Fibroids, also called uterine fibroids or leiomyomas, are muscle tumors that occur in the uterus (womb). Transformation into cancer is rarely observed in these tumors. Fibroids can occur in many shapes, sizes, and locations. The inside of the uterus, the uterine wall or its surface are among the areas where fibroids can develop. Their size may be too small to be seen with the naked eye, or they may reach sizes large enough to affect the shape of the uterus. In addition to these features, some fibroids may also have a stem or root-like structure.
Although the age group in which uterine fibroids usually occur is women in the reproductive age range of 30-40 years, it should not be forgotten that they can occur at any age.
What is myoma?
Fibroids are among the benign tumors that most commonly affect women. These formations take their name from the smooth muscle layer of the uterus called the myometrium. The cells forming the fibroid originate from this smooth muscle layer, and the growth of structures made up of these cells is related to the amount of estrogen in the bloodstream. Some cases of fibroids can become quite large, causing complaints such as abdominal pain or abnormal menstrual bleeding.
The typing of fibroids varies according to the uterine region where they occur:
Intramural fibroids are the most common type of fibroids. These types of fibroids occur within the muscular wall of the uterus. Intramural fibroids can grow over time, causing the uterus to stretch.
Subserosal fibroids arise from the serosa layer in the outer layers of the uterus. An enlarged subserosal fibroid can cause the inside of the uterus to appear larger on one side.
Pedunculated fibroids, another type of myoma, are the form of subserosal fibroids supported by a root or stem-like structure.
Submucosal fibroids occur in the myometrium, which is the middle part of the intrauterine muscle layer. This tumor type is seen more rarely than other fibroids.
What Are the Symptoms of Myoma?
Fibroid symptoms generally vary according to the number of tumors formed, their size and the region where they occur. It may not cause any complaints in some small fibroids or if the person is close to the menopause period. Asymptomatic fibroid cases are usually detected during routine screening. Some cases may follow a symptomatic course and cause various symptoms:
- Clotted and heavy menstrual bleeding
- Pain in the groin and back
- Increased frequency of menstrual cramps
- Increased frequency of urination
- Pain during sexual intercourse
- Feeling bloating or pressure in the lower abdomen
- Abdominal bloating or enlargement
How Is Myoma Diagnosed?
In the diagnostic approach to myoma cases, gynecologists first resort to a complete pelvic examination and medical history taking. Then, using ultrasonography or pelvic magnetic resonance imaging, they can determine the exact number and location of fibroids. Thus, it is ensured that the most appropriate treatment is planned for the person.
How Is Myoma Treatment?
The course of treatment for uterine fibroids varies according to the age of the patient, the size of the fibroid, and general health. In some people, the use of drugs that block hormone production can shrink fibroids. In the presence of various complaints, surgical interventions may be necessary for treatment:
- excessive menstrual bleeding
- Bleeding between menstrual periods
- Intense pain and pressure in the lower abdomen
- Excessive increase in urination frequency
- Feeling as if the bladder has not been fully emptied when urinating
In addition to such complaints, surgical removal of fibroids may be on the agenda in women who want to conceive in the future. Caution should be exercised as some fibroids can increase a person’s risk of miscarriage.
What is Myoma Surgery?
Myoma surgery is the treatment method used in cases where there is a pregnancy request in people with these formations and if the existing fibroids pose a risk for the continuation of pregnancy. Large or multiple fibroids can be removed with surgical interventions. This procedure, called myomectomy, can be performed either open surgery or laparoscopically (closed). In laparoscopic myomectomy, small incisions are made in the abdomen so that the camera and surgical instruments can pass into the abdomen. There is a risk of regrowth of fibroids after laparoscopic surgery. After laparoscopic surgery, people usually spend the night under observation in the hospital, but recovery times are faster than open fibroid surgery.
Open Fiomom Surgery
Myoma surgery in the uterus can also be performed in the form of open surgery through an incision made in the abdomen. This operation is especially preferred in women with multiple or very large fibroids in the uterine wall.
In the pre-operative period, physicians may prescribe various drugs to some people to make their fibroids shrink so that they can be removed more easily during the operation. These drugs, which are classified as gonadotropin-releasing hormone antagonists, inhibit the production of hormones such as estrogen and progesterone in the body. Thus, people are put into a temporary menopause state. After discontinuing the use of drugs, menstruation starts again in people and they can realize the pregnancy request.
What is the main cause of myoma?
To the physician who will perform the operation before open myoma surgery; If there are drugs, vitamins, supplements or herbal products used, it should be stated. Another issue to be considered before surgery is tobacco use. In general, smokers are expected to stop their habits 6-8 weeks before open myoma surgery. Cessation of tobacco use is very important in terms of not adversely affecting the healing process of individuals.
In open myoma surgery performed under general anesthesia, surgeons first start the operation by making an incision in the lower abdomen above the region of the uterus. This incision can be made vertically or horizontally.
Horizontal incisions are usually 7-10 centimeters long and are made just above the pubic bone. This type of incision, which is considered sufficient for the removal of fibroids in the uterus, usually causes less pain and leaves a smaller scar after the operation.
How long does it take to recover from fibroid surgery?
The vertical incision technique is an application that is rarely used in open myoma surgeries. It starts just below the navel and continues over the pubis bone. Vertical incision can be applied in very large fibroids.
After the incision is made, the surgeon cleans the fibroids in the uterine wall. After the removal of the fibroids, it provides the reunification of the intrauterine muscle layers by means of surgical sutures. Most patients are observed in the hospital for a period of 1-3 days following this open fibroid surgery.
It is natural to experience pain after surgery. Physicians prescribe various pain relievers in order to relieve this complaint. At the same time, it is normal for patients to have bleeding in the form of spotting during a period of a few days to weeks. When the person can return to their normal activities varies according to the procedure applied. The recovery period of open surgical operations is longer than other applications. While the recovery period after laparoscopic surgery is generally accepted as 2-4 weeks, the recovery period after open abdominal myomectomy can vary between 4-6 weeks.
Surgical removal of these structures in symptomatic fibroids can relieve the person’s complaints. The surgical technique to be chosen varies according to the number and size of fibroids in people. Following the operation, people should avoid heavy lifting or strenuous exercises before they fully recover. It is recommended that people consult their physician about when they can return to both their daily activities and sexual activities.
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