Myomas, the most common benign tumors of the uterus; They are masses that form in the uterus and cervix and develop from the smooth muscle tissue of the uterus. They can range in size from very small millimeters to sizes that fill the entire abdomen and enlarge to the level of the navel. They can be detected anywhere in the womb (uterus). In 10-15% of all women, fibroids of varying sizes and numbers, with or without symptoms, can be encountered. It is most common in women aged 35-45 years. They are rarely seen in adolescence. The growth potential of the fibroid stops when the person enters the menopause, and even the fibroid starts to shrink during the menopause period. The risk of developing cancer in fibroids is about 1/10,000 and it is accepted that fibroids do not become malignant in practice. However, the detection of a sudden and rapid growth in myoma after menopause is a condition that requires examination. Mostly, in this case, the uterus is surgically removed. The number, size and growth rate of fibroids vary from woman to woman. Since the growth of fibroids is dependent on estrogen and other female hormones, a small fibroid does not cause any complaints or does not become very large until menopause, while large fibroids often cause complaints and symptoms in the long term. Even if fibroids are removed in women of childbearing age, the possibility of recurrence of new fibroids until menopause should always be kept in mind. For this reason, it would be wiser to wait for fibroids in women who do not complain and especially in women who are in the fertile period, and if the person wishes, it would be more rational to concentrate on plans and treatments for pregnancy and childbirth.
The exact cause is unclear. To summarize some of the responsible reasons;
The incidence of uterine fibroids is higher, especially in people whose first-degree relatives on the mother’s side, such as mothers, aunts, and sisters, have fibroids.
Ethnicity and race
The incidence is approximately 10 times higher in blacks than in whites.
Increases in estrogen hormone levels
Estrogen (female hormone) is believed to make fibroids grow. For example; The growth of fibroids due to increased estrogen levels during pregnancy and the shrinkage of fibroids with decrease in estrogen in menopause supports this theory.
Submucous fibroids:They grow into the uterine cavity.
Intramural fibroids: They have grown in the middle layer where the uterine muscle is. It is the most common type of myoma.
Subserous fibroids: They develop in the outer layer of the uterus. They have grown outside the uterus into the intra-abdominal cavity.
They often do not show any symptoms. They are detected incidentally in gynecological examinations performed for other reasons. Depending on their size; swelling and enlargement in the abdomen, frequent and excessive menstrual bleeding and as a result anemia, frequent urination or urinary incontinence, pain in sexual intercourse, the appearance of breakthrough bleeding outside the menstrual period, penetrating or blunt pains intermittently especially in the lower-pelvic region, disrupting the relationship of the tubes with the uterus. or fertilized embryo by reducing the possibility of attachment to the uterus, infertility they cause, constipation due to slowing of passage caused by pressure on the intestines, problems in conceiving if they cause irregularity in the intrauterine cavity, or miscarriage that prevents the continuation of pregnancy even if pregnant, or its recurrence as recurrent pregnancy lossesas ,problems can be seen.
Almost 100% diagnosis can be made only with gynecological examination and transvaginal ultrasonography. Pelvic MRI may be required in cases where a definitive diagnosis cannot be made or especially in cases that grow rapidly after menopause. In cases with suspected submucous myoma, HSG (uterine film) sonohysterography or hysteroscopymust be done.
Most fibroids do not require treatment. However, treatment is required in cases that cause complaints, are large enough to affect fertility, or are suspected of malignancy. In small fibroids that do not cause pain, pressure sensation, irregular and excessive bleeding, and do not cause a medical problem, especially if the person has not completed his or her fertility; In order to evaluate the size changes and complaints in myoma, it would be more appropriate to perform controls every 6 months.
Although GnRH analogues cause temporary menopause and shrink myomas, they cause menopausal symptoms and complaints such as osteoporosis, vaginal dryness and hot flashes when used for a long time. This group of drugs; They are given for a short period of time in order to shrink the fibroids before the surgical treatment, to reduce the bleeding during the operation, to restore the blood of the patient with anemia and bleeding to normal and then to take the operation for a short time.
Surgical treatment is considered in the foreground in fibroids that cause complaints or grow rapidly. If we summarize the surgical treatment options and features;
It is the process of removing the fibroid from the uterine wall. It is especially preferred in cases that have not completed their fertility. Myomas that are very large and cannot be removed by laparoscopy are removed by abdominal myomectomy by opening the abdomen. But most cases laparoscopy It has features that can be easily removed with Delivery in pregnancies of myomectomy cases cesarean sectionshould be carried out.
Myomectomy of submucous fibroids is performed by hysteroscopy.
Hysterectomy (Removal of the uterus)
The uterus can be removed as a radical method in the presence of rapidly growing fibroids that cause complaints and if the patient has completed the childbearing age.
uterine artery( uterine artery) embolization (plugging operation)
It is a modern alternative to myomectomy and hysterectomy. Examination of the patient with pelvic MR before this treatment is necessary as it will give more detailed information about the number and location of fibroids. Process; After the recommendation and planning of the gynecologist, it is performed by the interventional radiologist under local anesthesia. The uterine artery is entered with a catheter from the inguinal region and small occlusive materials are placed in these vessels. Since the occlusion of the vessels reduces the nutrition of myoma, shrinkage is observed in myoma over time. After the procedure, 80-90% reduction in bleeding and pain is observed. Although it is believed that it does not adversely affect fertility, there is still no knowledge to make a definitive decision on this issue. Rarely, major complications that require infection and removal of the uterus are encountered.
myol scar and cryomyolysis
They are alternative treatments to myomectomy and hysterectomy. Myoma is entered with special devices and mostly accompanied by laparoscopy, in cryomyolysis (freezing myoma)While myoma tissue is frozen with liquid nitrogen at -196 degrees, myolysis also; Myoma is cauterized with high frequency electric current or laser. In both techniques, fibroid tissue blood supply is reduced or completely cut off. Over time, the fibroid shrinks, the complaints decrease and disappear. Since scar tissue and infection can develop in the uterus after the procedure in both procedures, serious complications may occur in subsequent pregnancies. Therefore, both techniques should be applied in small fibroids and in cases where pregnancy is not considered.