We can briefly answer the question of ‘’what is fibroid’’ as benign, non-cancerous mass-forming growths in or around the uterus.
It is the division of smooth muscle cells and connective tissue cells of the uterus that creates fibroid growth. Most women are unaware of the presence of fibroids. This is because most fibroids do not cause any symptoms.
The cause of fibroid is the uncontrolled growth of smooth muscle cells of the uterus.
Although it is not known for certain, it is thought that genetic factors, immune system and excessive response of cells to growth factors play a role in fibroid formation.
If we examine the symptoms of fibroids, it has been determined that these symptoms are seen in 30% of patients with uterine fibroids.
Abnormal menstrual bleeding: One of the most common complaints among the symptoms of fibroids is excessive menstrual bleeding (menorrhagia) or non-menstrual bleeding. Up to 30% of women with fibroids experience menstrual irregularity, excessive bleeding, or bleeding after intercourse. According to the type of myoma; The amount of bleeding varies according to the location in the uterus, its size and the pressure on the uterus wall.
Pain: Depending on the size of the fibroid, its location and degeneration (decay due to the deterioration of the fibroid's nutrition),fibroids may cause pain. Fibroid pain mostly hits the groin and leg. Rarely, it can cause back pain.
Complaints due to fibroid compression: Fibroid symptoms vary according to the organ that the fibroid presses on. For example, if fibroid has grown forward towards the bladder, it presses on the bladder (urinary bag)and cause frequent urination and inability to empty the urine completely.
If fibroid has grown backwards, it causes intestinal pressure, which can cause constipation, frequent bowel movements, and painful bowel movements.
Very large types of fibroids may rarely press on the ureters, which may cause enlargement of the kidneys and consequently kidney pain, flank pain.
Infertility: Although it is not scientifically proven that fibroids cause inability to become pregnant, if there are no other factors causing infertility, fibroids may be responsible for inability to conceive. Fibroids, especially close to or pressing on the uterine wall or tubes, can cause infertility.
Recurrent miscarriages: Fibroids, especially close to the endometrium (the inner layer of the uterus),where the baby will settle, may cause pregnancy loss in early pregnancy weeks. Large fibroids that are not close to the uterine wall may cause premature birth in the following weeks of pregnancy.
What Are the Symptoms of Myoma? ▶ You can get more detailed information by examining our page.
Estrogen and progesterone hormones are blamed as the most important cause of fibroid growth. These hormones are ovarian-derived reproductive hormones.
It is observed that fibroids grow between the ages of 15 and 49, when reproductive hormones are actively secreted, while these hormones decrease and menopause experience a slight shrinkage during menopause.
The incidence of uterine fibroids is 30% and is observed in women between the ages of 25 and 50. It has been determined that fibroids are more common in overweight women due to the increased amount of estrogen. In terms of race, fibroids are more common in black women than in white women. Fibroids are less common in women who have given birth. The incidence of uterine fibroids decreases with increasing number of births.
Fibroids can occur anywhere in the uterus and of any size. Fibroid size can range from the size of a pinhead to the size of a soccer ball. Types of uterine fibroids are:
Fibroids embedded in the uterus (intramural fibroids): It is the most common type of myoma. The type of fibroids embedded in the uterine muscle layer (myometrium) is called intramural fibroid. Intramural fibroids usually do not show symptoms until they reach very large sizes. When it reaches large sizes, it can cause bleeding, menstrual delay and irregularity by putting pressure on the uterine wall or it can grow out of the uterus and press on the surrounding organs, causing symptoms such as inguinal pain, frequent urination and constipation.
Submucous fibroids (fibroids on the inner wall of the uterus): This type of fibroid, which is located in the endometrium, the inner layer of the uterus, causes more bleeding. Even if the submucous fibroid is very small in size, it bleeds more because it expands the uterine wall.
It is a type of myoma that prevents the embryo from attaching to the uterine wall (implantation) and the continuation of pregnancy. It is the type of myoma that must be removed before assisted reproductive techniques such as IVF.
Subserous fibroids (fibroids growing out of the uterus): Subserosal fibroids are a type of fibroid located under the membrane layer that surrounds the outside of the uterus. Subserous fibroids usually do not bleed, they cause more compression complaints (groin pain, frequent urination, constipation, kidney pain). However, in order to cause these complaints, the fibroid must reach large sizes.
