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. It can occur during pregnancy 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 reason for hysterectomies is (surgery to remove the uterus) 35%) are myomas.
A woman may have a single myoma in her uterus (this is called myoma uteri) or more than one myoma may exist together. (this is called uterus myomatosus)
Myoma types:
1-Subserous myomas (in the outer layer of the uterus)
2-Intramural myomas (in the middle layer of the uterus)
3-Submucous myomas (in the inner layer of the uterus)
Myoma symptoms:
Myomas often do not cause symptoms. They are detected incidentally during routine gynecological examinations.
However; Most of the time, they can give the following findings in proportion to growth:
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Excessive menstrual bleeding, menstrual irregularity (the most common complaint)
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Bleeding after sexual intercourse
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Intermenstrual bleeding
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Frequent urination
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Enlargement or swelling in the abdomen
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Pain towards the coccyx during menstrual periods or sexual intercourse
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Anemia due to excessive bleeding
What do myomas cause?
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Collapse of the tubes or Myomas that cover the opening of the uterus can cause infertility.
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Large fibroids cause constipation by putting pressure on the intestines and preventing the feces from moving through the intestines.
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Myomas that are located in a way that prevents the fertilized egg from remaining 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 because there is a decrease in hormones. 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:
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Black race
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Nulliparity (Not having given birth)
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Early menarche ( First menstrual period starting at an early age)
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Nutrition
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Obesity
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Alcohol
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Familial predisposition
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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.
How is myoma diagnosed?
Unless 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 CT, MR, SIS, HSG, laparoscopy Other diagnostic methods such as may be needed.
Myoma treatment:
Myomas are generally small and do not require treatment because they do not cause complaints. 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 also 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:
Myoma is removed from the uterus. It is the process of removing the uterine wall by simply peeling it off. It can be done laparoscopically or openly. It is an approach that ensures the preservation of the uterus in people who want to have children.
The risk of recurrence of myomas within 5 years in a person whose myomas have been removed by myomectomy has been found to be 50-60%, in 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. Pregnancy is allowed if the patient wishes 6 months after the myoma is removed.
Hysterectomy surgery (removal of the uterus):
Those who have rapidly growing myomas that cause complaints, may become pregnant in the future. in patients who do not think It is an applied 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.
What is uterine artery embolization?
Uterine artery embolization It is the process of blocking the arteries that carry blood to the womb (uterus) using special techniques. With uterine artery embolization, the blood flow to the fibroids decreases and thus the myomas shrink. The surgery is performed by entering the vein under local anesthesia, the abdomen is not opened.
A new method in Dada, which is still in the research phase and not applied 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 will decrease and hormone levels will decrease. It may not always shrink.
Can myomas turn into cancer?
Myomas are not cancer, they are benign tumors. There is no evidence that they turn into cancer.
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, myomas may grow 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 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. Spell The risk of recurrence is higher in those with many small myomas than in those with a few myomas. The average myoma recurrence rate is 15%.
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