They are benign masses formed by abnormal proliferation of smooth muscle in the uterus. They are well-circumscribed masses. They are classified according to their location (submucous, intramural, subserous, pedunculated, etc.). The incidence is generally known as 20-25%.
Why Do Myomas Occur?
Why Do Myomas Occur?
The exact cause of myoma formation is not yet known. Some factors such as hormonal changes (excess estrogen hormone), genetic factors, obesity and early menstruation, alcohol and caffeine use, and heavy red meat consumption are held responsible for the formation of myomas.
Hormonal changes (excess estrogen hormone): Myomas tend to grow due to excess estrogen hormone before menopause. Myomas shrink after menopause. If myoma continues to grow after menopause, the presence of sarcoma, or cancer tissue, should be investigated.
Genetic Factors: If there are myomas in the family, especially in first-degree relatives, the risk of myoma formation in other family members increases.
Age: Myomas are most frequently observed between the ages of 30-40. When menopause occurs, the growth of myomas stops because the estrogen hormone decreases.
Obesity: As body mass index, waist circumference, and body fat percentage increase, the amount of estrogen formed from fat tissue increases and fibroid formation or growth increases.
Early Age of First Menstruation: If the first menstrual period is before the age of 11, the frequency of fibroids increases because there will be more exposure to estrogen.
Consuming Red Meat: According to some studies, consuming too much red meat increases the formation of fibroids. Therefore, it is recommended to limit red meat consumption.
Excessive Alcohol and Caffeine Consumption: May cause fibroid formation.
How Does Myoma Form?
Although the exact cause is unknown, the female hormone known as estrogen is held responsible for the formation of myoma. This tumor is a hormone-dependent tumor and is present in approximately one in every five women of reproductive age (20%).
Myomas tend to grow during pregnancy. Myomas are more common in women who menstruate early and in overweight women due to excessive exposure to the estrogen hormone. During menopause, myomas tend to shrink because the estrogen hormone decreases. It is stated that familial predisposition and genetics also play a role.
What are the Symptoms of Myoma?
Most myomas are detected during routine gynecological check-ups without any symptoms. The symptoms vary according to the location and size of the myoma.
The most common symptom is irregular, prolonged and excessive menstrual bleeding. Myoma can disrupt the ability of the uterine muscle to contract, which can change the regularity and shape of menstrual bleeding. As a result, the patient develops anemia.
Myomas that hold the inside of the uterus or press on the uterus (submucous or intramural) can cause bleeding, prevent a baby from attaching and cause infertility, miscarriage, recurrent pregnancy loss or early pregnancy loss.
Large myomas can press and cause abdominal bloating, a feeling of pressure, groin or lower back pain, indigestion, frequent urination, kidney problems or constipation, and again bleeding and infertility.
In myomas that block the cervix, menstrual bleeding can stop and cramps can cause pain.
Rarely, some myomas can protrude from the uterine cavity into the vagina, causing vaginal bleeding, post-coital bleeding, and foul-smelling discharge that causes infection.
Myomas can sometimes reach giant sizes and in this case, the patient may feel that she has gained weight and may feel a large hardness in her abdomen.
How Are Myomas Diagnosed?
Myomas are benign tumors found in or around the uterus. Myomas usually do not cause any symptoms and can be detected incidentally during a routine gynecological examination. However, various methods can be used to diagnose myoma in people with symptoms and signs. Here are some methods used to diagnose myoma:
Gynecological Examination: The doctor can feel the presence of a growing myoma in the uterus during a pelvic examination.
Ultrasound: Ultrasonography is a common imaging method used to determine the size, location and number of myomas in the uterus. It is the most commonly used diagnostic method.
Computed Tomography (CT) or Magnetic Resonance Imaging (MRI): In particular, MRI (MR) evaluates myomas in more detail and is superior to ultrasound. MRI shows myoma degenerations better. Since MRI also shows cystic structures in the myoma, it can predict the success of treatment in patients who are planned to undergo embolization.
Diagnostic Hysteroscopy: This procedure uses a tube-shaped device (hysteroscope) to visualize the inside of the uterus. This can help diagnose uterine fibroids and even remove them if they are visible in the lining of the uterus.
Endometrial Biopsy: An endometrial biopsy involves taking a sample of the uterine lining and sending it to a laboratory for examination. This is done to rule out any other uterine pathology besides fibroids.
If you have any symptoms or concerns, it is important to consult a gynecologist who is experienced in fibroids to determine a proper diagnosis and treatment plan. If you want to have children, a fertility specialist may be your choice.
Do Fibroids Prevent Pregnancy?
Do Fibroids Prevent Pregnancy?
