tumor in the uterus When it is mentioned, the first thing that comes to mind is myomas. Myomas, or as they are commonly called myomas, myons or myomas They are benign tumor structures that develop from smooth muscle tissue and can be seen in the uterus and cervix.
They are usually round and pinkish in color and can be found anywhere in the uterus. 20% of women over the age of thirty-five tumor in the uterus (myoma or myoma) is seen. So, they are actually quite common occurrences. Myons are most common in women in the 35-45 age group. It is a very rare condition to be seen during adolescence. Again, the incidence of myoma is low during menopause, and most women diagnosed with myoma during their reproductive years experience a decrease in myoma size and a regression in complaints when they enter menopause.
Why does myoma occur?
Although the mechanisms in the formation of myoma are not fully clarified, it has been shown that estrogen (female hormone) is involved in its development and growth. Although it is generally accepted that there is a 0.5% probability of cancer development in myomas, many studies have shown that this rate is much lower. So, women with myomas do not need to worry.
What are the complaints caused by myoma?
Myomas often do not cause symptoms. Sometimes they are detected completely by chance during gynecological examinations. However; Most of the time, they can give the following findings in proportion to their growth and location;
Heavy and prolonged menstrual bleeding
Breakthrough bleeding during the menstrual period
Anemia due to excessive bleeding
Frequent urination due to pressure on the bladder
Causing constipation by putting pressure on the intestines
Enlargement or swelling in the abdomen, palpable mass
Pain towards the coccyx during menstrual periods or sexual intercourse
Causing infertility by covering the tubes or uterus
Myomas lining the uterus can sometimes lead to recurrent miscarriages. It is easy to diagnose myoma (uterine tumor). Diagnosis is made with a simple gynecological evaluation (examination and ultrasound) in a woman presenting with typical symptoms.
Treatment:
Myomas generally do not require treatment because they are small and do not cause any complaints. However, those with significant symptoms, those that are large enough to affect fertility, or those that can be confused with cancer or similar malignant tumors require treatment. Treatment of myomas should be tailored to the patient's complaints and plans for the future period of his life. If a large part of the uterus is covered with fibroids in older women who do not plan to have children, have completed their families, the most appropriate option is to remove the entire uterus. It should not be forgotten that the uterus has no other function than carrying and giving birth to babies.
If a myoma is detected in a young woman who is likely to give birth and if it causes complaints, then of course the myoma will need to be removed and the uterus will need to be protected. This processing myomectomy It is called operation. Myomectomy operation and hysterectomy Although operations are generally open operations, in some cases Laparoscopy It can also be performed in the form of closed and non-cutting operations. For this, a physician experienced in such endoscopic procedures must perform these operations.
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How to Remove Fibroids?
As I mentioned before, the uterus has no known function other than carrying the baby during pregnancy. For this reason, it may generally be recommended to remove the uterus instead of removing the fibroids in a woman who has completed the number of children. Thus, although this proposal may seem antipathetic to most women, no problems related to the uterus (recurrence of fibroids, different bleeding problems, the possibility of uterine and cervical cancer, etc.) will occur again. At this point, the issue that worries women and must be explained in detail by the physician is that removal of the uterus is not the same as entering menopause.
The event that determines menopause is not the cessation of menstrual bleeding, but the cessation of ovarian functions.
If a woman's uterus is removed and her ovaries are left during the operation (it is generally preferred to leave the ovaries if the uterus is removed before the age of 40-45), menstrual bleeding will stop as the bleeding organ is removed, but the ovaries will continue to secrete hormones until that woman reaches the age of natural menopause, meaning that the person will not actually enter menopause.
How to Remove Fibroids?
Generally speaking, the main determinant of how to remove fibroids is the size of the myoma and its location within the uterus. totally submucosal a myoma that has settled, that is, grown into the uterus hysteroscopy It can be removed by entering the uterus through the vagina with special tools, using a method called .
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Myomas that are numerous, embedded in the uterus, or quite large are usually removed by opening the abdomen. with "open surgery" (laparotomy) Removal is recommended. Same procedure in appropriate cases laparoscopy It can also be achieved via .
Myomas are masses that are generally separated from the healthy tissue with clear boundaries by the outer sheath called the capsule that surrounds them, and they can be removed as a whole with this outer sheath by entering through the incision made in the uterine tissue during surgery. All myomas that can be removed during the operation are removed without damaging the uterus and especially its inner membrane.
Can myoma be removed during cesarean section?
It is possible for an existing myoma to grow or new myomas to form due to increased hormones during pregnancy. For this reason, myomas are relatively common during cesarean section surgery. In cases where myomas are deeply embedded in the uterus, the incision made in the uterine muscle to reach the myoma may cause serious bleeding. Because at the time of pregnancy, the uterus has grown a lot and its blood supply has increased significantly. For this reason, it is not recommended to remove myomas by cesarean section, except for myomas that are superficially located or connected to the uterus with a small stem. Since almost all myomas that grow after pregnancy have a tendency to shrink, it is not necessary to remove myomas during cesarean section.
