Myoma uteri

Fibroids are benign tumoral structures that develop from the smooth muscle tissue of the uterus. It can be in more than one number or in different sizes, it may or may not give symptoms depending on this.
It is most common in women aged 30-45 years. It is rarely seen during adolescence. The incidence of fibroids during menopause is very low or existing fibroids shrink during menopause.
The exact cause of fibroids is unknown. However, it is thought that the estrogen hormone, which is high in the body during the childbearing period, causes the growth of fibroids. It is thought that both the increased estrogen hormone during pregnancy and the increased blood flow in the uterus due to pregnancy accelerate the growth of fibroids. Since the estrogen level decreases in menopause, fibroids also shrink.
Genetic factors are also thought to be effective in the formation of fibroids. It is more likely to be seen in people with fibroids in first-degree relatives such as mother-sister-grandmother. In addition, having never given birth, starting the first menstruation at an early age, nutrition, obesity, and the incidence of fibroids in the black race are increasing.
Myomas are named as subserosal (external myoma), intramural (internal myoma), and submucous myoma according to their location in the uterus. Intramural fibroids are the most common.
Since fibroids do not usually cause symptoms, they are often noticed during general gynecological examination and ultrasonography. However, menstrual irregularity, excessive menstrual bleeding, anemia, pain during sexual intercourse, frequent urination, enlargement and swelling in the abdomen, pain, infertility and miscarriage due to its location close to the tubes or in the uterus, pain in the coccyx due to pressure on the intestines, Constipation, torsion due to large and pedunculated myoma turning around itself may cause complaints.
The probability of fibroids turning into cancer is around 2 in 1000, usually seen in menopausal women. If myoma is growing rapidly, it should be investigated in terms of cancer risk.
If fibroids are small and do not cause complaints, they usually do not require treatment. Routine gynecological examination and ultrasound follow-up every 6 months is sufficient.
GnRH analogs and some drugs can reduce fibroids with the effect of temporary menopause by suppressing the ovaries. The purpose of its use is to make the operation easier and reduce bleeding by shrinking the fibroid before surgery. However, this effect is temporary, as soon as the drug treatment is stopped, the fibroid returns to its former size. In addition, it can cause existing small fibroids to shrink even more, causing them to be overlooked during surgery. In addition, if these drugs are used for a long time, they cause complaints such as osteoporosis and hot flashes.
Surgical treatment is required if the fibroid is large and numerous to cause significant complaints, is located to cause infertility or miscarriage, is the cause of excessive menstrual bleeding and anemia, and cannot be differentiated from malignant tumors such as cancer. must be taken.
The surgical method to be chosen in the treatment of fibroids varies depending on the patient’s age, social status and child desire. In addition, the number, size and location of fibroids determine the type of surgery. According to these factors, only removal of fibroids (myomectomy) or complete removal of the uterus (hysterectomy ) preferable. It is usually performed as an open surgical operation (laparotomy), in recent years, laparoscopy is also preferred in appropriate cases.
In myomectomy surgery, it is aimed to strip the fibroids from their capsule and remove them. It is an approach that generally protects the uterus in women who want a child. However, the risk of developing myomas again in women whose fibroids were removed by myomectomy is 50-60% within 5 years. Because it can be thought that all fibroids are removed in the surgery, but fibroids that are too small to be noticed with the naked eye may enlarge and become noticeable over time after the operation and may require reoperation. Pregnancy is allowed 1 year after myoma is removed. Since the risk of thinning and rupture in the region of myoma operation will increase during labor, cesarean section should be preferred as the delivery method.
Hysterectomy should be preferred in women with rapidly growing fibroids and who do not plan to become pregnant in the future. The uterus is completely removed, but the ovaries can be left in order to prevent the patient from entering menopause. After this operation, the person will not be able to menstruate again and have a baby. However, since the vagina is not touched, the vagina does not lose its shape and length. After about 1 month, the patient can easily return to his normal sexual life.

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