Fibroids are most common benign tumors in women. They originate from the smooth muscle tissue which form the uterus itself. Possibility of malignance (called as sarcoma) is less than 1%. Presence of fibroid in the family history increases the likelihood of occurrence in the person but that doesn’t mean that it will definitely occur. Often occurs between the ages of 35-45. There is almost no possibility of reversion during puberty or after menopause.
These are estrogen hormone dependent tumors. Therefore, they are affected in the periods when estrogen levels are low and high. Forexample, whereas fibroids may grow due to increased estrogen levels during pregnancy, they got smaller during puerperal. So getting pregnant as soon as possible and breastfeeding the baby longer are recommended for the patient having fibroid who plan pregnancy. If the complaints are appropriate for follow up during menopause, it is better to wait without intervening. Estrogen level decreases with menopause and fibroids get smaller.
There are many factors which affect physicians' approach to the fibroids. The treatment approach is determined depending on the place of residence, findings, types and severity of the patient's complaint, growth rate, age of the patient, whether the patient has given birth or not, the pregnancy plan, and proximity to menopause period and many other factors. Fibroids may reside out of the uterus (subserosal), inside the muscle tissue of the uterus (intramural), close to the spill area of bleeding, right into the uterus (submucosa), into cervix (cervical) and the ligaments of the uterus within the abdomen (intraligament the machine). Sometimes they may grow and hang from the vagina. Approach and treatment method vary according to this differentiation. For example, while an appropriate removal of fibroid (mypmectomy) is performed for the patient having fibroid localized right inside the uterus with continuous bleeding in whom pregnancy is planned, performing hysterectomy (removal of the uterus) may be planned for the patients with bleeding and large fibroid who doesn’t expect pregnancy anymore. Initially, getting pregnant is recommended for the group patients planning pregnancy whose fibroid has enlarged towards outside of the uterus.
Fibroids mostly don’t present symptoms. Most of the time, they are told to the patient during routine gynecologic examination just because lest they are detected. Follow up examination once every 6 months would be sufficient. The patient mostly admits due to irregular menstruation. Frequent complaints are interval bleeding, irregular menstruation, prolonged bleeding, an increase in the amount of bleeding, clotted menstruation, starting and ending of the menstruation only by staining and painful menstruation. If the fibroid has resided right in the uterus and forming compression inwards despite being outside, these bleedings occur since they defect the contraction mechanisms of the uterus despite being in small sizes. If the fibroid is large, groin pain, a palpable mass in the abdomen, lower back pain, rectal fullness of scissors, constipation, feeling of crash during intercourse, urinary incontinence, frequent urination symptoms are seen more frequently. Sometimes a small fibroid in a bean size resides right into the uterus, causes irregular menstruation and determination of surgery, sometimes it might have reached to an orange size without presenting any finding since it enlarges towards outwards the uterus. Main reason of the pain in patients having fibroid is the mass compression. Suddenly starting severe pains suggest fibroid degeneration. Rapidly growing fibroids develop due to insufficient blood vessels which feed the fibroid. This condition develops mostly during pregnancy when estrogen levels are elevated highly and rapidly. Resting, pain killer and hot pack are recommended. Fibroids during pregnancy may trigger abort or premature birth. In pregnant patients who are under risk group, treatment with uterine relaxants which prevent abort are arranged. Risk of the baby inside the uterus being harmed by the fibroid is very low.
Treatment of the fibroids is most of the time follow-up. If operation is concerned, our approach varies according to its size, amount and localization. Myomectomy can be tried for the fibroid in the uterus with a device (hysterescopic) put inside the uterus via vaginal tract. closed operations (laparoscopic) with instruments inserted through the abdomen with 2-3 holes or open myomectomy can be performed for other settlements. Best method is determined by discussing it with the patient about fibroid localization, size, whether she wants pregnancy, operation time, duration of hospitalization, recovery period. Approximately 2 days of hospitalization may be required. The patient feels herself well and without problem within 6 to 7 days. There may be pains related to suture flexion and tissue recovery. A simple pain killer resolves the problem. No complication other than occasional vaginal spotting are to be expected. After 40 days, it’s observed that recovery process is over. The time for follow up examination is at the end of this 40 days. The duration to be expected for Pregnancy after surgery is at least 6 months. Of course, there may be complications of this surgery as it may happen in any intervention. Most common complications are removal of the uterus, necessity of re-surgery due to unstoppable bleeding, injuries of peripheral tissue and organs - urinary bladder-bowels and these are very rare.
3 things to be kept in mind while reading all these;