Fibroids, or by their other name leiomyomas, are benign tumours that occur inside the uterus and are not malignant. Fibroids can rarely turn into a sarcoma, which is a malignant tumour. Many women have fibroids at some point in their lives.
Because fibroids generally do not cause any sign, they are mostly noticed during a routine gynaecological examination. Their size varies from too small to be seen with the eye to as large as the abdomen of a pregnant woman.
Why fibroids form is not known exactly. It is thought that a genetic predisposition, differences in oestrogen and progesterone levels or other insulin-like growth factors make the formation of fibroids easier.
Do Fibroids Always Grow?
In situations where no sign or complaint is seen, it is preferred to observe the fibroids and not to intervene. This is because malignant transformation of these masses is very rare; on the other hand, it should be kept in mind that they can be malignant.
Some fibroids press in particular on the inner layer of the uterus or grow directly in the place where the embryo will implant and can prevent pregnancy. They usually grow slowly, or do not grow at all and stay the same size for years. After the menopause, because of the fall in hormone levels, they can shrink or stay the same without a change in size.
Is It Necessary to Treat Every Fibroid We See?
First of all, it is not necessary to treat every fibroid we see. Fibroids that are small and do not cause complaints in the patient are only observed. What is important is simply not to neglect the follow-up examinations. If there is an increase in the growth rate of fibroids after the age of 45 or in the menopausal period, or if there is a change in their appearance, this must be shared with the patient with a view to treatment.
Treatment Methods
There is no single method of treatment for fibroids. Treatment processes vary according to the number, size and location of the fibroids and the signs they cause. In situations where there are complaints such as heavy menstrual bleeding or pelvic pressure, drug treatments such as tranexamic acid, progesterones, GnRH drugs and progestin-releasing intrauterine devices can be preferred.
Methods That Preserve the Uterus
Today, thanks to advanced technologies, fibroid treatments can be performed while the uterus is preserved. Some of the treatment methods used in the past could end in infertility. Because of methods that included procedures such as removing the entire uterus, it was not possible for patients to have children after the operation.
Fibroid treatment is generally divided into two as non-invasive and minimally invasive. In non-invasive methods no incision is made for the procedure and high-energy ultrasound transducer treatment is applied while the patient is inside the MRI device. With MRI imaging the location of the fibroids is determined exactly and in this way the ultrasound waves can be directed straight at the fibroid. The fibroid heats up and breaks apart. This is quite a new method.
The other group is the minimally invasive methods. With uterine artery embolisation, embolic agents are injected into the arteries that feed the uterus. In this way the blood flow to the fibroids is cut off and over time they die.
Radiofrequency ablation is another of the options. High radiofrequency energies break the fibroids apart and also shrink the vessels that supply them with blood. This procedure can be performed laparoscopically or transcervically through the vagina.
The most widely used method for removing fibroids in the uterus while preserving the uterus is the surgical procedure called myomectomy, performed by hysteroscopic, laparoscopic or robotic surgery. In this treatment, surgeons reach the fibroids through the vagina and cervix with hysteroscopy, or through the abdomen in robotic or laparoscopic surgery, and remove them.
In a woman who has many fibroids that do not cover the entire uterus (the size of the fibroid is less important), it is possible to preserve the uterus by using these methods together. In patients whose fibroids are very large, in whom healthy tissue would not remain in the uterus after a myomectomy, or in patients with a possibility of malignancy, the option of removing the uterus must be shared with the patient.
Do Fibroids Come Back After Surgical Treatment?
After good surgical treatment, that is after complete surgery in which no fibroid is left behind, the risk of recurrence is low, especially if surgery was performed for a single fibroid. If this surgery was performed at the beginning of the reproductive years, the risk increases because that patient will be in the hormonally active period for many years. Therefore the regular follow-up of these patients is extremely important.
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