Stem fibroids are fibroids that are attached to the uterus by a stalk.
Parasitic fibroids: Myomas that occur as a result of subserosal fibroids growing over time, becoming unable to feed from the uterus, separating from the uterus and feeding and growing from the organ in the abdomen where they fall are called parasitic fibroids.
Fibroids which protruded into the vagina: This type of fibroid, which occurs as a result of submucous fibroids growing and protruding from the cervix with the effect of gravity, is very rare.
In the classification of fibroids, the classification of FIGO, the International Federation of Obstetrics and Gynecology Associations, which is shaped according to the location of the fibroid in the uterus and from Type 0 to 8 is used.
Determining the location of the fibroids clearly before the surgery will increase the safety of the surgery.
If the fibroids do not cause any complaints or if the problems related to pregnancy and conception are not foreseen, there is no need for any fibroid treatment or fibroid removal.
Fibroid size or newly developing symptoms are followed up with frequent examinations for 3-6 months. At the age of close to menopause, fibroid growth stops and the size decreases somewhat after menopause.
In fibroids that do not respond to medical treatment, treatment is planned according to the patient's desire to reproduce, age, fibroid location and size. Medical treatments are ineffective if the fibroid size has increased.
If we list the agents that are frequently recommended in the medical treatment of fibroids;
How is fibroid treated? This question is one of the most frequently asked questions from our patients. Age, reproductive conditions, desire for reproduction, size and uterine location of fibroids play an important role in the treatment of uterine fibroids. Necessary surgical operations and medical treatment for fibroids carry variety of risks for the patient. Planning the risk and cost of operation is utmost importance.
If we analyse fibroid treatment methods, we can indicate them under 3 main headings;
Is there any drug treatment for myoma uteri? We often encounter this question in our daily life. If we look at the medical literature, we see that many agents are recommended. Although the agents we will mention below provide some benefit in reducing myoma complaints according to their mechanism of action, they cannot eliminate the negative effects of fibroids in the long term.
• Spirals containing levonorgestrel: These devices, also known as medicated spirals and placed in the intrauterine cavity, secrete progesterone hormone slowly, preventing the thickening of the inner membrane tissue covering the uterine cavity and keeping it thin. The most common side effects are abnormal menstrual bleeding, acne, headache, breast tenderness and cessation of menstruation.
• Tranexamic acid: If the contraceptive effect created by the spiral is not desired, tranexamic acid can be tried. Tranexamic acid can reduce the amount of bleeding by 50% by blocking the blood flow in the thin vessels of the uterine lining. Tranexamic acid tablets can be taken 3-4 times a day during the menstrual period. If no results can be obtained from the treatment within 3 months, it is discontinued. Indigestion and diarrhea are the most common side effects of tranexamic acid.
• NSAID (non-steroidal anti-inflammatory drugs): Typical drugs of this group are Ibuprofen and Mefenamic acid. It can be taken 3 times a day during the menstrual period. These drugs cause a decrease in prostaglandins in the body, which are associated with heavy menstruation. These are also known as pain relievers. It has no birth control effect. Indigestion and diarrhea are the most important side effects.
• Birth control pills: In addition to the birth control effect, it makes the menstruation lighter and painless.
• Oral progesterone tablet use: Progesterone tablets taken 1 per day between 5 and 26 of the menstrual cycle days can reduce the amount of menstruation. It affects by preventing the thickening of the intrauterine membrane tissue. Tablets makes it harder to conceive. It has side effects such as weight gain, breast tenderness and acne.
• Needle-administered progesterone: This type of progesterone can be administered once every 12 weeks. It can cause premenstrual syndrome symptoms such as weight gain, abnormal menstrual bleeding, menstrual cessation, bloating, breast tenderness.
• Gonadotropin-releasing hormone-like drugs: These types of drugs may cause some shrinkage of the fibroid. By affecting the pituitary gland, it prevents the ovaries from secreting estrogen. It can be recommended to reduce bleeding before surgery. The disadvantage of these drug is to make it difficult to surgically separate the fibroid from the uterus and the border between the fibroid and the uterus is lost. The drug can cause menstrual interruption. It can cause hot flashes, increased sweating, muscle stiffness and vaginal dryness by creating menopause-like side effects. The use of low-dose estrogen after treatment can reduce these complaints. Bone resorption is also a symptom that can occur if these drugs are used for a long time. These drugs are not used for more than 6 months.
