It is perhaps the most common problem faced by women and the one that leads to the most frequent operation.
This disease, which is expressed in medicine as Fibroid, Fibromyoma, Leiomyoma or Myoma, is actually a benign tumor of the uterus. Myoma is seen in one of every 4-5 women. The cause is unknown, it is not possible to be genetically transmitted. They can be found in different parts of the uterus and are named according to their location. (See Figure). Myomas continue to develop in women's reproductive age until menopause. After menopause, their development stops and they shrink a little over the years. During pregnancy, it grows in size and regresses to its original size after pregnancy.
Fibroids do not turn into cancer due to the tissue they develop, but they can turn into sarcoma (malignant) at a rate of less than 0.5%. This transformation can usually be understood by the rapid growth of the existing fibroids after menopause.
FIGURE: Myomas in the uterus are named according to their location. Usually 1 or 2 of the fibroids seen in the figure can be found in the same woman. It is very, very rare for all the fibroids in the above figure to be found in the same woman.
Fibroids do not cause any complaints in the majority of women, such as two-thirds. Generally, the symptoms of fibroids vary according to their location. For this reason, many women are diagnosed with fibroids by chance during their annual check-up or during the investigation of another disease. While subserous or pedunculated fibroids do not cause any complaints even if they are large, intracavitary or submucous fibroids may cause excessive bleeding, even if they are the size of a hazelnut. (see figure)
The most common complaint in women with fibroids, as high as 75%, is bleeding. These bleedings are usually in the form of excessive and/or prolonged menstrual bleeding. These hemorrhages may be of such dimensions as to cause anemia in women. In fact, some women are diagnosed with fibroids by chance while being investigated for anemia. In addition, it should be investigated whether there is another reason for bleeding in women with bleeding complaints.
Pain complaints are not usually encountered in fibroids. However, pain complaints may be encountered in very large fibroids or depending on the organ on which it develops.
Fibroids are not a cause of infertility. Very rarely, depending on the region of the fibroid (intracavitary, submucous) it may be the cause of infertility. However, it should be known that fibroids may grow during pregnancy, rarely lead to surgery during pregnancy, may be a cause of premature birth, and may cause bleeding after delivery.
As we mentioned above, not every fibroid is a cause for complaint and can be found by chance. Moreover, after menopause, their development stops and even decreases in size. For this reason, women with fibroids and who do not have any complaints do not need to be treated.
There is no drug treatment for fibroids. However, in rare cases, we may have to temporarily use certain medications. This is not a treatment, it can be applied temporarily to save time. However, some charlatans, most of whom are not even doctors, deceive people for profit by claiming that they treat fibroids with drugs or herbs. The treatment of fibroids is surgery, that is, surgery.
On the other hand, if a woman with fibroids has bleeding problems, the cause of this bleeding should be investigated, this bleeding may not be caused by myoma and may be misleading. For example, if the cause of bleeding is a simple polyp, the patient may be operated unnecessarily. Therefore, women with bleeding should be treated with medication first. Because most women close to menopause may experience hormonal bleeding problems, even if they do not have fibroids. The presence of myoma is misleading.
Myomas that do not require any treatment should be checked twice a year.
As mentioned above, most fibroids that do not cause complaints do not require treatment. Unfortunately, many patients are offered surgery unnecessarily and even by instilling fear.
The following 3 conditions are among the conditions that require surgery:
1.Persistent bleeding or pain that cannot be prevented by treatment.
2.Observation of fibroid growth in an excessive size than expected in a short time in the controls.
3.Even if there is no complaint, the fibroid is too large (3 months of pregnancy).
Fibroids should not be removed during pregnancy or cesarean section. It can cause excessive bleeding, putting the patient's life at risk. If necessary, the operation can be performed after 6 weeks after delivery.
Of course, the above situations may show personal differences, and there may also be differences of opinion among doctors. Therefore, it would be sensible to get more than one opinion.
Usually, only the removal of the fibroid, which is the cause of the complaint, is sufficient. The most important factor is the fertility status of the patient, that is, the desire and expectation of pregnancy. It should be reminded once again that not all fibroids are the cause of infertility in general. For this reason, the type of surgery is in the form of the following alternatives according to the age and expectation of the woman;
1.Removal of fibroids or fibroids only. The presence of the uterus and its fertility are preserved.
2.Removal of the uterine region with myoma. It is possible for the patient to menstruate, fertility is not possible.
3.Removal of the uterus and release of the ovaries. The patient cannot menstruate, but is prevented from entering menopause.
4.Removal of uterus and ovaries together. The patient enters menopause.
These surgical alternatives may also differ depending on the patient's condition and the doctor's experience.
