Myomas are benign tumor structures seen in the uterus and cervix, developing from the smooth muscle tissue in the uterine structure. It is called "ur" among the people. Myomas can vary in size from the size of a pea to the size of a basketball. They are usually round and pinkish in color and can be found anywhere in the uterus. It is called myoma uteri or uterine fibroid. Each myoma in the uterus is called a myoma core.
It is seen in 20% of women between the ages of 20-35. As age progresses, the incidence of myoma also increases. Approximately 40% of women over the age of 35 have fibroids. Myomas are most common in women in the 35-45 age group. It is a very rare condition to be seen during adolescence. Pregnancy can also occur even though there is a fibroid in the uterus. In this case, myoma grows in the early stages of pregnancy, that is, in the first 3 months. It may then shrink, remain unchanged, or continue to grow. This is difficult to predict. The incidence of myoma is low during menopause, and in most women diagnosed with myoma during their reproductive years, a shrinkage of myoma cores is observed when they enter menopause.
The most common cause of hysterectomies (surgery to remove the uterus) is myomas (35%).
A woman may have a single myoma in her uterus (this is called myoma uteri) or there may be more than one fibroid together (this is called uterus myomatosus)
Myoma types:
1-Subserous myoma
2-Intramural myoma (inside the myometrium)
3-Submucous myoma (grows into the endometrial cavity)
The most common myomas are intramural myomas. If there is a single intramural uterus globally, it is called a Kugel myoma.
If a substressing myoma is connected to the uterus by a stem, it is called a healthy myoma. subserous m If the tumor grows into the ligamentum latum, it is called intraligamentary myoma. If a subserous myoma breaks its connection with the uterus and connects to another tissue and starts feeding from there, it is called a parasitic myoma. Myomas that develop inside the cervix are called cervical myomas.
FIGO myoma classification:
– Type 0: It is a stalked submucous myoma, all of it is within the uterine cavity.
– Type 1: More than 50% is endometrial. within the cavity, less of it is intramural.
– Type 2: Less than 50% is within the endometrial cavity, more of it is intramural.
– Type 3: It is an intramural myoma adjacent to the endometrioma, but it does not show intracavitary extension.
– Type 4: It is a myoma that is located in the middle of the myometrium and has no connection with the endometrium or serosa.
– Type 5: It is a myoma that is less than 50% subserous and more of it is within the myometrium.
– Type 6: 50% More than 100% of myomas are subserous and less are intramural myomas.
– Type 7: It is a pedunculated subserous myoma.
– Type 8: Cervical myomas and parasitic myomas fall into this group.
Symptoms:
Myomas often do not cause symptoms. They are detected incidentally during routine gynecological examinations. However; They can often present the following findings in proportion to growth:
Excessive menstrual bleeding, menstrual irregularity (menorrhagia is the most common symptom.)
Bleeding after sexual intercourse
Intermenstrual bleeding during the intermenstrual period
Frequently urination
Enlargement or swelling in the abdomen
Pain towards the coccyx during menstrual periods or sexual intercourse
Anemia due to excessive bleeding
Myomas that cover the mouth of the tubes or uterus cause infertility.
Submucous myomas can cause infertility
Large myomas put pressure on the intestines and prevent the feces from progressing through the intestines. They cause constipation.
Myomas that are located in a way that prevents the fertilized egg from being buried in the uterus cause recurrent miscarriages.
The development of myomas is closely related to the hormones in the body. For example, after menopause, myomas usually shrink as hormones decrease. Although the estrogen hormone is mainly responsible for the development of myoma, recent studies have shown that the progesterone hormone is also effective.
Risk factors that increase the development of myoma:
– Black race
– Nulliparity (not having given birth)
– Early menarche (First menstrual period starts at an early age)
– Red meat diet
– Obesity
– Alcohol
– Familial predisposition
– Hypertension
Exercise and smoking are thought to be factors that reduce the development of fibroids. Birth control pills may have a protective effect against the development of myoma.