What are the Risks of Myoma Removal Surgery (myomectomy)?
Myoma removal surgeries are surgeries performed under general anesthesia. Therefore, first of all due to general anesthesia Risks that may occur may also occur in this surgery. Careful preliminary evaluation and anesthesia given by an experienced anesthesiologist greatly reduces these risks. Myoma removal surgeries are generally "bloody" surgeries. Although the amount of bleeding is not excessive in short surgeries in which one or a few myomas are removed, surgeries in which many myomas are removed at the same time may cause significant blood loss because a separate incision is required in the uterus to remove each myoma.
Proper and rapid removal of fibroids by an experienced physician, keeping the number of incisions made on the uterus to a minimum, and preparing a few units of blood for blood transfusion when necessary minimizes possible risks due to blood loss. In this regard, caution should be exercised, especially in patients who develop anemia due to myomas. In all gynecological surgeries performed on the abdomen, internal organs risk of adhesion formation There is. If these adhesions form around the ovaries and tubes, they can negatively affect the functions of these organs and cause the tubes to close, leading to inability to conceive or difficult pregnancy. This risk can be reduced by completing the surgery in a short time and taking some additional precautions to minimize adhesion, but it is not possible to completely prevent adhesion formation, even if a method that causes very little adhesion formation, such as laparoscopy, is used.
The extent of adhesion in the abdomen varies depending on the structural characteristics of the person and the surgical technique.
It may not be possible to leave the uterus, especially during problematic surgeries where many and large myomas are removed or where myomas are located in areas that are difficult to remove, such as the cervix. This is a very, very rare condition seen in a woman with one or more myomas. used for myoma removal surgical technique It is another condition that determines the risks that may occur due to surgery. There are risks associated with this method in surgeries performed through open surgery, that is, by entering through the abdomen, and there are risks associated with this method in surgeries performed through laparoscopy, that is, surgeries performed through a camera without opening the abdomen through thin tubes.
The general principle is that the surgeon performs the operation with the technique that he can best use and is experienced with.
While the myoma is being removed, disruption of the integrity of the uterine wall at any stage requires delivery by cesarean section in future pregnancies. This is because there is a possibility that the uterus may tear during labor contractions from the incision area made on the uterine muscle to remove the myoma. No matter how good the surgical technique is used and how well the incision is repaired, this possibility may occur if the myoma is buried in the uterus.
Therefore, women who have undergone myoma removal surgery may need to give birth by cesarean section.
Will Myoma Occur Again After Myomectomy Operation?
Myoma is a condition related to genetic characteristics. Unless the uterus of a woman with fibroids is removed, she can form fibroids again. However, sometimes it may be related to the fact that the small myomas present during the surgery were not completely removed.
Is it not possible to treat myomas with medication?
There are currently no medications known to shrink fibroids. analog called menopause, which temporarily puts the person into menopause. monthly or quarterly injections When applied, the volume of the myoma will of course shrink due to the decrease in hormone levels similar to menopause. However, after the medication is stopped and menstruation returns 2-3 months later It appears that the myoma has returned to its previous size. In addition, in the temporary menopause situation, the patient severe hot flashes and if the treatment takes a long timeosteoporosis It may also happen. This treatment method is recommended by some physicians before surgery in order to reduce the blood loss that may occur during the operation and to facilitate the operation by reducing the volume of the myoma. short term It is used as. Especially if the surgery is desired to be performed laparoscopically and the myoma is very large in size, these medications can be used before surgery. In addition, since this group of patients develop anemia due to prolonged excessive bleeding, this treatment provides correction of anemia. Because during the treatment, the patient does not menstruate and there is no blood loss.
Apart from this, some other drugs that can be used are:
Progestins: Progesterone hormone acts by reducing the release of hormones that stimulate the ovaries from the pituitary gland and by blocking the effect of estrogen, the main female hormone, in myoma tissue. They can sometimes reduce the excess bleeding caused by fibroids, but they are not considered an effective treatment for shrinking fibroids.
Danazol: It is less effective than analogues. It has been observed that it causes a decrease in the size of myomas when used for four to six months. It is not preferred due to its side effects such as weight gain, hair growth and deepening of the voice.
Raloxifene: Although animal studies have shown that it causes a reduction in the size of myomas, there is not enough data on this subject in humans.
caused by fibroids prolonged bleeding, breakthrough bleeding In case of menstrual irregularities such as progesteroneTreatment is also applied with different pills containing hormones.
However, it should be noted that these treatments do not cure the myoma itself, but may temporarily correct the bleeding problems it causes.
If excessive bleeding also causes anemia in the person with iron pills treatment should also be applied.
It should not be forgotten that the definitive treatment of myomas It is surgery.
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Assoc. Prof. on In Vitro Fertilization. Dr. Click to Consult Selman Laçin