Fibroids are usually benign tumors that occur in approximately 30% of women of reproductive age. They are formed by the proliferation of smooth muscle structures in the uterus and are very unlikely to turn into cancer. Although it is rare, it should be kept in mind that they can turn into malignant and follow-up should not be neglected. While it can cause major problems in women of reproductive age, it can sometimes be detected incidentally in a gynecological examination. The overgrowth of fibroids can cause problems with pregnancy and menstrual cycle. It can cause abnormal vaginal bleeding, infertility and miscarriage.
Why Do Myomas Occur?
Many theories have been proposed on this subject. One of the accepted theories is; It is the formation of fibroids by primitive cells with many potentials originating from smooth muscle cells, connective tissue cells and blood vessels. Some researchers argue that these tumors originate from mature muscle cells or stromal connective tissue elements.
Fibroids are most common in women aged 30-40, but can occur at any age. The female hormone estrogen is known to increase the growth of fibroids. Estrogen levels can increase or decrease depending on natural events. Estrogen increases during pregnancy and decreases during menopause. Medications can also cause changes in estrogen levels.
Myoma Symptoms
Although the majority of fibroids do not cause any symptoms, the symptoms can be different in every woman, with different severity and frequency. Common symptoms of fibroids are as follows:
1. Changes in menstrual bleeding:
Excessive and frequent bleeding, long menstrual periods
Vaginal bleeding during non-menstrual periods
Anemia (due to blood loss)
2. Pain
Pain during intercourse or pain in the lower abdomen and back
3. Pressure
Frequent urination or difficulty urinating
Anal pain, constipation or difficulty in bowel movements
Abdominal cramps
4. Growth in the abdomen and uterus
5. Infertility and miscarriages
Is Myoma an Obstacle to Pregnancy?
Fibroids can sometimes make it difficult to conceive, depending on their location in the uterus (womb). If there is no other reason, fibroids that prevent children from having a child can be operated.
Diagnostic Methods in Myomas
Ultrasoundography; It is possible to detect fibroids with the pelvic and transvaginal ultrasound method. With ultrasonography, it is possible to determine the localization and size of fibroids in the uterus (womb) and pelvis, and it is easy to detect if there is a simultaneous pregnancy.
Hysterosalpingography (HSG); Submucous fibroids that develop towards the endometrial cavity (inner part of the uterus), in hysterosalpingography; It can be defined by images in the form of irregularity and filling defect in the uterine cavity (inner part of the uterus).
Magnetic Resonance Imaging (MR); It can be used to determine the localization, number, size and degree of degeneration (hyaline, cystic, fatty and red) of fibroids and to distinguish between gynecological and non-gynecological diseases.
Endometrial Biopsy; It is a method that can be used for the differential diagnosis of other pathologies (en-dometrial hyperplasia, polyps and cancer) in patients with heavy and frequent bleeding.
Hysteroscopy; It is used for differential diagnosis and simultaneous surgical treatment in submucous fibroids that develop into the uterine cavity. However, fibroids may shrink after menopause.
Myoma Treatment
There is no need to treat fibroids in patients who have no symptoms or complaints. In patients with symptoms and complaints, treatment can be recommended according to the symptoms and complaints. form of treatment; the patient's desire for pregnancy, the size of the fibroid, the location and the symptoms related to myoma determine. Treatment is divided into medical and surgical. The aim of medical treatment is to reduce symptoms such as heavy bleeding, pain, anemia. If there is no decrease in heavy bleeding despite medical treatment, no relief from myoma-related pain complaints, and no pregnancy due to myoma, the option of surgical treatment is evaluated.
How is Myoma Surgery Performed?
Myoma surgery is performed with two techniques. makes; closed method (robotic, laparoscopic, hysteroscopic surgery) and open method. With these techniques, which we call laparoscopy and hysteroscopy, patients can return to their normal lives in a shorter time. in power.
How to Perform Myoma Surgery with Hysteroscopy?
The most commonly used technique in submucous fibroids (close to the inner layer of the uterus) is hysteroscopy. In hysteroscopy, surgery is performed by entering the uterus through the vagina. With this technique, fibroids can be removed without making large incisions. The location of the fibroids is determined exactly and the fibroid is removed with simultaneous appropriate surgery.
How to Perform Myoma Surgery with Laparoscopy?
In the laparoscopic technique, surgery is performed by entering the abdomen through holes of approximately 0.5-1 cm. is performed. In women who have completed the number of children and do not want to give birth, the whole uterus can be removed by surgery instead of only myoma. The vast majority of women who have a myomectomy are able to conceive and have children later on. There is a possibility of recurrence of fibroids in 10% of patients.
Do Myomas Turn into Cancer?
Some changes are seen in fibroids over time and this is called 'degeneration'. Although there are many types of degeneration, the most important one is sarcomatous degeneration. Sarcomatous degeneration indicates that the fibroid is now a malignant tumor. Normally, fibroids are benign tumors. Although the incidence of these sarcameutous changes varies (possibility of cancer), it is evaluated as 1 in 500 women on average. The likelihood of developing into cancer increases with advancing age. In other words, fibroids are less likely to be malignant in younger patients. Definitive diagnosis can be made by pathological examination after surgery.
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