Myoma (Myoma Uteri)
Myoma is a benign tumor developing from smooth muscles of the womb. It is encountered by 20-25% in reproductive ages, by 40% over the age of 35. It can be single or multiple. Sometimes it can grow as much as a soccer ball.
Types of myoma: It has various types according to localization in the womb.
The most common are intramural (in the middle layer of the womb), subserous (in the external layer), and submucous (in the internal layer). Additionally, pedunculated, interligamentous (in the midst of ligaments holding the womb on at its position), parasitic (feeds on organ that it adheres) myomas are present too.
CAUSES OF FORMATION OF MYOMAS
Although it is clearly not known, it is considered to be associated with hormones. Estrogen hormone and progesterone hormone in recently some studies are held responsible. Among risk factors increasing development of myoma: Familial predisposition, alcohol, obesity, hypertension, nutrition, black race, nulliparity, early onset of menarche can be counted. Exercise may reduce the development of myoma. Use of birth control pills may also show a protective effect.
SIGNS OF MYOMA
They are frequently identified coincidentally during gynecologic examination. Signs depend on size, number, and region where they are found in the womb. Excessive and abnormal vaginal bleeding, pain, abdominal swelling and enlargement are most common seen. Bleeding following sexual intercourse, intermediate bleeding between menstruations, frequent urination due to compression, and constipation are among signs. They cause infertility by closing the inlet of tubes or cervix. Anemia may also be seen due to long-lasting bleeding.
Myoma is noted in 3% of pregnancies. They generally grow during pregnancy. They may cause severe waist and abdominal pain that are not healing with rest by red (cavernous) change. Because of localization, size, and number, they may lead to abortion, preterm birth, early separation of placenta, birth-end bleeding, and inflammation during pregnancy. In the presence of myoma during pregnancy, the possibility of cesarean also increases. Excision of myoma during cesarean is not preferred so much because it may cause severe bleeding.
If myoma is not so small, it is usually felt with hand while examination. Transvaginal ultrasound informs better about localization. Sometimes diagnosis methods such as CT, MRI are also needed. If myoma is noted, its growth should be followed up with frequent controls once every three months if the person is pregnant.
COMPLICATIONS OF MYOMA
- Torsion (impairment of bleeding by revolving around its peduncle)
- Ascites (fluid collection in abdominal cavity)
- Degeneration (change in cell structure)
- Transformation to cancer: Leiomyosarcoma develops in 0.5% of those with myoma in the future. In some studies, it is considered that this cancer does not originate from myoma and develops alone as independent from others. Myoma begins to grow rapidly. If pain and fever are observed, it should definitely be examined in detail.
TREATMENT OF MYOMA
Its exact treatment is surgery. If:
- It causes bleeding, pain, compression on bladder or intestines
- It compresses on urinary tract, and causes difficulty in urinary flow
- A growth is present in menopause period
- Torsion (revolving around itself) and ascites are formed
- The size of the womb reaches the size of 3-month pregnancy
- It extends to vagina (extension from cervix to cavity)
- It is a reason for infertility (barrenness), surgery is inevitable.
Myomectomy (excision of myoma in people planning a child by protecting the womb) or hysterectomy (totally excision of the womb in extensive large myomas that the protection of the womb is impossible and in those whose childbearing age is passed or who do not want a child anymore) are performed in operations. The possibility of recurrence of myoma within 5 years after myomectomy is by 50-60%. Cesarean, as birth method, is preferred for the next pregnancies.
GnRH analogues are rarely used. When they are given as medication, they create temporary menopause, so a diminution in the size of myoma may happen. Its effect is temporary. It may be given in order to diminish myoma before some operations. Uterine artery embolization (to plug artery transporting blood to the womb by a special technique) can make a diminution in the size by decreasing blood flow going to myoma. These two treatment methods are not used so much.
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