Myomas are the most common non-cancerous benign tumors that develop within the uterine muscle mass. Fibroids are a tumor present in more than one-third of the female population and are the most common cause of hysterectomy, surgery to remove the uterus. Myoma develops in 20-40% of women of reproductive age. It may be a single myoma or it may be multiple. Myomas are uterine tumors that occur as a result of uncontrolled growth of some muscles in any part of the uterus. It has not been fully revealed why they form, but they have a connection with the female hormones estrogen and progesterone. So much so that they appear at the productive age when hormones are working and regress with the loss of hormones at menopause. Over time, their diameter may increase as long as the effect of female hormones continues during the hormonal active period. After menopause, they may stop growing or even shrink as a result of the decrease in the effectiveness of these hormones. Although they are most often seen between the ages of 30-40 in the productive age, they can occur at any age.
Myoma can grow from a small diameter to large enough to fill the entire lower abdomen, which we call the pelvis. It may be single, or it may be numerous enough to fill almost every corner of the uterus. The place where myomas are located in the uterus can be in the outer shell, in the inner part or right inside the muscle layer.
Clinical complaints in myoma
Myoma can grow in some women without causing any complaints and can even be detected by chance. a film result can be detected. Sometimes it can appear in gigantic sizes, filling the entire abdomen, advancing insidiously, and not causing any complaints until it grows. They are of this size and may present with complaints mostly due to the pressure they put on neighboring organs. They may also present with clinical symptoms that are not related to gynecological diseases, such as frequent urination and urinary incontinence due to pressure on the urinary tract, or constipation due to pressure on the intestines.
The most common complaints in women where myoma causes complaints are increased menstrual bleeding and menstrual duration. prolongation, intermittent bleeding, groin pain, and in some women, inability to become pregnant (infertility).
Bleeding caused by myomas
My If the area where the tumors are located is far from the inner wall of the uterus, called the endometrium, it will not cause any bleeding. Myomas that form at the outer level can only start bleeding when they reach very large sizes and reach the inner wall of the uterus. Sometimes, having a large number of myomas can disrupt the contraction and bleeding stopping function of the uterus and lead to increased bleeding.
Pain complaint in myomas
The closer the myomas are located to the nerve tissues entering the uterus, the more pain they cause. They start to make way. The entrance points of these nerves are towards the cervix. Myomas located far from the cervix may sometimes not cause pain, even if they reach very large sizes.
Another problem that myomas can cause is infertility
There are hundreds of women who become pregnant despite their myomas. If the myoma does not extend to the inner wall of the uterus and does not take up much space there, and if it does not obstruct the tubes in a way that prevents the passage of sperm, it may not prevent them from getting pregnant. There are women who have many myomas or who have become pregnant with a single but giant myoma. While they can cause problems during pregnancy, they can come to birth without causing any problems.
However, if the myoma takes up too much space in the uterine cavity, in the bed where the baby will be placed, is located close to the tubes and blocks the passage, there may be difficulty in getting pregnant. In these cases, myomas may need to be removed before pregnancy can be achieved.
DIAGNOSIS OF MYOMAS
Myomas are easily recognized by a simple gynecological examination performed in the clinic. Ultrasounds, available in every clinic, are sufficient to make a diagnosis. Usually no other imaging method is needed. Rarely, in very large and numerous myomas, tomography or MRI may be requested to determine their interaction with neighboring organs or to distinguish myomas with a complex structure that may be confused with other diagnoses.
Hysteroscopy (telescopic imaging of the inner wall of the uterus) and laparoscopy (telescopic imaging of the inside of the abdomen). methods are also methods that can be used for diagnosis.
TREATMENT OF MYOMAS
Medical treatment; There is no drug treatment that we call medical in the treatment of myomas.
Myoma embolization (occlusion of the uterine vessel); A set of imaging methods applied by interventional radiology. The aim is to find the vein that feeds the uterus underneath and block the main vein, thus shrinking the myoma and reducing bleeding.
Surgical treatment of myoma; In women who are no longer of childbearing age and have other problems, removal of not only the myoma but also the uterus may be considered. The possibility of the myoma reappearing in another area is also eliminated. For this age group, removal of the uterus, which has become an organ that has lost all its necessary functions, may be considered. However, for women of reproductive age who have not completed their labor, who want to become pregnant and cannot, only the removal of the myoma or myomas is sufficient. The process of removing myomas while preserving the uterus is called myomectomy.
MYOMECTOMY (REMOVING MYOMA)
It is not always necessary to remove the uterus due to myoma. Myomectomy is a surgery to remove only the myoma or fibroids while preserving the uterus. Myomectomy is recommended especially for women with myomas who want to have children. Myomectomy is usually performed through large abdominal wall incisions. The wounds on the uterine wall caused by myomas removed from the uterus should be repaired very carefully. Repairing the socket where the myoma originates will reduce the risk of bleeding and infection, prevent intra-abdominal adhesions, and prevent uterine rupture in subsequent pregnancies. Before myoma surgery, you should definitely discuss with your doctor whether you want the uterus to be preserved and whether this surgery should be performed as a minimally invasive, closed surgery performed only through the abdominal holes.
In the laparoscopic myomectomy method, after the intra-abdominal gas is inflated, it is attached to the abdominal wall with a diameter of 10 mm and 5 mm. Small incisions are made and the instruments to perform the surgery are placed in the abdomen. With the tools passing through these incisions, which are about the diameter of a skewer, the internal organs become better visible and the opportunity to see them much more closely is provided.
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