by Bam Basan-Anino
I was diagnosed with sub mucous myoma on November 2009. It all came down to this after years of suffering from excruciating menstrual cramps, heavy flows, and fainting spells. I have tired every pain killers from simple ibuprofen to Nubain, still every time I get my monthly visit I always end up in our ER.
I have always dismissed these menstrual pains as hormonal imbalance as I was treated by my mom’s OB-GYN way back in high school. So I equate these as my monthly “stings” and dismiss it as it would normally last for a day or two. These “stings” kept getting worse and literally had me crawling to the emergency room for treatment. My hardheadedness was ignored as the resident doctor insisted to have a stat ultrasound to check my uterus to bleeding.
As I lay in the OB ultrasound table waiting while sonologist, Dr. Capoy probed through my uterus, I prayed that there would be no findings that this just a hormonal imbalance. I just want to go home and rest until the pain goes away as it normally does. But she saw some mass in the sonogram, it was initially diagnosed as a blood clot at around 2 centimeters but she was leaning towards a sub-mucous myoma.
Needless to say I was confined and discharged after a 2-day confinement. I visited Dr. Ababon my OB-GYN days after my confinement and was asked to have a repeat ultrasound to rule out the initial diagnosis. I complied. I was saddened when the sonologist confirmed that it was in deed a sub-mucous myoma and I also have poly-cystic ovaries. We immediately, consulted Dr. Ababon on managing my condition, she was hopeful as it were detected early and can be treated.
Although I did not agree to undergo treatment months after the diagnosis, as I was pregnant. My heart broke when we lost our first child. At the time my myoma has ballooned to 7cm. I have to undergo D&C. After the procedure, Doc Fides was adamant that I undergo treatment to shrink my myoma and promised me that she will help us get pregnant. We scheduled our treatment for three months and I was required to get a monthly sonogram every after treatment. My body underwent an induced menopause to stop the myoma from growing. I felt every text book symptoms from hot flashes to uncontrollable mood swings. All these for a healthy uterus.
A year of hard work, faith and perseverance did do wonders as I conceived and gave birth to a wonderful baby boy, Juan Ramon Alfonso on October 20, 2010.
Uterine Fibroids
Fibroids, or uterine myomas (short for leiomyoma), affect more than 30% of women. Most myomas do not cause symptoms, and do not require treatment. Fibroids may require treatment in the following circumstances:
- Fibroids are growing large enough to cause pressure on other organs, such as the bladder.
- Fibroids are growing rapidly
- Fibroids are causing abnormal bleeding
- Fibroids are causing problems with fertility.
Types of Fibroids
Uterine Fibroids are classified by their location (see figure), which effects the symptoms they may cause and how they can be treated. Fibroids that are inside the cavity of the uterus will often cause bleeding between periods and often cause severe cramping. Submucous myomas are partially in the cavity and partially in the wall of the uterus. They too can cause heavy menstrual periods (menorrhagia), well as bleeding between periods.
Intramural myomas are in the wall of the uterus, and can range in size from microscopic to larger than a grapefruit. Many intramural fibroids do not cause problems unless they become quite large. There are a number of alternatives for treating these, but often they do not need any treatment at all. Subserous myomas are on the outside wall of the uterus, and may even be connected to the uterus by a stalk (pedunculated fibroid.) These do not need treatment unless they grow large, but those on a stalk can twist and cause pain. This type of fibroid is the easiest to remove by laparoscopy.
Diagnosis of Fibroids
Fibroids may be felt during a pelvic exam, but many times myomas that are causing symptoms may be missed if the examiner relies just on the examination. Also, other conditions such as adenomyosis or ovarian cysts may be mistaken for fibroids. For this reason, an ultrasound examination at the time of the first visit when a woman has symptoms of abnormal bleeding or cramping is the best tool. A transvaginal ultrasound only takes a few minutes to do, is not uncomfortable, and rapidly provides invaluable information if the physician is experienced in looking at uterine abnormalities.
