What is Myoma?
Myomas are benign tumors that form in the muscle layer of the uterus. Also known as fibroids, myomas usually occur during women’s reproductive years. They are very common. Approximately 2 out of every 3 women develop at least 1 myoma at some point in their lives. Myomas originate from the muscle layer of the uterus and can usually be of various sizes. They can usually be seen as a single myoma, but sometimes more than one myoma can be found at the same time.
Myomas usually grow under the influence of hormones, especially estrogen and progesterone. For this reason, myomas can tend to grow during pregnancy and usually shrink after menopause.
Myomas are mostly asymptomatic and women usually do not notice their presence. However, large myomas can cause some symptoms. These symptoms may include heavy menstrual bleeding, bleeding between periods, painful menstrual bleeding, prolonged menstrual periods, infertility, pelvic pain or pressure, difficulty urinating, pain during intercourse, constipation, and frequent urination.
Fibroids usually do not require medical treatment, but they may require treatment if symptoms are severe or if the fibroids continue to grow. Treatment options include medications, surgery, and nonsurgical procedures. Depending on the symptoms or size of the fibroids, a treatment plan should be determined by a specialist.
Types of Myoma
Subserous Fibroids: Subserous fibroids are fibroids that are located just under the outer layer of the uterus. They usually grow outside the uterus and are less likely to cause symptoms. However, depending on their size, they may cause symptoms such as pelvic pain or a feeling of pressure.
Submucous Fibroids: Submucous fibroids tend to grow into the inner lining of the uterus (endometrium). Because of this, they can affect menstrual bleeding and cause symptoms such as heavy bleeding or bleeding between periods. Submucous fibroids can also contribute to infertility or a risk of miscarriage.
Intramural Fibroids: Intramural fibroids are the most common type of fibroid that is found in the muscle layer of the uterus. These fibroids are located between the inner and outer layers of the uterus. Intramural fibroids are usually asymptomatic, but as they grow they can cause pelvic pain, pressure, or increased menstrual bleeding.
Pedicled Fibroids: Pedicled fibroids are fibroids that are attached by a stalk or root. These fibroids are usually found on the outer surface of the uterus and can move because they are attached by a stalk.
The types of fibroids vary in terms of their symptoms and effects. The type and size of the fibroid should be considered when creating a treatment plan.
How is Myoma Diagnosed?
Fibroids are usually detected during routine annual checkups by an obstetrician-gynecologist.
Physical Exam: Your doctor can detect the presence of fibroids by checking the size and shape of your uterus during a pelvic exam. Some fibroids, such as subserous or pedunculated fibroids, can be felt during a physical exam.
Ultrasonography (USG): Ultrasonography is a common imaging technique used to create images of the uterus and pelvic organs. This technique can be used to determine the size, location, and number of fibroids.
Computed Tomography (CT) or Magnetic Resonance Imaging (MRI): CT and MRI are advanced imaging techniques used to produce more detailed images. These imaging techniques can better assess the size, location, and relationship of fibroids to surrounding tissue.
Hysteroscopy: Hysteroscopy is an endoscopic procedure used to see inside the uterus. This technique can be used to diagnose submucous fibroids and to directly remove small fibroids.
Endometrial Biopsy: An endometrial biopsy is the removal and examination of a tissue sample from the lining of the uterus. This method can be used to confirm the presence of submucous fibroids and to exclude other potential endometrial pathologies.
Fibroids are usually diagnosed using one or a combination of these methods. Each patient is different, so the diagnostic methods and process may vary depending on the doctor’s evaluation. Once a fibroid is diagnosed, treatment options and an appropriate treatment plan are determined.
Myoma Treatment
If the myomas do not cause any complaints and do not grow rapidly, they can be monitored with regular check-ups. However, surgery may be required for myomas that cause complaints, grow rapidly, occur during menopause, or have suspicious imaging results.
Non-surgical Myoma Treatment:
Non-surgical myoma treatment includes non-surgical methods to relieve myoma symptoms or reduce myoma size. These methods may include:
Drug Therapy: Hormonal medications, especially birth control pills, drugs that cause false menopause such as GnRH analogs, or hormonal IUDs (intrauterine devices) can be used to relieve myoma symptoms. Hormonal therapy can stop the growth of myomas or reduce symptoms.
Embolization (Uterine Artery Embolization): In this procedure, embolizing substances are injected into the arteries that feed the myomas, which causes the myomas to have reduced blood flow and shrink in size.
High Intensity Ultrasonography (HIFU): This method uses focused ultrasound waves to heat and destroy fibroid tissue. HIFU can be used as a non-invasive treatment option.
Laser Ablation: Laser ablation uses laser light to heat and shrink fibroids. This method can be a non-invasive option, but its effects and success rates are still under investigation.
Surgical Myoma Treatment
Surgical fibroid treatment involves surgical procedures such as removing the fibroids or completely removing the uterus (hysterectomy). These treatment options may include:
Myomectomy: In this procedure, only the fibroids are removed and the uterus is preserved. Myomectomy can be performed as laparoscopic surgery, robotic surgery, open surgery (laparotomy), or hysteroscopic surgery.
Hysterectomy: Hysterectomy is the complete removal of the uterus. This procedure is considered a last resort for fibroids and is usually preferred in women who do not want to have children or for fibroids that have not responded to other treatments.
Surgical fibroid treatment is determined by the size of the fibroids, symptoms, and the patient’s health status. The most appropriate treatment plan for each patient should be determined by a gynecologist.
Complications of myoma:
It can cause complications such as anemia due to heavy bleeding, infertility due to pressure, premature birth due to narrowing of the uterus, miscarriage due to preventing the embryo from attaching, and severe pain if it grows rapidly during periods such as pregnancy.
Although there is no definitive method to prevent the formation of myomas, it is important to follow them up with regular check-ups. It is very important to visit Assoc. Prof. Dr. Esra ÖZBAŞLI for diagnosis and treatment when you have complaints such as long-lasting pelvic pain, severe and heavy menstrual bleeding, bleeding or spotting between menstrual periods, difficulty urinating, pain during intercourse, painful menstruation.