Myomas can prevent pregnancy, but not every fibroid prevents pregnancy. Factors such as the location, size and number of fibroids determine the effects of fibroids on pregnancy. Here are some situations:
Small fibroids that are outside the uterus usually have minimal effects on pregnancy and most of the time do not affect the pregnancy process.
However, if fibroids grow inside the uterus (intramural fibroids) after a certain size, they can press on the inner lining of the uterus or if they grow on the inner wall of the uterus, they can prevent the baby from attaching to the wall of the uterus, making it difficult to get pregnant and causing complications during pregnancy.
Myomas can also grow with increasing hormone levels during pregnancy and can cause pain or complications during pregnancy.
If you are considering pregnancy and have fibroids, it is important to consult an experienced gynecologist. Your doctor will evaluate the size, location and potential effects of the fibroids on pregnancy and recommend the most appropriate treatment plan for you. In some cases, fibroids may need to be treated or monitored during pregnancy. Your doctor's experience is very important for uterus-preserving surgery.
How Do Myomas Cause Infertility?
Do myomas cause infertility? Myomas are tumors that form inside or around the uterus and can cause problems during pregnancy. Myomas can affect reproductive ability through various mechanisms that can cause infertility:
Implantation Obstruction of Myomas: Myomas that grow into the uterus can prevent the embryo from implanting in the uterus. This can make it difficult to conceive or cause it to fail.
Inhibition of Embryo Development: Large myomas can reduce the volume of the uterus, which can lead to insufficient space for the embryo to develop normally. This can cause miscarriages or termination of pregnancy in the early stages of pregnancy.
Deformation of the Uterine Wall (Deterioration of the Structure of the Uterine Wall): Myomas can change the normal anatomy of the uterus by growing in or inside the uterine wall. This can create an environment that is not suitable for the embryo to attach or develop healthily in the uterus.
Interfering with Blood Flow: Fibroids can press on blood vessels in or near the uterus, which can prevent the embryo from receiving the nutrients and oxygen it needs.
Disrupting Hormonal Balance: Some fibroids can cause hormonal imbalance, which can affect ovulation (when ovulation occurs) or the quality of the endometrium. This can make it difficult to conceive or increase the risk of miscarriage.
Obstructing Sperm or Embryo Passage: Fibroids located in the area that opens from the uterus to the fallopian tubes can block sperm or embryo passage.
In short, fibroids can cause infertility through a variety of mechanisms during pregnancy. However, each case of fibroids is different and their effects can vary from person to person. Therefore, it is important to see a gynecologist or reproductive endocrinologist to evaluate the effects of fibroids on reproductive health.
What are the Symptoms of a Myoma Bursting?
A fibroid rupture is a rare condition and usually does not cause any symptoms. However, a fibroid rupture can cause some symptoms:
Sudden and Severe Abdominal Pain: A fibroid rupture can cause sudden and intense abdominal pain. This pain can be focused at one point or spread.
Vaginal Bleeding: In the case of a fibroid rupture, there can be mild to moderate bleeding. This bleeding is usually in the form of vaginal bleeding.
Signs of Shock: Due to excessive blood loss, some people who experience a fibroid rupture may experience symptoms of shock. These symptoms may include rapid heartbeat, low blood pressure, pale skin, weakness and feeling faint.
High Fever: A fever may increase in the case of a fibroid rupture.
A fibroid rupture may require immediate medical attention. It is important for people who experience any of these symptoms to immediately see a gynecologist or emergency room. A fibroid rupture can lead to serious complications and therefore require rapid medical attention.
What Are the Risks of Myoma Embolization?
What Are the Risks of Myoma Embolization?
Myoma embolization is a minimally invasive surgical procedure used to treat uterine fibroids. In this procedure, embolizing substances are injected into the blood vessels that feed the fibroids by entering the uterine arteries, thus stopping the fibroids from growing and shrinking. Although myoma embolization is generally an effective treatment option, it carries some risks, as with any medical procedure. These may include:
Temporary Abdominal Pain and Discomfort: Pain, abdominal pain or discomfort may be experienced during or after the procedure. This is usually temporary and will subside over time.
Vaginal Bleeding: In rare cases, excessive bleeding may occur after myoma embolization. In this case, additional medical intervention may be required.
Infection: Infection may occur as a result of microbes entering the needle sites or during the procedure. However, this risk is low and can usually be controlled with antibiotics.
Allergic Reactions: In rare cases, allergic reactions to embolizing substances may develop.
Temporary Hormonal Changes: There may be temporary changes in hormone levels after fibroid embolization. This may cause changes in menstrual cycles or temporary menopausal symptoms in some people.
Reproductive Function: In rare cases, there may be changes in uterine function after fibroid embolization. Therefore, caution should be exercised in this regard for those who have had fibroid embolization and who wish to have children.
As with any medical procedure, the risks and benefits should be carefully considered before fibroid embolization. People considering embolization should consult with an experienced gynecologist, radiologist and cardiovascular surgeon in detail.
