Uterine Myoma (Myoma Uteri)

Fibroids are benign tumoral structures that develop from the smooth muscle tissue of the uterus (womb). It can be in more than one number or in different sizes, it may or may not give symptoms depending on this.

It is most common in women aged 30-45 years. It is rarely seen during adolescence. Its regression or even disappearance after menopause, the tendency to grow during pregnancy, the more intense presence of estrogen receptors in the fibroids, the shrinkage when GnRH agonists are used show that estrogen has a role in its pathogenesis.

Types of Myomas:

Myomas are named as subserosal, intramural, submucous myoma, intraligamentary, cervical myoma according to their location in the uterus. Intramural fibroids are the most common.

How Are Myomas Seen?

Fibroids can vary in size from 2-3 mm to 25-30 cm in diameter. It can be a single tumor or it can be multiple. Especially in large fibroids, sometimes degenerative changes are seen. These are: hyaline degeneration (most common), carneous degeneration (mostly in pregnancy), cystic (5-10%), calcific (postmenopausal), fatty (rare), septic, necrotic, malignant degeneration (0.1-0.5%).

Symptoms of fibroids

Since fibroids do not usually cause symptoms, they are often noticed during general gynecological examination and ultrasonography. However, menstrual irregularity, excessive menstrual bleeding, anemia, pain during sexual intercourse, frequent urination, enlargement and swelling in the abdomen, pain, infertility and miscarriage due to its location close to the tubes or in the uterus, pain in the coccyx due to pressure on the intestines, Constipation, torsion due to large and pedunculated myoma turning around itself may cause complaints.

Diagnosis of fibroids

The best method for diagnosis is gynecological examination and ultrasonography. On examination, the uterus is palpated as larger and harder than normal, when the number of fibroids is high, the normal uterus shape is distorted, myoma born into the vagina is seen as a mass extending from the cervix to the vagina. If there are degenerative changes in myoma, fibroid nodules are felt as soft. The size and localization of the fibroids are easily recognized by ultrasonography, especially in the diagnosis of small submucous fibroids, vaginal USG gives better results. In addition, Hysteroscopy, Hysterosalpingography, Laparoscopy, CT and MR can be used in differential diagnosis. However, Dialation and Curettage are performed to rule out other pathologies associated with bleeding fibroids.

In the differential diagnosis: Pregnancy, Adenomyosis, Adnexal mass, Ectopic pregnancy, Endometrial polyp, Endometrial cancer, Congenital uterine anomalies should be considered.

Can fibroids turn into cancer?

The probability of fibroids turning into cancer is around 2 in 1000, usually seen in menopausal women. If myoma is growing rapidly, it should be investigated in terms of cancer risk.

Treatment of fibroids

 If fibroids are small and do not cause complaints, they usually do not require treatment. Routine gynecological examination and ultrasound follow-up every 6 months is sufficient.

GnRH analogs and some drugs can suppress the ovaries and reduce fibroids with the effect of temporary menopause. The purpose of its use is to make the operation easier and reduce bleeding by shrinking the fibroid before surgery. However, this effect is temporary, as soon as the drug treatment is stopped, the fibroid returns to its former size. In addition, it can cause existing small fibroids to shrink even more, causing them to be overlooked during surgery. In addition, if these drugs are used for a long time, they cause complaints such as osteoporosis and hot flashes.

Surgical treatment is required if myoma is large and numerous to cause significant complaints, is located to cause infertility or miscarriage, is the cause of excessive menstrual bleeding and anemia, and cannot be clearly differentiated from malignant tumors such as cancer. Since myomas located close to the ovaries can be confused with ovarian tumors in women older than 40 years of age, they should definitely be removed.

The surgical method to be chosen in the treatment of fibroids varies depending on the patient’s age, social status and child desire. In addition, the number, size and location of myomas determine the type of surgery. According to these factors, only removal of fibroids (myomectomy) or removal of the uterus (hysterectomy) is preferred. It is usually performed as an open surgical operation (laparotomy), and in recent years, laparoscopy is also preferred in appropriate cases.

In myomectomy surgery, it is aimed to strip the fibroids from their capsule and remove them. It is an approach that generally protects the uterus in women who want a child. However, the risk of developing myomas again in women whose fibroids were removed by myomectomy is 50-60% within 5 years. Because it can be thought that all fibroids are removed in the surgery, but fibroids that are too small to be noticed by the eye may grow and become noticeable over time after the surgery and may require surgery again. Pregnancy is allowed 1 year after myoma is removed. Since the risk of thinning and rupture in the region of myoma operation will increase during labor, cesarean section should be preferred as the delivery method.

Hysterectomy should be preferred in women with rapidly growing fibroids and who do not plan to become pregnant in the future. The uterus is completely removed, but the ovaries can be left in order to prevent the patient from entering menopause. After this operation, the person will not be able to have a period again and have a baby. However, since the vagina is not touched, the vagina does not lose its shape and length. After about 1 month, the patient can easily return to his normal sexual life.

Myoma and Pregnancy : In 5% of pregnancies, uterine fibroids are found, most of them do not affect the course of pregnancy. However, the incidence of abortion (miscarriage) has increased by 2 times, it may cause early pregnancy bleeding. 30% of fibroids grow during pregnancy, this growth occurs mostly in the first 10 weeks of pregnancy, carneous degeneration is common during pregnancy. This degeneration creates a picture similar to acute abdomen, it is usually controlled with rest and analgesics. If unsuccessful, surgery is resorted to and myomectomy is performed. However, this is not used much because it causes both excessive blood loss and fetal loss.

In pregnancies with fibroids, placement of the placenta and anomalies of the baby’s posture have increased, especially cervical fibroids may obstruct the birth canal, intramural fibroids may prevent the coordinated contractions of the uterus. The probability of preterm birth, premature rupture of membranes, malpresentation, ablatio placentae, placental retention and postpartum hemorrhage increases. The incidence of birth by cesarean section is high. As a general rule, myomectomy is not performed in the pregnant uterus, but hysterectomy during cesarean section is a good treatment option for women with multiple myomas who no longer want children.

Risk factors that increase myoma development:

Fibroids usually enlarge in women of childbearing age and often shrink after menopause. However, research also shows that they shrink more in postmenopausal white women than in postmenopausal black women. For African American women, fibroids typically develop at a younger age, become larger and cause more severe symptoms.

 Various factors can increase the risk of developing fibroids:

 * Age (30-40 years old)

 * African American race

 * Obesity

 * family history

 * Hypertension

 *Having never given birth

 * Vitamin D deficiency

 * Lifestyle (caffeine and alcohol consumption, stress, smoking, soy milk use)

Factors that can reduce the risk of fibroids:

 Pregnancy (the risk decreases with the number of births)

Long-term use of oral or injectable contraceptives

Asian women are at lower risk

Appointment  Contact Information for Jin.Op.Dr.Yeşim Yerçok (Gynecology and Obstetrics Specialist) is below.

Address:  Fener Kalamış cad. Billur apt. No:5 Da:9 Kızıltoprak – Kadıköy / İSTANBUL

Phone:  +90 216 385 17 15

E-Mail:
info@dryesimyercok.com