Fibroids are benign, estrogen-sensitive tumors that arise from muscle tissue in the uterus.
Fibroids can be located inside the uterus, on the outer surface of the uterus, embedded in the uterine wall or in a
They may be attached to the uterus with a stalk. The most common benign tumor in women
Fibroids can start to appear with puberty. In women of reproductive age
The incidence of fibroids increases with age. In most, but not all, patients
After menopause, fibroids shrink with the decrease in estrogen.
WHAT ARE THE RISK FACTORS FOR FIBROIDS?
Having one or more births reduces the chance of fibroids.
Women who menstruate before 10 years of age are more likely to develop fibroids. With the transition to puberty
Increased estrogen is associated with an increased risk of fibroids.
Most studies show an association between fibroids and obesity.
Excessive alcohol consumption, especially beer, increases the risk of fibroids.
Smoking inhibits the enzyme aromatase, which converts testosterone to estrogen in the body.
decreases the amount of fibroids. Interestingly, recent studies have shown that smoking may be linked to fibroids by this mechanism.
reduces the likelihood of occurrence.
WHAT ARE THE SYMPTOMS ASSOCIATED WITH FIBROIDS?
Most fibroids are small and asymptomatic and can be detected by a chance imaging method.
They can also cause the following complaints in some patients:
– Prolonged, frequent and excessive menstrual bleeding (menorrhagia, metrorrhagia)
– Intermediate bleeding
– Anemia due to blood loss
– Dysmenorrhea (painful menstruation)
– Dyspareunia (painful sexual intercourse)
– Pain in the abdomen and groin
– Feeling of pressure and pressure in the lower abdomen
– In fibroids that grow towards the bladder, it is difficult to make all urine as a result of pressure.
Difficulty or frequent urination, rarely inability to urinate.
– Difficulty in defecation due to pressure in fibroids growing towards the intestines, constipation
can be seen.
– Fibroids in the uterine cavity can cause recurrent miscarriages or difficulty conceiving.
may be the cause.
HOW ARE FIBROIDS DIAGNOSED?
– Most fibroids are well-circumscribed and hypoechoic with ultrasound performed through the abdomen or vaginally,
may appear as round masses.
– Cervical fibroids can be seen during speculum examination.
– Hysteroscopy can show fibroids in the uterus. The uterus through the vagina with a thin device
the fibroids in the uterus are visualized with a camera by entering into the uterus, and at the same time the treatment
may also be used.
Hysterosalpingography, MRI or tomography can also be used to diagnose fibroids, but most
it is not always necessary. Ultrasound and hysteroscopy, which provide diagnosis and treatment together, and
laparoscopy will usually be sufficient.
CAN FIBROIDS TURN INTO CANCER?
Fibroids are benign masses, however, sarcoma, which is a malignant tumor, is very rare.
Care should be taken in follow-up in terms of the possibility of transformation.
TREATMENT OF FIBROIDS
Asymptomatic, small and not growing during one year of follow-up, seen in pregnant women or
Fibroids that occur close to menopause do not require treatment. These fibroids can be treated
They are monitored and followed up with ultrasound examination.
They cause complaints that interfere with daily life, are indistinguishable from other tumors, rapidly
fibroids that grow and interfere with pregnancy should be treated.
The main treatment for uterine fibroids is surgery, but the size of the fibroid, its location, the patient’s age and
Appropriate treatment is selected according to the child’s wishes.
DRUG TREATMENT FOR FIBROIDS
Medicines can relieve the symptoms of excessive bleeding and pain caused by fibroids, but they can also prevent fibroids from forming.
they do not eliminate it. For this, hormonal birth control pills, hormonal spirals
can be used. A group of drugs called GnRH agonists can temporarily shrink fibroids and
can be used before surgery. However, the definitive treatment for fibroids is surgery.
SURGICAL TREATMENT OF FIBROIDS
Our two main surgical treatments for fibroids are myomectomy and hysterectomy. However, there are
There are also new treatment options, but not yet in patients who are planning a pregnancy.
is not preferred because it has not been shown to be effective.
