Fibroids

What is a Fibroid?

A fibroid is a benign tumor formed by the excessive growth of smooth muscle cells in the uterus. Fibroids have well-defined borders and do not spread. However, they may become parasitic fibroids if they obtain their blood supply from surrounding organs. This condition should not be confused with cancer, as it only derives blood supply from other organs.

Where are Fibroids Found?

When fibroids are located in the inner lining of the uterus, they are referred to as intracavitary fibroids. If they are situated on the outer wall of the uterus, they are called subserosal. When they are located in the broad ligament, they are known as intraligamentous fibroids, and if they are within the uterine muscle itself, they are called intramural fibroids.

What Symptoms Do Fibroids Cause?

Intracavitary fibroids in the inner lining of the uterus can cause irregular periods and significant increases in bleeding volume. Additionally, intramural fibroids in the muscle tissue can also increase bleeding and may make surgery inevitable. Fibroids located within the uterine cavity may prevent implantation, leading to infertility. Very large fibroids can press on the developing fetus, hindering its growth. During pregnancy, fibroids may cause internal bleeding and pain, creating an emergency situation. They may also compress the bladder and intestines, causing issues such as urinary problems and constipation. Abdominal bloating and pain are quite common.

Fibroids in Women Who Have Not Given Birth

For women who have never given birth, making the correct decision before performing a myomectomy (fibroid removal surgery) is crucial. If pregnancy occurs, the uterine walls may thin as the baby grows, increasing the risk of early spontaneous rupture. In cases where myomectomy has been performed, spontaneous rupture can lead to internal bleeding and pose serious risks to both the baby and the mother. Pregnant women who have had a myomectomy should be closely monitored, and any pain should be immediately assessed for differential diagnosis.

If myomectomy is performed in a woman who has not given birth, open surgery should be preferred, avoiding thermal energy application, and a three-layer closure should be made. In women who have not given birth and plan to do so, myomectomy should be performed with an open abdominal incision.

How are Fibroids Treated?

Fibroids are generally treated surgically. Other methods include hormone therapy, which induces artificial menopause, and embolization techniques. Artificial menopause typically results in a reduction of about one-third, which is why it is not often preferred. Embolization also carries risks of pain and infection.

There are certain considerations to keep in mind when deciding whether surgery is needed for fibroids. Since fibroids can recur, they may be monitored without surgery if they do not cause symptoms and shrink post-menopause. However, fibroids that cause bleeding, pain, or rapid growth should be surgically removed.

How is Fibroid Removal Surgery (Myomectomy) Performed?

There are two methods: laparoscopic myomectomy and open surgical myomectomy. Laparoscopic myomectomy has less pain and a shorter hospital stay. The preferred method is laparoscopic (minimally invasive) myomectomy. However, for very large fibroids, women who have never given birth, or those with rapidly growing fibroids suspected to be malignant, open surgery should be the method of choice.

What are the Risks of Fibroid Surgery?

Every myomectomy carries risks of bleeding and blood vessel damage, which may require removal of the uterus in extreme cases. However, with a thorough preoperative examination and planning, these risks can be minimized.

Can Fibroids Turn into Cancer?

All fibroids have the potential to transform into cancer. Therefore, women diagnosed with fibroids should never skip their annual check-ups. If rapid growth is detected, the fibroid should be removed via open surgery and sent for pathological examination. Sarcoma is the term used for a fibroid that has transformed into cancer, and it is difficult to treat. Before surgery, it is important to perform an MRI to assess rapidly growing fibroids for surgical planning.