Myoma cases when the surgery is necessary

Last updated date: 09-Nov-2021

Acibadem Kadikoy Hospital

4 mins read

Incidence of myoma – benign tumors originating from myometrium that is the muscular layer of the womb – is pretty high. Such that myoma is detected in one of every four women in our country.

Questions about myoma

Myomas are commonly detected in women who are at reproductive age ranging from 25 years to 45 years. This is related to the estrogen hormone which is produced at the reproductive age. Growth of myoma halts, when production of estrogen ceases in menopause. If myoma causes simply problems such as heavy menstrual bleeding and pain, symptomatic treatment is generally deemed sufficient. However, surgical removal of the myomas becomes extremely important in some cases, because indication of the surgery changes and removal of uterus may be required, when delayed.


Prevalence of myoma is lower in athletic women

Recent studies are yet to reveal the exact causes of myoma. However, the fact that myoma is less common in athletic women, but prevalent in women with sedentary life and overweight women suggests an important role of muscle activity in prevention of myoma. Myoma is detected in approximately 25 out of 100 women, although lesions vary in size and number. Size and growth rate of myoma varies in each woman. Such that, a myoma can measure 1 to 2 cm in size or grow up to sizes which obliterate the uterus and fill the entire pelvic cavity. It can grow in the uterine cavity as a solitary piece or appear in the form of multiple lumps. Growth of a myoma by 1-2 cm per year is considered normal, but enlargement by 1.5 to 2 times may suggest important problems such as cancer (sarcoma).


Transformation of myoma into cancer is a low possibility

Presence of the myoma does not always necessitate surgery. Because a myoma transforms into cancer very rarely (1-1.5%) Moreover, myoma may relapse in menopause even if a myoma is surgically removed at reproductive age. Hence, surgical removal of myoma is not usually preferred, especially for females at reproductive age, if it does not cause any discomfort or lead to any adverse event. Regular follow-up myoma and medication treatments or other treatment options for bleeding and irregular menstrual cycles are preferred over an immediate surgery.

Presence of the myoma is not a reason for treatment Myomas are surgically removed solely in certain circumstances. These are:

If it is an obstacle for pregnancy: Surgery is decided if there is no other reason preventing the pregnancy but the myoma.

If it leads to miscarriage: Removal becomes necessary, if the patient is able to get pregnant, but it results in miscarriage(s).

If it grows rapidly: Risk of transformation into cancer (sarcoma) is high, if myoma grows 1.5-2 times more than its initial size. Therefore, this risk is taken into consideration when surgery is decided.

If there is heavy menstrual bleeding: Surgery is deemed necessary if it effects menstrual bleeding enough to lower the quality of life or cause anemia.

If peripheral organs are compressed: myoma may cause signs and symptoms by compressing the nearby organs depending on its location and size. Compression of the urinary bladder leads to urinary frequency, while compression of urethra results in difficulty emptying bladder, compression of colon causes constipation and compression of peripheral nerves is associated with pain. Surgery is also deemed necessary in these circumstances.


Symptoms of myoma

Myomas are usually asymptomatic and they are incidentally detected in a gynecologic exam in most cases. However, they can cause various symptoms in direct proportion to their growth. These are;

  • Heavy menstrual bleeding,
  • Bleeding between periods,
  • Bleeding after sexual intercourse,
  • Frequent urination or difficulty emptying bladder
  • Abdominal distension or bloating,
  • Pain radiating to coccygeal area in periods or sexual intercourse,
  • Anemia secondary heavy menstrual bleeding,
  • Constipation due to compression of end-segment of colon.


Removal of uterus is not necessary in myoma surgery!

Laparoscopic surgery is preferred, if the myoma is not oversized. This is due to advantages of laparoscopy for the patient. Advantages of laparoscopy include absence of large incisions, milder pain, lower risk of bleeding and infection along with early discharge and return to work earlier. Moreover, laparoscopy causes no adverse effect over pregnancy due to minimal adhesion. Removal of uterus is unnecessary in myoma surgeries. Nowadays, healthy organs are not removed by surgeons. For example; only the cancerous part of the breast is removed rather than the whole breasts – an approach preferred in the past. In this context, it is adequate to remove myomas rather the womb, regardless of the patient’s age.


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