1.Laboratory tests Complete blood count and blood smear: leukocytosis can be caused by necrosis due to torsion or degeneration. Decreased hemoglobin and hematocrit levels indicate chronic blood loss. 2. Pregnancy test for chorioetic gonadotropin Often helps in the evaluation of a symmetrical uterine enlargement resembling pregnancy or coexisting with pregnancy. 3. Ultrasonography When the presence of a pelvic mass is in doubt, sonography may be helpful. 4. Intravenous pyelogram a. Cervical Pap smear Always indicated to uncover cervical neoplasia prior to hysterectomy. b. Hysterosal pingogram It is recommended if the client wants more children in the future to evaluate the distortion of the uterine cavity and the continuity of the tubes

Nearly half of cases of uterine fibroids are discovered incidentally during a routine pelvic exam. Patients do not have any complaints and are not aware that they are carrying a tumor in the uterus. Factors that influence the onset of clinical symptoms include: 1. The size of myoma uteri 2. Localization of myoma uteri 3. Changes in myoma uteri. Pain Pelvic pain due to pressure, occurs because most of the myoma pressing on the structure in the pelvic area. In submucosum myomas that are born can constrict the cervical canal, causing dysmenorrhea. Symptoms of compression Emphasis on the urinary bladder causes polyuria, on the urethra causes urinary retention, on the ureters causes hydroureter and hydronephrosis, on the rectum causes obstipation and tenesmia, on the blood and lymph vessels causes leg edema and pelvic pain.

The exact cause of myoma is not known with certainty. Miomas are rarely found before puberty, are strongly influenced by reproductive hormones and only manifest during reproductive age. These tumors originate from normal muscle cells, from immature muscles within the myometrium or from embryonic cells in the uterine blood vessel walls. Whatever the origin, the tumor starts as multiple, very small seeds scattered throughout the myometrium. These seeds grow very slowly but progressively (years) in months under the influence of estrogen

Uterine myoma begins to grow as a small seed in the myometrium and gradually enlarges because of that growth the myometrium is forced to form a kind of pseudocapsule or until all around the tumor in the uterus there may be one myometrium but there are usually many myomas. If there is one myoma can protrude forward so that it presses and pushes the bladder up so that it often causes complaints of micturition. But problems will arise if there is a reduction in blood supply to uterine myomas which causes the tumor to enlarge, causing pain and nausea. In addition, the problem can arise again if there is abnormal bleeding in the uterus that is excessive, causing anemia. This anemia can cause physical weakness, weak body condition, so that self-care needs cannot be met. In addition, with a lot of bleeding can cause a person to experience a lack of fluid volume and the risk of infection. And if surgery or surgery is carried out, there will be injury so that it can cause tissue damage to the integrity of the skin

By Location a. Cervical (2.6%), generally grows towards the vagina and causes infection. b. Isthmica (7.2%), more often causes pain and urinary tract disorders. c. Corporal (91%), is the most common site and is often asymptomatic. Based on Uterus Layer a. Myoma Uteri Subserosum Tumor that arises just below the surface of the peritoneum (serosa) of the uterus, appears as a small to large mass or a lump that protrudes from the surface of the uterus. b. Intramural Uterine Myomas Tumors within the uterine wall are referred to as intramural or interstitial tumors. If small, these tumors may not cause changes in the shape of the uterus

1.Conservative Treatment In the last decade there have been attempts to treat uterine myomas with gonadotropin releasing hormone (GnRH) agonists. GnRH agonist treatment for 16 weeks in uterine fibroids resulted in hyaline degeneration in the myometrium until the uterus became small. After administration of GnRH agonists the shriveled myoma stopped

2. Operative Treatment Operative measures for uterine myomas are carried out for myomas that cause symptoms that cannot be treated with operative treatment, operative measures

Prognosis
The prognosis of uterine myomas is determined by the number, type, size, and location of the myomas. The management and treatment chosen also affect the prognosis of uterine fibroids. In addition, uterine myomas can cause various complications which are also related to the prognosis for these patients