Cyprus Myoma Treatment
What is Myoma?
Myomas are benign tumors composed partly of muscle tissue of the uterus and the diameters of which change between 1 and 15 cm and which are encountered most frequently in female genital organs. Myoma may sometimes be named as fibroid, leiomyoma, leiomyomata or fibromyoma. One third of women aged over 35 years have myoma that are big enough to be diagnosed through examination or ultrasound. However; some researchers believe that myoma develops almost in every woman until menopause including very small myoma. In most of the patients, more than one myoma develops inside the uterus. Such number may sometimes increase over 50. Estrogen that is known as female hormone causes myoma to get bigger. Therefore, the size of myoma generally increases by 2 to 3 times during reproductive age and pregnancy. However; they generally become smaller during menopause if the patient is not taking hormone drugs.
Myomas are divided into 3 groups based on their locations in the uterine tissue:
Submucous Myomas
They are the myomas which develop towards the inner lining of the uterus. They are the type of myoma which occurs the least. However; these myomas are the ones with the biggest bleeding problem. Bleedings generally occur in form of increased or extended menstrual bleeding.
Intramural Myomas
These myomas develop inside the muscle tissue of uterus. They are the most frequently encountered myomas. Just like submucuous myomas, hey cause increased menstrual bleeding, extended menstrual period and consequently anemia. Moreover, they may cause stomach pain and feeling of fullness due to overgrowth in uterus and frequent urination as it puts pressure on urinary bladder.
Subserosal Myomas
These myomas develop towards the outer lining of uterus. Typically, they do not cause bleeding problem. They are mostly manifested in form of symptoms such as stomach pain, back pain, feeling of fullness, frequent urination and constipation.
What are the Symptoms of Myoma?
Most myoma does not cause any complaints and do not require treatment. However, in 10 to 20% of all myoma, severe complaints may occur. The most frequent complaint as to myoma is prolonged and heavy menstrual bleeding. Such bleeding may sometimes be very heavy and may include clots. Patients may suffer from anemia due to chronic bleeding
The other complaints which are encountered frequently in patients with myoma are as follows:
- Stomach pain and feeling fullness
- Back pain and leg pain
- Feeling pain during sexual intercourse
- Frequent urination (as myomas put pressure on the urinary bladder)
- Constipation and gas (as myopas put pressure on large bowel)
How are Myomas Diagnosed?
Most of myomas are diagnosed by gynecologists or radiologists through ultrasonography. However; in ultrasonography, only some of the myomas diagnosed can be seen. Some underlying diseases may go unnoticed. Though magnetic resonance (MR), both uterine can be analyzed through different angles and all of the myomas can be viewed. Therefore, patients with myoma must be asked to undergo MR to determine the method of treatment.
Myomas must be monitored at least at 6-month intervals. Although myomas get cancerous rarely, in case of myomas that grow within a short period of time, canceration may be suspected.
How Do Myomas Affect Pregnacy?
Uterine myomas may sometimes have negative effect on pregnancy. Such effects can be divided into 2 groups:
- They may reduce the chance of conception.
- They may cause miscarriage, premature birth, bleeding and premature rupture of membranes.
Myomas do not prevent conception frequently. However; if myomas are located in close proximity to the point where tubes enter into the uterus, they may block tubes and prevent sperm from meeting the egg. If a single tube is blocked, the chance of conception is reduced. If both tubes are blocked, then in such case it is not possible to get pregnant in normal ways. It may require in vitro fertilization.
If myomas have developed towards the inner lining of uterus, which means if they are submucous myomas, they may prevent embryo’s attachment to the inner lining of uterus and therefore hinder pregnancy. Again myomas which develop towards the inner lining of uterus (submucous) and inside the muscle tissue (intramural) increase in size due to hormones secreted during pregnancy and may put pressure on the embryo inside the uterus and cause problems such as premature birth, bleeding and premature rupture of membrane and, as such, may prevent growth of embryo.
However, they do not necessarily cause these problems to occur in every patient. A lot of patient, even those with large myomas, can get pregnant and give birth in a completely healthy way.
Myoma Treatment
Generally, myomas do not cause any symptoms or complaints and therefore are diagnosed randomly. It is recommended that such myomas are monitored frequently without any treatment.
If myomas cause complaints in the body, some treatments can be administered. The type of treatment is chosen in accordance with the complaints. Painkillers and contraceptive pills can be used for menstrual cramps.
If patient does not respond to medication, infertility persists despite the desire to get pregnant, myoma grows faster than average and complaints of myoma-related pelvic pain, abdominal bloating, constipation, severe anemia and bleeding get more serious, doctor decides to perform operation.
The scope of the myoma operation is determined based on patient’s age and complaints, number and location of myomas and whether the patient has a child or not.
Myomectomy Operation
Myoma operations can be performed in two ways. The first choice would be removal of myoma. If the patient does not have a child and planning to have one in the future, myoma is removed by protecting the uterus so that the patient can have a child until another myoma develops.
The second choice would be complete removal of uterus. As myomas develop in the uterus very frequently and if the patient has a child and does not want to have another one, the option of removal of uterus can be considered after the age of 40 so that myoma does not develop again.
These operations can be performed by use of couple of different methods:
Hysteroscopy
In Hysteroscopy, small myomas which cause pain in the uterus and frequent or heavy bleeding are diagnosed through a special viewing system and cleaned through vagina.
Closed Surgeries
Closed surgeries are performed by use of laparoscopic or robotic surgical methods. Myomas that are larger than 4 to 5 cm are removed from the uterus and, if any, bleeding is intervened and the area is sutured.
Open Surgery
This method is used if very large tumors distend the stomach. It is not possible to remove large myomas through laparoscopic or robotic surgical methods because there is not enough space in the area of operation. In open surgery, myoma can be removed after incision.