Should Myomas Be Treated?
Questions from patients; When should I have myomas removed? How big does myoma grow, does surgery need to be done? Can myomas be treated with medication?
If myomas show symptoms and these symptoms bother the patient, they should be treated. Depending on the severity of these symptoms, the patient's age, the size of the myoma and its location, observational, medical or surgical treatment (laparoscopy, laparotomy, hysteroscopy) can be applied.
Since myomas are usually detected by chance, if there is no symptom or the patient has no complaints, just monitoring will be sufficient.
In Which Cases Should Myomas Be Treated?
In cases of excessive menstrual bleeding and the development of anemia, groin pain, swelling and a palpable mass, rapid growth of the myoma in a short period of time, infertility complaints, recurrent miscarriages, recurrent IVF failure, urinary incontinence, constipation, enlargement of the urinary tract or kidney problems, myoma treatment or myoma treatment should be applied.
How is Myoma Treated?
1. Observational Treatment: With ultrasound and clinical follow-up.
2. Drug Treatment: Hormone therapy, GnRh Agonists, Antiprogestins.
Hormone Therapy: Birth control pills and drugs containing progesterone hormone (oral progestins or progesterone-containing IUDs (mirena)) reduce the amount of bleeding by thinning the inner lining of the uterus.
GnRH Agonists: Cause an average of 40-50% reduction in myoma size. However, since GnRh agonists have serious side effects such as bone loss when used for more than 6 months, long-term use is not recommended. If the myoma is large, GnRh agonists can be used for a short time before surgery to reduce the size of the myoma. However, myomas grow back after the medication is stopped.
Antiprogestins: Can be used in the treatment of myoma.
3. Uterine Artery Embolization (Non-surgical Myoma Treatment): The aim is to block the vessels leading to the myoma in order to reduce its size. It should be preferred for patients who cannot undergo surgery because it can cause pain.
4. Surgical Treatment: It should be performed by removing the myoma or removing the uterus. The woman's age, desire for fertility, the size of the myomas, and suspicion of cancer are important in this decision. We prefer fertility-preserving surgery in myoma patients who want to have children and we preserve the uterus and remove only the myomas. However, if the patient is over 40 and does not want children, if the myomas are large, numerous, or if there is cancer, i.e. sarcoma, the removal of the uterus is preferred.
A) Myomectomy (Open Surgery): If we think the myoma is malignant, if the patient is older or if the myoma is large, open surgery is preferred.
B) Laparoscopic Myomectomy (Closed Surgery): If the mass looks like a myoma, is not too large and we do not suspect cancer, i.e. sarcoma, it is our first choice. However, the location of the myoma is also important. In laparoscopic myoma surgery, the removed myoma mass is placed in a bag in the abdomen and separated into pieces with a morcellator. During this time, there may be a risk of tissue spillage and in this case, the malignant tumor may spread. Therefore, morcellation is not recommended in cases of suspected cancer and the myoma should be removed with open surgery.
C) Hysteroscopy: If the myoma protrudes into the uterine cavity, it is possible to remove the myoma with a short operation by performing hysteroscopy.
D) Hysterectomy (Removal of the Uterus): In the following years, myomas recur in half of the women who have myomectomy. The definitive treatment for myomas is removal of the uterus. We recommend removal of the uterus in women who are older, do not want to have children and have been diagnosed with cancer, which we call sarcoma. When the uterus is removed, women do not menstruate, but they do not enter menopause either. Because the ovaries are not touched during the surgery and the eggs continue to produce hormones and function.
E) In Vaginal Myomas: Myomas can be removed directly from the vagina.
When Should Myoma Surgery Be Performed?
If the complaints continue despite medical treatment, if the myoma shows any symptoms depending on its size, or if there is a suspicion of cancer, these myomas should be surgically removed.
Should Open Surgery or Closed Surgery Be Preferred?
In terms of wound healing and patient comfort, closed surgeries are our preference, but if the myoma is large, if it is not possible to remove it with closed surgery due to its location, or if we suspect cancer, which we call sarcoma, it is preferred to remove the myoma with open surgery.
What Happens If Myomas Are Not Treated?
What Happens If Myomas Are Not Treated?
Myomas are usually benign tumors and usually do not cause serious problems even if they are not treated. However, not treating myomas can lead to certain symptoms or complications:
Increased Symptoms Caused by Myomas: Symptoms may increase as myomas grow or settle in a certain location. These complaints may include heavy menstrual bleeding, groin pain, difficulty urinating, or bowel problems (constipation).
Anemia (iron deficiency, anemia): Due to heavy menstrual bleeding, myomas can cause iron deficiency anemia in women. Symptoms may include fatigue, weakness, and paleness.