What is a Transvaginal ultrasound?
Transvaginal ultrasound is a type of pelvic ultrasound. It is used to look at a woman's reproductive organs, including the uterus, ovaries, cervix, and vagina. Transvaginal means across or through the vagina.
How is it performed?
The patient has to lie down on a table with knees bent and feet in stirrups. The sonologist will then place a probe, called a transducer, into the vagina. The probe is covered with a condom and lubricated with a gel. The ultrasound probe sends out sound waves, which reflect off body structures. A computer receives these waves and uses them to create a picture. The doctor can immediately see the picture on a nearby monitor.
The sonologist will then move the probe within the area to see the pelvic organs. This test can also be used during pregnancy.
In some cases, a special transvaginal ultrasound method called saline infusion sonography (SIS), also called sonohysterography or hysterosonography, may be needed to more clearly view the uterus. This test requires saline (sterile salt water) to be placed into the uterus before the ultrasound. The saline helps outline any abnormal masses, so the doctor can get a better idea of their size.
This procedure is not done on pregnant women.
Preparation for Ultrasound?
You will be asked to undress, usually from the waist down. A transvaginal ultrasound is done with your bladder empty or partially filled.
How the Ultrasound feel?
The test is relatively pain free, although some women may have mild discomfort from the pressure of the probe. Only a small part of the probe is placed into the vagina.
Why Ultrasound is performed?
Transvaginal ultrasound may be done for the following problems:
- Abnormal findings on a physical exam, such as cysts, fibroid tumors, myoma or other growths
- Abnormal vaginal bleeding and menstrual problems
- Certain types of infertility
- Ectopic pregnancy
- Pelvic pain
Transvaginal ultrasound is also used during pregnancy to:
- Evaluate cases of threatened miscarriage
- Listen to the unborn baby's heartbeat
- Look at the placenta
- Look for the cause of bleeding
- Monitor the growth of the embryo or fetus early in pregnancy stages
- See if the cervix is changing or opening up when labor is starting early
What are the risks of a transvaginal ultrasound?
Unlike traditional x-rays, there is no radiation exposure with this test. There are no known harmful effects of transvaginal ultrasound on humans.
Alternative Names
Endovaginal ultrasound; Ultrasound - transvaginal; Sonohysterography; Hysterosonography; Saline infusion sonography; SIS
Davao Doctors Hospital’s OB Ultrasound
Luckily, Davao Doctors Hospital offers one of the most sophisticated OB Ultrasound facilities in Mindanao.
It uses the Siemens Acuson Antares Ultrasound Machine; a complete ultrasound system that offers and delivers superior image quality that is essential in having a powerful and efficient diagnostic tool.
The Hospital’s team of capable medical professionals (sonologists, OB-Gynecologists and OB Ultrasound technicians) equipped with expertise and knowledge, gives you a peace of mind that you will be able to receive quality health care, an accurate diagnosis.
References
http://www.gynalternatives.com/fibroids.htm
http://www.nlm.nih.gov/medlineplus/ency/article/003779.htm
http://www.medical.siemens.com/webapp/wcs/stores/servlet/ProductDisplay~q_catalogId~e_-1~a_catTree~e_100010,1007660,12761,1005253~a_langId~e_-1~a_productId~e_147540~a_storeId~e_10001.htm
Katz VL. Diagnostic procedures: Imaging, edometrial sampling, endoscopy: Indication and contraindications, complications. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM eds. Comprehensive Gynecology. 5th ed. Philadelphia, Pa : Mosby Elsevier; 2007: chap 11.
Bradley L. Menstrual dysfunction. Women's health. In: Carey WD, ed. Cleveland Clinic: Current Clinical Medicine 2010. 2nd ed. Philadelphia, Pa: Saunders Elsevier;2010:section 14.
Lobo RA. Infertility: etiology, diagnostic evaluation, management, prognosis. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM, eds. Comprehensive Gynecology. 5th ed. Philadelphia, Pa: Mosby Elsevier;2007:chap 41.
