Myomas (Fibroids)

We frequently encounter fibroids in daily gynecologic practice. They are benign tumors that originate from the muscle layer of the uterus.

Myomas Threaten Women's Health

Myoma is an abnormal, smooth muscle mass which is developed in or around the uterus and cervix. They may pose a serious threat to health and cause abnormal vaginal bleeding, infertility or miscarriages.

Although tumors are popularly known as cancer, the likelihood of Myomas turning into cancer is quite low. However it should still be kept in mind that they may turn malignant, even if slightly, and follow-up should not be neglected. Sometimes they are detected incidentally during a routine gynecological examination. When found in a woman of reproductive age, it can cause major problems. It is often seen in the 35-40 age group. It is very unlikely to be seen during adolescence, but its incidence increases in parallel with advancing age.

Since myomas are hormone dependent, they tend to grow with estrogen hormone and this growth may continue during pregnancy. They may also cause some problems such as pain and be seen differently on ultrasound during pregnancy due to a change what we call degeneration. But these situations do not always occur. On the other hand, as a result of this hormone dependency, they may also shrink due to the decrease in estrogen hormone after menopause.

Myomas, which usually present with different symptoms, may be asymptomatic and detected incidentally on routine checks in some cases. Therefore a comprehensive and regular gynecological examination is required for early diagnosis of myomas.

Symptoms of Myomas

  • Heavy bleeding during menstrual periods,
  • Anemia,
  • Fullness in the abdomen and pelvis,
  • Severe pain during sexual intercourse,
  • Pain in the lower back and coccyx,
  • Frequent urge to urinate,
  • Blockage of the tubes (in some cases) 
  • Constipation

Myomas may cause different problems depending on their sizes, numbers and growth rates. Each woman may experience different symptoms with different severities.

Surgery may be necessary when they cause severe symptoms and interfere with the patient's daily life. Myomas can be removed surgically, but there is a risk of recurrence after the surgery. Subcentimetric myomas may remain after the surgery and grow over time.

If the myomas are small, Myomas can be monitored closely without surgery if they are small and asymptomatic. Clinical follow-up may be enough for myomas that do not cause major problems. Considering that the myomas keep growing, early diagnosis is very important. When they are diagnosed late, they may be in very big sizes or cause serious clinical complaints. In these cases surgical intervention becomes inevitable.

Is Open Surgery Mandatory in Surgical Treatment?

Nowadays, minimally invasive techniques are frequently used for surgical treatment of myomas. Hysteroscopy is performed if myoma is close to the inner layer of the uterus, however laparoscopic surgery is preferred if it is larger and located deeper. In recent years, robot-assisted surgeries are being performed successfully and frequently for myomas.

Should the Uterus be Removed in Myomas Surgeries?

The answer is clear: NO. The uterus can be preserved in many cases of myoma. However the experience of the surgeon who applies the surgical technique is one of the most important things in these cases. Postoperative follow-up is also very important in patients in whom the uterus is preserved.