Fertility Problems: Myomas can prevent implantation during pregnancy or affect normal fetal development. In addition, myomas can increase the risk of premature birth during pregnancy.
Complications: In rare cases, myomas can burst or twist, blocking blood circulation. This may require emergency medical attention.
Decreased Quality of Life: The quality of life of people living with fibroids can decrease due to increased symptoms or complications.
Whether or not fibroids are treated depends on the severity of the symptoms, the size and location of the fibroids. Treatment can be done to relieve symptoms or reduce the risk of complications. Therefore, it is important to consult an experienced gynecologist if you have any concerns or symptoms related to fibroids.
Myoma Treatment Prices Istanbul
Since each patient presents different findings and each patient's treatment is different, we first examine our patients, then perform ultrasound and necessary tests, and then make a follow-up or treatment decision. Since the price is also affected by the choice our patients make among the hospitals we have agreements with for myoma surgery Istanbul, we give prices that vary from person to person for the operation.
You can contact us for detailed information about myoma treatment prices in Istanbul and myoma surgery fees, and make an appointment with Associate Professor Çiğdem Yayla Abide, an expert in Gynecology, Obstetrics and In Vitro Fertilization.
Frequently Asked Questions About Myoma and Myoma Treatment
What happens if there are fibroids in the uterus?
Fibroids in the uterus can reduce the quality of life with pain and heavy menstrual bleeding. In this way, fibroids with intense symptoms can be treated, and in people without complaints, just monitoring is sufficient.
Is myoma a dangerous disease?
Myomas are harmless, non-cancerous tumors that develop in the uterus. Complications that may occur as a result of not following myoma can be dangerous.
What happens if myomas are not removed?
If myomas are not treated, bleeding and groin pain may increase and they may also cause other problems by putting pressure on the bladder.
Does myoma affect sexual intercourse?
If myoma does not show symptoms such as bleeding or pain, it may not affect sexual intercourse. However, if its symptoms are felt excessively, it may cause sexual intercourse to be painful.
When do myomas turn into cancer?
Myomas are benign tumors and have a very low risk of turning into cancer. Myomas do not contain cancerous cells within themselves.
Where does myoma pain affect?
Myoma pain usually affects the lower abdomen and groin. Menstrual bleeding can also be long and heavy.
How do we know if it is a myoma?
Myoma is usually detected through a gynecological examination. Myoma can be diagnosed through ultrasound.
What does myoma mean?
Myomas are benign tumors that form in or around the uterus. They are usually seen in women of reproductive age and are usually not cancerous. Myomas often do not show symptoms, but they can cause symptoms such as heavy menstrual bleeding, groin pain, and urination problems. Myomas can form in the uterus, on the uterine wall, or outside the uterus. Treatment options vary depending on the symptoms, size, and location of the fibroids and may include medications, surgical interventions, and minimally invasive procedures. It is important to consult an experienced gynecologist to treat fibroids and determine the most appropriate treatment options.
How is myoma diagnosed?
The presence of myoma is usually diagnosed during routine gynecological examinations. The mass observed on ultrasound is generally typical for myoma. Sometimes, an atypical image can be obtained due to degenerations within the myoma, and at this time, we can use three-dimensional ultrasound, MRI, and tomography to exclude sarcoma, a rare type of cancer, or to decide on the type of surgery.
A malignant tumor (sarcoma) transformation is observed in 0.1% - 0.5% of myomas. The definitive diagnosis of this malignant tumor can only be made through pathology; that is, through surgery.
Who is affected by myoma?
Myoma is frequently observed in women of childbearing age, especially between the ages of 30-40.
At what size is myoma removed? At what size should myoma grow to be surgically removed?
The woman's complaint is more important than the size of the myoma. Surgery is recommended in cases of heavy bleeding that continues despite drug treatment, infertility, recurrent miscarriages, abdominal and groin pain, constipation, and difficulty urinating.
Is myomectomy risky? Is the uterus removed during myomectomy?
There may be bleeding in the area where the myomectomy was performed after myomectomy. We do not remove the uterus during myomectomy. We perform uterine-preserving myomectomy, especially in women who want to have children or who will want to have children in the future, and we only remove the myomas.
Should a cesarean section be performed after myomectomy?
If the endometrium was entered during myomectomy, we recommend that the next delivery be performed by cesarean section, assuming that a cesarean section has been performed. If a normal delivery is attempted after myomectomy, the uterine stitches may open during labor contractions, posing a life-threatening risk.
How to shrink myomas?
Some medications can temporarily shrink myomas. Or embolization treatment can be tried in suitable patients.
How long does myoma embolization take?
Myoma Embolization time varies depending on the number of myomas and their location. It takes 1-2 hours on average. A 1-day stay in the hospital is sufficient after myoma embolization.