Myoma nuclei may sometimes undergo changes called degeneration. The most common (65%) of these is hyaline degeneration. Fatty degeneration, cystic degeneration, red degeneration (carneous degeneration), which is common during pregnancy, and calcific degeneration, which is common after menopause, are other types of degeneration. Red degenerations seen during pregnancy can cause severe abdominal pain.
Diagnosis:
Unless the myomas are very small, they can usually be felt during examination. With ultrasound, myomas can be seen very well and their sizes can be measured. Sometimes, myomas that have advanced from the cervix to the vagina can be seen during speculum examination. Sometimes other diagnostic methods such as CT, MRI, SIS, HSG, laparoscopy may be needed.
Treatment:
Myomas are usually small and do not cause complaints. They do not require treatment. However, those that cause significant complaints, are large enough to affect fertility, or may be confused with cancer or similar malignant tumors require treatment. If your myoma is small, follow-up examinations should be performed every 6 months. The growth rate of the myoma is thus monitored. Surgery is almost always used for treatment. There is no very successful and widely used drug treatment yet.
GnRH Analogues, which are hormones, are rarely used as medicine. These temporarily cause menopause and thus cause the fibroids to shrink temporarily. But the effect is not permanent. Especially in large myomas, if given before surgery, it can make the myoma shrink and the surgery easier. However, it may cause small myomas to shrink even further and be overlooked during surgery, and may make it difficult to separate the myomas from the uterine wall during surgery.
Other drugs used rarely and mostly in studies: GnRH agonists, GnRH antagonists, mifepristone, danazol, gestrinone. , selective estrogen receptor modulators, selective progesterone receptor modulators, IUD (mirena) containing levonorgesterol
Myomectomy surgery:
It is the process of removing the myoma by simply scraping it off the uterine wall. It can be done laparoscopically or openly. It is an approach that protects the uterus in people who want to have children. The risk of recurrence of myomas within 5 years in a person whose fibroids were removed by myomectomy was found to be 50-60%, and one quarter of them (10-15%) required re-operation. Since this procedure may cause thinning of the uterine wall, cesarean section must be preferred instead of normal (vaginal) birth in subsequent pregnancies. Myoma was removed Pregnancy is allowed after 6 months if the patient wishes.
Hysterectomy surgery (removal of the uterus):
It is a procedure performed on patients with rapidly growing myomas that cause complaints and who do not plan to become pregnant in the future. is the method. The uterus is completely removed, including the myoma. To prevent the patient from entering menopause, the ovaries can be left without being removed.
Although surgery is mostly performed for the treatment of myomas, studies and research enable the application of some new treatment methods. Examples of these are methods such as uterine artery embolization or uterine artery occlusion or myolysis, which are also applied in our country.
UTTERINE ARTERY EMBOLIZATION It is the process of blocking the arteries that carry blood to the uterus (uterus) with special techniques. With uterine artery embolization, the blood flow to the fibroids decreases and thus the myomas shrink. The surgery is performed through intravenous access under local anesthesia, the abdomen is not opened.
A newer method, which is still in the research phase and not implemented in our country, is "MR Guided Focused Ultrasound System (MR Guided Focused Ultrasound)" Its name abroad is "ExAblate® 2000 System". In this method, the location of the myomas is visualized with magnetic resonance imaging (MRI) and tissue destruction is attempted in the myoma with ultrasound waves. It is an external method performed without surgery on the patient. Since the uterus is not removed, it is suitable for patients who want to have children.
Will My Myomas Shrink After Birth?
Myomas usually shrink after birth, as the blood supply to the uterus decreases and hormone levels decrease, but they do not always shrink. may not shrink.
Can myomas turn into cancer?
Myomas are not cancer, they are benign tumors. The ones that turn into cancer There is no evidence that.
Do myomas form again after surgery?
Genetic factors are very important in the formation of myomas. Therefore, a uterus that is prone to producing fibroids may produce fibroids again. Even if all myomas are removed during surgery, new myomas may form again. In addition, it may be thought that all myomas are removed during the surgery, but myomas that are too small to be noticed by eye may be in the uterus and these may grow and become noticeable over time after the surgery. The risk of recurrence is higher in those with many small myomas than in those with a few large myomas. The average myoma recurrence rate is about 15%.
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