FIBROIDS

Fibroids are benign (non-cancerous) tumors that develop in the uterus and originate from the muscular layer of the uterus called the myometrium. Fibroids can vary in size, number, and location. Depending on their location, they can cause some symptoms in patients.

Fibroids are most commonly seen between the ages of 30-40, but they can occur at any age.

What Are the Symptoms of Fibroids?

Fibroids often do not cause any symptoms and are detected during routine gynecological examinations. Depending on their location and size, they can cause some symptoms:

CHANGES IN MENSTRUAL BLEEDING PATTERNS

Heavy bleeding, more frequent bleeding, prolonged bleeding, cramps during bleeding, anemia due to excessive bleeding

PAIN

Pain felt in the abdomen and lower back, pain during intercourse

PRESSURE-RELATED

• Frequent urination, difficulty urinating, constipation
• INFERTILITY
• MISCARRIAGE
• SENSE OF ABDOMINAL SWELLING

What Complications Can Fibroids Cause?

Fibroids attached to the uterus tissue with a stalk can cause pain, nausea, or fever if they twist around themselves. Rapidly growing fibroids can cause pain. Rarely, they may be associated with cancer.

How Are Fibroids Diagnosed?

• Ultrasound
• Hysteroscopy, a method of visualizing the inside of the uterus by inserting a camera (hysteroscope) through the vagina.
• Hysterosalpingography is a uterine film taken by giving a special drug. It is known as drug-induced uterine film among the public. It can detect abnormal changes in the size and shape of the uterus and fallopian tubes.
• Sonohysterography is a test where fluid is given through the cervix to visualize the inside of the uterus. After the fluid is given, the uterus expands and fibroids in the uterus are investigated by ultrasound.
• Laparoscopy is a procedure where a doctor looks into the abdomen with a thin camera (laparoscope) to help see inside. It is performed under general anesthesia by placing a camera inserted through a small incision to visualize fibroids outside the uterus.
• Imaging tests such as magnetic resonance imaging (MRI) and computed tomography scans may also be used, but they are rarely necessary.

When Is Treatment Necessary for Fibroids?

If fibroids do not cause any complaints in the patient, are small in size, do not show a significant increase in size during follow-up, or if the patient is approaching menopause, treatment is not required. However, fibroids causing the following symptoms may require treatment:

• Fibroids causing anemia or affecting the patient’s quality of life due to heavy or painful menstrual periods
• Fibroids causing bleeding outside of menstruation
• Fibroids that grow at a rate suggesting transformation to cancer during follow-up
• Fibroids causing infertility
• Fibroids causing abdominal pain

How Are Fibroids Treated?

There are different options for fibroid treatment. The most suitable treatment for you depends on your symptoms, your age (because most fibroids tend to shrink after menopause), your desire to have children, whether they cause anemia, the size, location, and number of fibroids.

Treatment Options:

Medications: Birth control pills, patches, vaginal rings, injections used for contraception may reduce your menstrual bleeding. An intrauterine device or hormonal IUD is among the treatment options. If your main complaint is bleeding, these treatments may help reduce your bleeding.

Surgery (Myomectomy or Hysterectomy): Myomectomy involves removing the fibroids, while hysterectomy involves removing the entire uterus. Myomectomy is often a good choice for women who may (still) want to have children. Fibroids can recur after surgery. Sometimes, hysterectomy may also be an option for patients who do not desire children and have multiple fibroids. In this case, there is no risk of fibroid recurrence, but the patient cannot conceive.

Hysteroscopy: This technique is used to remove fibroids growing towards the cavity of the uterus. A camera called a hysteroscope is inserted into the uterus through the vagina, and the fibroid is removed with electric or laser beams. Fibroids associated with bleeding and infertility usually grow towards the inside of the uterus, and this method is effective for such fibroids. Hysteroscopy can often be performed as an outpatient treatment (you don’t have to stay in the hospital overnight).

Endometrial Ablation: The layer that lines the inside of the uterus is called the endometrium. Menstrual bleeding occurs when this tissue sheds. In endometrial ablation therapy, the endometrial tissue is destroyed with a thin tube inserted into the uterus. The purpose of this procedure is to reduce bleeding in patients with heavy bleeding, but it is not suitable for every patient. It is not used in patients planning pregnancy.

Uterine Artery Embolization: The uterus is nourished by arteries called uterine arteries. These arteries also indirectly supply the fibroids. The aim of this procedure is to stop the blood flow in the uterine arteries to stop the fibroids from being nourished. During this procedure, a radiologist inserts a thin tube into the artery in the leg and uses small plastic bubbles to block the blood flow in the uterine artery, but it is not suitable for every patient. It is not used in patients planning pregnancy.

Which Option Is More Suitable for Me?

You should decide with your doctor to understand how different treatment