Myomectomy surgery is the removal of only fibroids while preserving the uterus. Thus, the woman
can have a child after fibroid surgery. Smaller incision, less bleeding, more
laparoscopy offers many advantages such as rapid recovery, diagnosis and treatment.
or myomectomy by hysteroscopy are the techniques of choice. Submucosal fibroids(
fibroids in the inner cavity of the uterus) can be removed by hysteroscopy without an incision in the abdomen. Many
In patients with large or multiple fibroids, open surgery may be preferred.
Hysterectomy surgery is the removal of the uterus together with the fibroids. Together with
The ovaries may or may not be removed. Hysterectomy for large fibroids, other treatments
when it is not useful, when there is no desire to have children. Again, primarily laparoscopic
hysterectomy, or hysterectomy with open surgery.
Embolization is one of the new approaches in fibroid treatment. In this procedure, the blood vessels
certain substances are injected into the vessels to block them and thus the fibroids can be reduced in size. Longer
studies are ongoing in terms of its effect on pregnancy in the period
MRI-guided ultrasound surgery is another new approach. In this technique, ultrasound
waves are directed to the fibroid with the help of MRI and the fibroid is tried to be treated with this effect.
The effects of this treatment on women who want to become pregnant are still under study.
IS THERE A POSSIBILITY OF RECURRENCE OF FIBROIDS AFTER SURGERY?
Unfortunately, there is a five-year recurrence rate of fibroids in patients who have undergone fibroid surgery.
It is around 50%. However, 7 percent of these fibroids require reoperation.
WHEN CAN I GET PREGNANT AFTER FIBROID SURGERY?
It is recommended not to get pregnant for 3-6 months after fibroid surgery. After this period, the uterus
You can get pregnant because the healing will be complete.
CAN I HAVE A NORMAL DELIVERY AFTER FIBROID SURGERY?
Most of the time, cesarean delivery is recommended after fibroid surgery in order not to take risks. However
In very superficial fibroids, normal delivery can also be attempted.
LAPAROSCOPIC MYOMECTOMY (CLOSED MYOMA SURGERY)
Laparoscopic (closed) fibroid surgery is performed under general anesthesia. Laparoscopic
(closed) fibroid surgery can be considered as 5 stages:
First, several 1-2 cm incisions are made in the abdomen, one in the navel and the others under the navel. Abdomen
is inflated with carbon dioxide gas and through one of the incisions a camera device called a laparoscope is inserted.
The uterus, ovaries and neighboring organs can be easily seen. Through other incisions
laparoscopic laparoscopic surgery by inserting devices in the form of thin tubes that will be used in surgery.
(closed) uterine fibroid surgery is performed.
After the preparation is completed, the outer wall of the uterus is cut, the fibroid is found and the uterus
It is removed by separating it from the wall.
After the fibroid is removed from the uterus, the incision in the uterine wall is repaired by suturing.
The fibroid is removed out of the abdomen through incisions. If it is a large fibroid, a morcellator
It is removed by breaking it into small pieces inside the abdomen with a device called a moreelation. This procedure is called moreelation.
Laparoscopy instruments are removed from the abdomen and the small incisions are closed with sutures and the operation is terminated.
WHICH FIBROIDS CAN BE REMOVED WITH LAPAROSCOPIC (CLOSED) SURGERY?
Generally, laparoscopic (closed) surgery is preferred for fibroids smaller than 15 cm.
Multiple fibroids can also be removed by laparoscopic (closed) surgery. Number of fibroids
and its size as well as its location are also effective in the choice of surgery.
WHAT ARE THE ADVANTAGES OF LAPAROSCOPIC (CLOSED) FIBROID SURGERY?
– In laparoscopic (closed) fibroid surgery, the incisions are smaller and the scar remains less.
– There is less pain after laparoscopic (closed) fibroid surgery. Patients recover from surgery
They can start walking and going to the toilet in a short time after surgery.
Patients with laparoscopic (closed) fibroid surgery can be discharged faster. Patients
discharged 1 day after laparoscopic uterine fibroid surgery and back to normal work within 1 week
they can go back to their lives.
There is no risk of hernia formation in laparoscopic (closed) fibroid surgery.
Laparoscopic (closed) fibroid surgery is more likely to cause infection than open surgery.
Fewer unwanted intra-abdominal adhesions after laparoscopic (closed) fibroid surgery
is seen. This is safer for subsequent intra-abdominal surgeries and pregnancies.