Uterine fibroids are the most common benign tumor of the uterus, generally originating from smooth muscle and fibrous tissue cells of the myometrium. Although it is defined by terms such as fibroid, fibromyoma, myoma, and leiomyoma, the term fibroid has been widely accepted. The uterus consists of smooth muscle. Fibroids are benign growths that develop from the smooth muscle of the uterus. A benign myoma is unlikely to progress to cancer.
Fibroids are quite common. In nearly 80% of women, fibroids will be encountered at some point in their lives. However, not all women with fibroids will develop complaints.
The exact cause of fibroids is unknown. It has been shown in clinical studies that it responds to the female hormone, estrogen and progesterone. Genetic studies have identified specific genes that predispose fibroids in a woman and her family.
The frequency of fibroids also increases as the age progresses during reproductive period. Fibroids, grow especially in the reproductive period and during pregnancy, while they shrink after menopause.
The vast majority of uterine fibroids are small in size and do not cause any complaints. However, we also see fibroids over 10 cm. Some women may experience periods of heavy bleeding and prolonged (longer than 7 days) menstrual cycles. Pressure or pain may be felt in the lower abdomen.
The three most important factors that determine the development of complaints due to fibroids are: size of fibroids, number of fibroids and location of fibroids. As the size and number of myomas increase, the likelihood of complaints increases. However, even in smaller sizes, myomas located inside the uterus are more likely to develop complaints such as bleeding.
Large fibroids may cause discomfort and feeling of pelvic pressure, similar to those felt by pregnant women. Fibroids that put pressure on the bladder or the bowel can require frequent bathroom visits.
Relationship with Pregnancy
Many women with fibroids can get pregnant without any problems and complete their pregnancy without any difficulty. While the fibroids that are located on the outer surface of the uterus have verylimited effect on conception, those on the inner surface of the uterus can cause miscarriages. We suggest that women planning pregnancy should have routine gynecologic examinations.
Fibroids that do not cause any complaints need not be treated. In patients with symptoms, treatment may be recommended according to the severity of the symptom. The method of treatment is determined by the number of fibroids, fibroid size, location and possible pregnancy plan.
Treatment of fibroids can be done with medical or surgical methods. The goal of medical treatment is to reduce symptoms, especially heavy bleeding, pain and anemia. Beyond that, there are medical treatment options that shrink the fibroids.
Medical treatment options that we recommend according to the patient include: Hormone intrauterine device (IUD), birth control pills, contraceptive methods containing gestagen (such as patch, implant), nonsteroidal anti-inflammatory drugs, iron and vitamin supplements, progesterone receptor modulator, GnRH agonist, tranexamic acid. Mechanism of action of all these drugs is different and the side effect profile is also different. For patients who are recommended to receive medical treatment, one or more alternatives are presented according to the characteristics of the patient and information is given about how long the treatment will take, how it will be used, expected benefits and side effects and necessary follow-ups.
We recommend surgery to some of our patients with fibroids. Despite medical treatment, if heavy menstrual bleeding does not improve, if the patient cannot conceive and it is thought to be caused by fibroids or in large fibroids that cause complaints, we consider the option of surgical treatment.
Fibroid Surgery (Myomectomy)
Fibroid surgery is usually done in two ways. These are keyhole method (robotic, laparoscopic, hysteroscopic surgery) and open method.
In the robotic or laparoscopic method, incision is not large. The procedure is performed by entering through the holes of 0.5-1 cm and observing through it by a camera connected to a monitor. Having a small incision makes the postoperative process comfortable.
In the hysteroscopic method, surgery is performed to remove the fibroids that have grown into the uterus by entering into the uterus through the vagina. It is a comfortable and less painful operation just like laparoscopic method.
In laparoscopic or hysteroscopic myomectomies, the patient can be discharged on the same day or the next day.
In the open method, a 10-15 cm incision is made on the skin in the lower part of the abdomen. In patients with a large number of myomas (>10-15) located posteriorly, open method may be more appropriate in terms of operation time.
In women who have completed their fertility period, the entire uterus can also be removed surgically instead of fibroids only if it is considered necessary.
The majority of women with myomectomy may become pregnant afterwards and have children. In 10% of patients there is a possibility of recurrence of the fibroids.
Your doctor will inform you about possible treatment options and will answer your questions about fibroids.
(We preferred to use both of terms, fibroid and myoma, in our article because of their recognition by the general public).