FIBROIDS (Leiomyoma)

• It is a benign uterine mass. It develops from the smooth muscle layer of the uterus (myometrium).

• The possibility of transformation into cancer is one per thousand (1/1000).

• It is seen in 70%  in white race and 80% in black race.  Approximately 25% of patients have clinical symtoms.

• There may be more than one in various dimensions. Sometimes it can reach a size that fills the whole belly.

• It is divided into three groups according to the location.

Rahimdeki yerleşim bölgesine göre üç gruba ayrılır.

1. Subserous: This type grows from the outer layer of the uterus into abdominal cavity. It usually manifests itself with the mass effect and pressure to the surrounding organs.

2. Submucous: It is a type that bulges into the uterine cavity.  . Increased and interval bleeding are the most common 

3. Intramural: Grows within the uterine wall. It may  cause symptoms of both intramural  and subserous fibroid.

• The most common causes for surgery are:
        - Mass Effect : If uterus is palpable on abdominal  examination
        - Anemia due to increased bleeding that does not respond to medical treatment  (In women  with anemia        menstrual bleeding history should be asked and gynecological examination performed if needed)
       - If there is no other cause for recurrent pregnancy loss
       - Recurrent IVF Failure
       - Pressure symptoms to surrounding structures like urinary bladder and ureter
       - Unexplained chronic  lower abdominal pain
  Treatment: Despite widespread trials with various hormonal medications, there is no long-term and successful medical treatment of fibroids. Since they are estrogen dependent , they usually shrink after menopause. The most effective treatment is surgery, either removal of fibroid (myomectomy) or whole uterus (hysterectomy). The most important factors in this decision are ; 

• Age of the patient 

• Desire for fertility 

• Location  of the fibroids. 
  In general, it is possible to technically remove the fibroids and save the uterus in majority  of the cases. The main objectives of the operation are;
       -  minimal incision
       -  minimal blood loss 
       -  minimal tissue damage especially in patients with expectation of fertility 
       -  repair the uterine wall in layers for better healing . 
  
  Laparoscopic surgery could  be preferred if the surgeon's experience and technical facilities permit and the above conditions are met.   Hysteroscopic resection of submucous fibroids  is feasable in most cases. In recent years, entering into the uterine vessels (angiography) via peripheral arteries  and occlusion with special substances/particles (embolization) began to be used. Although ongoing pregnancies have been reported after this treatment, it is not yet a safe method for whom pregnancy is planned.
  Delivery mode following myomectomy operation should be cesarean section!