Myomas, one of the most common gynecological diseases today, are benign tumors originating from the muscular layer of the uterus. Myomas rarely in adolescence-young adulthood; It is more common in women between the ages of 30 and 40.
Although fibroids, which are known to be affected by hormonal conditions in general, tend to shrink in the post-menopausal period, myomas growing after menopause may need to be followed in terms of malignant transformation. Although the cause is not known exactly, less than one-thousandth of fibroids can be cancerous.
What are the symptoms?
Most fibroids may not show any symptoms in patients. However, some symptoms such as abnormal bleeding, uncomfortably painful and bleeding menstrual periods, low back pain and painful sexual intercourse may be encountered in some of them. Some fibroids prevent the bladder from expanding by pressing on the bladder and may cause the patient to urinate frequently. In addition, as a result of the pressure applied to the anus, it may cause the feeling of a constant toilet need.
One of the biggest problems with fibroids is that they act like a mass in the uterus and prevent pregnancy. Fibroids, especially close to the inner surface of the uterus, can disrupt the appropriate area where the fertilized egg, which is a combination of sperm and egg, will hold.
How is it diagnosed?
The diagnosis of myoma is made with suspicion when the irregular large uterus is felt during routine genital examination. If myoma is suspected, ultrasonography is the best and cheapest option. Ultrasonography can be performed from the abdomen (for large fibroids), vagina (for small fibroids).
In order to exclude uterine cancer or thickening of the inner lining of the uterus, sampling from the uterine lining should be performed from all patients presenting with abnormal bleeding after the age of 35. The number, location and diameter of myoma are evaluated with ultrasonography. Complete blood count is requested to evaluate anemia and bleeding-coagulation tests can be performed.
How is it treated?
Myoma treatment is generally performed by surgical methods. The surgery is decided according to the patient’s age, complaints, number and location of fibroids, and whether the patient has children, and the surgery is planned accordingly.
Surgical treatment of myoma can be done in two ways, the first option is removal of myoma. If the patient has no children and thinks of having a child in the future, fibroids can be removed in order to have a child and to continue the uterine function.
The second surgical option is the complete removal of the uterus. Since fibroids are tumors produced very often by the uterus, if the patient has a child and it is not possible to have another child, it may be recommended to remove the uterus after the age of 40 in order not to produce fibroids again. Several different methods can be applied in myoma surgery.
In the hysteroscopy method, small fibroids that cause pain and cause frequent or severe bleeding are removed through the vaginal route. Fibroids located under or in the inner layer of the uterus can be removed with a special imaging system.
Closed surgeries are performed by laparoscopic or robotic surgery methods. Fibroids larger than 4-5 cm are removed from the uterine bed.
The open surgery method involves the removal of very large tumors that have advanced to the upper part of the navel. Since there is no area to be worked in laparoscopic or robotic method due to the large size of myomas, myomas can be removed by incision with open surgery method.
In some eligible patients for whom surgery is not preferred, drug therapy can be used. Drug treatments do not eliminate fibroids, but provide benefits such as reducing excessive bleeding caused by fibroids and shrinking myoma.
In addition, in some suitable patients, the growth of myoma can be prevented and even shrinkage can be achieved by closing the vessels feeding the myoma with a catheter that is advanced through the inguinal vein with interventional radiological techniques.