Uterine Fibroids Treatment in Turkey

Myoma Uterine (Fibroids)

Fibroids are benign masses made up of uterine muscle tissue. They may be located inside the uterine cavity, within the uterin muscle or or grow from outer walls of the uterus. They may be in various sizes and shapes. There may be one or more fibroids in the uterus. They may grow slowly, fast or stay the same in size.

They are commonly found in females aged 30-40 years.

Fibroids are divided into three types according to their location:

Submucous: Fibroids growing inside the uterine cavity

Intramural: Fibroids growing within the uterine walls

Subserous: Fibroids growing out from uterus,sometimes they be connected to the uterus with a stalk.

What are the symptoms of a fibroid?

Most fibroids stay aymptomatic and they can be found incidentally on ultrasound. Others may cause:

• Changes in menstrual bleeding
• More intense, frequent and long-lasting vaginal bleeding
• Menstrual pain
• Anemia due to heavy blood loss
• Abdominal pain
• Back pain
• Pain during intercourse
• Feeling of pelvic pressure
• Pain during micturition or frequent bathroom visits
• Constipation or rectal pain
• Abdominal swelling due to increased uterine size
• Recurrent pregnancy loss
• Inability to get pregnant

What are the Complications of a Fibroid?

Some complications may be expected in patients having fibroids such as:

When a subserous fibroid is connected to the outer uterine wall with a stalk, it may be twisted around the stalk, causing severe pain, nausea and fever, this is called fibroid torsion. Fast growing fibroids or fibroid degeneration may also cause pain. Sarcomatous changes may start within a fibroid very rarely. Some fibroids may cause infertility due to their location.

What causes fibroids?

Genetic reasons: Fibroid cells may have different genetic composition than normal uterine muscle cells. Therefore it is hypothesized that there is a familial genetic tendency to have fibroids.

Hormones: Female hormones estrogten and progestin increase fibroid growth rate. Because fibroids have more receptors for these two hormones than normal uterine muscle cells. Therefore fibroids tend to grow fast during pregnancy due to increased hormones and they decrease in size during menopause.

Growth factors: Insulin like growth factor may cause fibroids to grow.

Extracellular matrix: It is increased in fibroids and is rich in growth factors which may play a role in fibroid growth.

Fibroids may be originating from a s*tem c*ell found in uterine muscle and may be growing due to uncontrolled cellular mitosis due to above factors.

What are the Risk Factors for Fibroid?

Several risk factors have been defined in patients having fibroids.

• Race-Black women have more fibroids
• Heredity: Women having fibroid in their mother and sisters are more prone to have fibroids.
• Menstruation at an early age
• Obesity (due to increased estrogen in adipose tissue)
• Vitamin D deficiency
• Overconsumption of red meat
• Low consumption of green vegetables
• High consumption of alcohol

Do Fibroids turn into Cancer?

Most fibroids are benign. Less than one per thousand fibroids may undergo sarcomatous degeneration and turn into leiomyosarcoma.

The differenciation of sarcoma from a benign fibroid can only be possible by pathological examination after fibroid removal.

Is it dangerous when a fibroid grows?

Some fibroids may grow fast when left untreated and may cause pressure on surrounding organs such as colon and bladder. This may lead to symptoms such as constipation or frequent micturition.

They may also cause pain due to distention or may go under degeneration due to decreased blood supply.

Does every fibroid need to be treated surgically?

Some asymptomatic fibroids do not need any treatment at all, they just need to be followed up. Other fibroids may be treated by alternative methods to surgery.

Do fibroids disappear spontaneously?

Some fibroids may decrease in size or disappear after menopause or child birth due to decreased hormone levels.

Do fibroids cause infertility?

Most fibroids do not cause infertility. But some submucous fibroids may cause infertility or recurrent pregnancy loss.

Do fibroids cause a problem during pregnancy?

Fibroids tend to grow during pregnancy due to increased hormones. They may also undergo some cellular changes during pregnancy called the red degeneration.

They may also cause:

• Ablatio placenta,
• Preterm labour,
• Intrauterine growth restriction of the baby.

Do Fibroids need to be removed surgically during C-Section?

Since most fibroids get smaller after birth and there is a high risk of bleeding during C-section, not all fibroids need to be removed during a C-section.

How can fibroids be diagnosed?

They can be diagnosed by various methods:

• Ultrasonography
• Histeroscopy
• Hysterosalphingography
• Sonohisterography
• Laparoscopy

Does every fibroid need to be treated?

Most fibroids do not need treatment. But when the following findings are present,they may need to be treated:

• Heavy bleeding and painful menstruations,anemia due to blood loss
• Intermenstrual bleeding
• Necessity to make a a pathological diagnosis to rule out sarcoma
• Fast growing fibroids
• Infertility
• Pelvic pain

Can fibroids be treated medically?

Symptoms of fibroids may be treated by certain medications:

Oral contraceptives: may decrease heavy bleeding and menstrual pain

Gn RH agonists: They cause transient cessation of menses. They are indicated in some cases to decrease fibroids in size before surgery to decrease bleeding. They cause menopausal side effects and fibroids grow back once the medication is stopped.

Progestin Intrauterindevice: May decrease heavy bleeding and menstrual pain.

What type of surgery for fibroids can be performed?

There are mainly two types of surgery for fibroids:

• Myomectomy(Removal of fibroids),
• Hysterectomy (Removal of the uterus).

Type of surgery depends on patient’s age and willingness to become pregnant.

What types of myomectomy procedures exist?

Hysteroscopic myomectomy: It is preferred for submucous fibroids. A camera and instruments can be inserted through the natural cervical opening and the fibroid can be removed in pieces through the cervix. Since no surgical incisions are necessary, most patients can be discharged on the same day after surgery.

Laparoscopic myomectomy: For intramural or subserous fibroids, a camera can be inserted through an umbilical incision, other 0.5-1 cm incisions on the abdominal wall can be made for instruments, and fibroid can be divided into small pieces by morcellation to be removed throught the small incisions.

Laparatomic myomectomy: Fibroids can be removed through an incision made in the lower abdomen similar to a C-section. It may be preferrred when there are adhesions in the abdomen, the fibroids are big and multiple in size.

What are the Alternative Treatment Modalities for Fibroids?

Uterine Artery Embolisation:

It is an interventional radiology procedure. A special agent can be injected into the uterine artery by an angiography procedure to block the blood supply to the fibroid.

It is not recommended for patients who plan to get pregnant in the future. It is preferred for patients with heavy bleeding and pain and are not suitable for surgery.