• Ulipristal acetate: This drug, which has been suggested as promising in the treatment of fibroids, can be recommended if the complaints are severe and surgery cannot be performed, but its effectiveness is lower than expected. The drug has a risk of serious liver damage.
If the complaints are very intense and drug treatments do not work, surgical treatment of fibroid can be considered. The majority of our patients who apply to our professor doctor Önder Koç gynecology and obstetrics clinic are patients who have been given all kinds of medical treatment and failed.
Fibroid surgery, the recommended procedures for fibroid surgery are as follows;
A hysterectomy is the removal of the entire uterus. It can be recommended to patients with multiple fibroids who have completed their reproductive period and whose uterus cannot be saved. Since the uterus is removed, it is not possible to encounter fibroids again. Hysterectomy can be performed by open or laparoscopic surgery.
Myomectomy is the surgical removal of the fibroid and preservation of the uterus. It is the most recommended method in our clinic in appropriate cases. Myomectomy can be performed by either open or laparoscopic surgery. If there is a submucous fibroid, it can also be performed hysteroscopically.
In the laparoscopic method, surgery is performed through holes with a diameter of 5-10 mm in the groin, accompanied by a camera image entering through the navel. In the hysteroscopic method, intrauterine fibroids are removed without any sutures, accompanied by intrauterine cameras that enter through the cervix vaginally.
Uterine fibroids surgery cost ranges from 2500 dollar to 3500 dollar depending on the myomectomy . The myomectomy surgery types may be laparoscopic, hysterescopic or open procedures depending on the size and number of fibroids.
Classical open surgical techniques are being replaced by laparoscopic or hysteroscopic surgeries, and non-surgical interventional methods may be recommended in selected cases.
Non-surgical fibroid treatment include;
Uterine artery embolization, occlusion of the uterine artery with occlusive agents has been suggested as an alternative to hysterectomy or myomectomy. It can be recommended for giant fibroids. On the other hand, its use is recommended in selected cases because of severe fibroid decay (degeneration) pain after the procedure, continued compression of the fibroid, and its adverse effects on reproduction in women with a desire to reproduce. This procedure is performed under local anesthesia with the help of a catheter placed in the groin by the radiologist.
Endometrial ablation is the process of removing the inner lining of the uterus. With the help of a hysteroscopic camera, the endometrium layer surrounding the uterine cavity is incinerated and scraped. This process can be done with wires carrying electrical energy or with a laser. The patient can be performed as a day procedure under local anesthesia. The process may take 25 minutes. After the procedure, inguinal cramps and spotting can be seen for a few days. This procedure is not recommended for patients who wish to conceive, due to the damage to the endometrium.
MR-directed procedures are two methods that have recently entered the practice and are not available in most clinics: MR-guided laser ablation and MR-guided transcutaneous focused ultrasound. In these techniques, the MRI guides fine needles to be inserted into the center of the fibroid. Laser energy or ultrasound energy passes through these needles to the fibroid. It is expected to cause destruction of myoma. These are new applications and their long-term results and benefits have not been clearly demonstrated. The effects on patients who want a baby are unknown.
Although some growth is observed in fibroids as a result of the increase in estrogen hormone during pregnancy, most of the fibroids do not have a negative effect on pregnancy. However, it may cause some negative pregnancy results depending on the location and size.
If the fibroid originates from the uterine wall or presses on the uterine wall (endometrium),it may prevent the baby from attaching to the uterus (implantation),leading to inability to become pregnant or miscarriage (abortion).
If fibroid reaches large sizes and causes deformity in the uterus, it narrows the baby's range of motion; It can cause developmental delays in the baby, such as premature birth and breech presentation.
Fibroids during pregnancy can lead to localization abnormalities of the baby's placenta. Anomalies of the placenta include placenta previa (abnormal localization of placenta),placenta accreta (excessive attachment of the placenta to the uterus),or placental abruption (premature separation of the placenta). These complications cause excessive bleeding before or after birth, putting the lives of both mother and baby at risk.
Studies have shown that pregnant women with fibroids have a 6-fold increased risk of postpartum hemorrhage.
