Myomas
Fibroids are masses that arise from the wall layer of the uterus. They are also called fibroids, fibroids, leiomyomas and leiomyomas. They are the most common masses in the female reproductive system. Although the prevalence in the society is not known clearly, it has been detected in 30-40% of women in community-based studies.
Fibroids can range in size from a few millimeters to masses that fill the entire abdomen. They can be located inside the uterus, in the muscle tissue or close to its outer surface. There are new classifications based on location. There are no obvious risk factors for fibroids. Starting menstruation at a young age, obesity, vitamin D deficiency and alcohol use are risk factors for fibroids. Many patients with fibroids do not have these risk factors. The genetics of fibroids are different from normal uterine cells. Estrogen, progesterone receptors and aromatase enzyme levels are higher than normal tissue. Therefore, fibroids are thought to be hormone-dependent.
Most patients with fibroids have no symptoms. The most common symptom (sign) is prolonged and heavy menstrual bleeding. Because of the pressure on the lining of the uterus, these patients often do not benefit from medication. They may have painful menstruation, painful intercourse or severe abdominal pain.
Another symptom is a feeling of pressure and fullness caused by the size of the fibroid. Fibroids can put pressure on the intestines and bladder, which are organs adjacent to the uterus. Constipation, frequent urination, enlargement of the kidneys may occur as a result of pressure on the urinary tract.
Patients with fibroids may also experience miscarriages, infertility, premature birth, failure of normal delivery and severe pain during pregnancy. Myomas located in the cervix can grow into the vagina and cause bleeding masses that can be felt with the finger.
There is also the possibility of myomas becoming cancerous or being associated with cancer. Cancers mixed with fibroids are called sarcomas. Sarcomas can cause swelling, fullness and mass in the abdomen in the same way as fibroids. Although the rapid growth of the mass is a warning sign for sarcoma, it is not enough to make a distinction. MRI (magnetic resonance) imaging method can provide information about sarcoma when applied with contrast material. Even when all diagnostic methods are used, it is not possible to make a definite distinction between sarcoma and fibroids before surgery. Sarcomas are less likely to be seen than fibroids. In patients who have had their fibroids or uterus removed, the chance of sarcoma is 1 in every 500 women. The US Food and Drug Administration (FDA) gives this rate as 1 in 360 women. Frozen (rapid pathology) examination performed during surgery is not successful in diagnosing sarcoma. The first rule in sarcomas is not to dissect the tumor. If it is to be dissected, it should be dissected in a closed bag. In laparoscopic (closed) uterine sparing myoma surgeries, the myoma is removed by shredding it with a grater outside the abdomen. During grating, large and small tumor pieces may be scattered in the abdomen. Because of the possibility of sarcoma, this grating process should be done in a bag. If the suspicion of sarcoma is high, open surgery should be considered.
Fibroids may remain the same size during the pre-menopausal period, but they usually grow. The rate of growth varies between patients. Some studies have found an average annual growth rate of 1.2 cm. In the postmenopausal period, their size decreases in most patients.