Myomectomy

Myomas (also known as fibroids or leiomyomas) are masses originating from the uterine muscle and are considered “benign.” They can be observed in 20-50% of women of reproductive age, either as solitary or multiple masses of varying sizes. While they may not cause any symptoms in many women, some may require surgical removal. Myomas are hormone-dependent tumors. They continue to grow in the presence of estrogen and progesterone; however, their growth halts and they may even shrink during menopause when these hormones decrease. They grow rapidly during pregnancy, especially when progesterone levels are at their peak. The incidence of myomas during pregnancy increases with advancing maternal age.

Myomas are classified and present symptoms based on their location. If they grow outward from the uterus, they are called subserosal myomas. If they grow within the muscle tissue of the uterus, they are referred to as intramural myomas, which is the most common form. If they grow towards the endometrium, they are called submucosal myomas. Even small submucosal myomas can cause heavy and prolonged vaginal bleeding.

The most common symptom is heavy and prolonged menstrual bleeding. Additionally, symptoms may include pelvic pain, painful intercourse, a feeling of pressure in the lower abdomen, urgent urination and urinary incontinence due to pressure on the bladder, constipation due to pressure on the bowel, abdominal mass, interference with pregnancy, or premature births.

Diagnosis is typically made through ultrasound. Magnetic resonance imaging (MRI) can be used to determine the size, location, and approach to treatment. Hysterosonography, where fluid is introduced into the uterus to demonstrate its relationship with the uterine wall, can also be utilized. Hysteroscopy can reveal the uterine cavity and its relationship with the tubal openings.

Treatment options include various medications, intrauterine devices containing hormones, and surgical intervention, such as myomectomy.