal incision), depending on the size and location of the myomas. - Hysterectomy
Removal of the uterus may be an option for women who no longer wish to be pregnant and have very heavy symptoms or multiple large myomas. It is a definitive solution for bleeding and for myomas in that uterus, but it is a major surgery and requires careful discussion. - Other interventional techniques
In selected cases, techniques such as uterine artery embolisation can be considered in collaboration with interventional radiology teams.
Realistic expectations are important. Surgery usually improves bleeding and pressure symptoms significantly, but new myomas can grow in the future if the uterus is preserved. Medical treatments often control symptoms while they are used, but effects may fade if they are stopped.
How Dra. Joana Faria approaches myomas in practice
Dra. Joana Faria knows that being told you have fibroids often brings many questions about pain, fertility and cancer risk. Her approach is to give you clear information and to help you choose among several possible paths.
In daily practice she:
- Listens carefully to your story instead of deciding based only on the ultrasound report.
- Explains which myomas are most relevant for your symptoms and which ones can simply be monitored.
- Discusses in detail the pros and cons of medical treatment, myomectomy and hysterectomy in your specific situation.
- Prefers minimally invasive surgical techniques when surgery is needed and works with experienced surgical teams.
- Coordinates care with fertility and pregnancy specialists when myomas are part of a broader reproductive plan.
The aim is for you to leave the consultation with a structured plan and the feeling that you have real choices, not a single imposed solution.
