By definition, myoma is a benign tumor formed by the differentiation of a single cell in the muscle layer of the uterus. In medical terminology, myoma, leiomyoma and fibroid are used synonymously. Myomas are one of the leading causes of hysterectomy (uterus removal) surgeries.<\/p>\n
\u0130yi huylu bu kitlelerin olu\u015fumda baz\u0131 risk fakt\u00f6rleri belirlenmi\u015ftir. Bunlar\u0131n aras\u0131nda en \u00f6nemlisi ya\u015ft\u0131r. Ya\u015fla birlikte myomlar\u0131n g\u00f6r\u00fclme olas\u0131l\u0131\u011f\u0131 artmaktad\u0131r; \u015f\u00f6yle ki beyaz \u0131rkta g\u00f6r\u00fclme olas\u0131l\u0131\u011f\u0131 35 ya\u015f\u0131nda %40 iken, 50 ya\u015f\u0131nda %70\u2019e y\u00fckselmektedir. Myomu oldu\u011fu bilinen bir kad\u0131n\u0131n birinci derece akrabalar\u0131nda myom g\u00f6r\u00fclme olas\u0131l\u0131\u011f\u0131 2.5 kat daha fazla olmas\u0131 myom ulu\u015fumunda ailesel fakt\u00f6rlerin etkin oldu\u011funu g\u00f6stermektedir. Erken menar\u015f ( 10 ya\u015f\u0131ndan \u00f6nce adet olma) ve v\u00fccut kitle indeksinin artmas\u0131 da riski art\u0131rmaktad\u0131r. Yap\u0131lan bir \u00e7al\u0131\u015fmada her 10 kg vuc\u00fct a\u011f\u0131rl\u0131\u011f\u0131ndaki art\u0131\u015f myom olas\u0131l\u0131\u011f\u0131n\u0131 %21 artt\u0131rmaktad\u0131r. Beslenmeyle ilgili net veriler olmamakla birlikte sebze a\u011f\u0131r\u0131kl\u0131 beslenme \u015fekli , et a\u011f\u0131rl\u0131kl\u0131 beslenme \u015fekline g\u00f6re myom olu\u015fumunu azaltt\u0131\u011f\u0131 bildirilmi\u015ftir; ayr\u0131ca D vitamini eksikli\u011finin de bu kitlelerin olu\u015fumu\u0131nda rol\u00fc olabilece\u011fi d\u00fc\u015f\u00fcn\u00fclmektedir. Do\u011fum kontrol haplar\u0131n\u0131n myom geli\u015fimi \u00fczerine etkisi saptanmam\u0131\u015ft\u0131r. Sigara kullan\u0131m\u0131n\u0131n ve do\u011fum say\u0131s\u0131n\u0131n artmas\u0131 ise myom insidans\u0131n\u0131 azaltt\u0131\u011f\u0131 g\u00f6r\u00fclm\u00fc\u015ft\u00fcr.<\/p>\n
Myom\u00adla\u00adr\u0131n olu\u015fumu ve seyri her kad\u0131na \u00f6zg\u00fcd\u00fcr; baz\u0131lar\u0131nda h\u0131zl\u0131, baz\u0131lar\u0131n da ise yava\u015f b\u00fcy\u00fcr; dolay\u0131syla ki\u015filer aras\u0131nda myomlar\u0131n seyri farkl\u0131l\u0131k g\u00f6stermektedir. \u00c7o\u011funlu\u011fu k\u00fc\u00e7\u00fck ve semptomsuz olmakla birlikte baz\u0131 ki\u015filerde ciddi problemlere yol a\u00e7maktad\u0131rlar. Myomalar\u0131n neden olduklar\u0131 semptomlar myomun boyutuna, yerle\u015fim yerine ve say\u0131s\u0131na ba\u011fl\u0131 olarak de\u011fi\u015fkenlik g\u00f6stermektedir. Bulgular\u0131 \u00fc\u00e7 kategoride ele all\u0131n\u0131r, bunlar; uzam\u0131\u015f ve \u015fiddetli adet kanamalar\u0131, kitle etkisine ba\u011fl\u0131 pelvik (kas\u0131k b\u00f6lgesi ) a\u011fr\u0131 ve bas\u0131n\u00e7 (bask\u0131) hissi ve infertilitedir (k\u0131s\u0131rl\u0131k). Bunlar i\u00e7erisinde hastalar\u0131n yakla\u015f\u0131k %26-29 oran\u0131nda en s\u0131k rastlanan semptom anormal uterin kanama ve adet a\u011fr\u0131lar\u0131d\u0131r. Ge\u00adnel\u00adlik\u00adle \u015fid\u00addet\u00adli ve uza\u00adm\u0131\u015f menst\u00adru\u00adas\u00adyon \u015fek\u00adlin\u00adde\u00addir. Rahim kanseri, en\u00addo\u00admet\u00adri\u00adal (rahim i\u00e7 zar\u0131) po\u00adlip, endometriyal hi\u00adperp\u00adla\u00adzi gi\u00adbi ne\u00adden\u00adler ile de benzer \u015fikayetler mey\u00adda\u00adna ge\u00adle\u00adbi\u00adlir . Myom\u00adlar me\u00adsa\u00adne \u00fcze\u00adri\u00adne ba\u00ads\u0131 ya\u00adpa\u00adrak s\u0131k id\u00adra\u00adra \u00e7\u0131k\u00adma, id\u00adrar yap\u00adma\u00adda zor\u00adluk ve na\u00addi\u00adren id\u00adrar ak\u0131\u00ad\u015f\u0131n\u00adda\u00adki ye\u00adter\u00adsiz\u00adlik gi\u00adbi \u00fcri\u00adner ya\u00adk\u0131n\u00adma\u00adla\u00adr\u0131n g\u00f6\u00adr\u00fcl\u00adme\u00adsi\u00adne se\u00adbep ola\u00adbi\u00adlir\u00adler. Rek\u00adtu\u00adma ( kal\u0131n ba\u011f\u0131rsa\u011f\u0131n son k\u0131sm\u0131na verilen isim) ba\u00ads\u0131 ise te\u00adnezm (s\u00fcrekli \u0131k\u0131nma hissinin olmas\u0131 ancak buna kar\u015f\u0131n d\u0131\u015fk\u0131laman\u0131n olmamas\u0131) ve kons\u00adti\u00adpas\u00adyon (kab\u0131zl\u0131k) gi\u00adbi so\u00adrun\u00adla\u00adr\u0131 mey\u00adda\u00adna ge\u00adtirebilmektedir. Rahim a\u011fz\u0131na (serviks) yerle\u015fen myom\u00adlar in\u00adfer\u00adti\u00adli\u00adte\u00ad , ili\u015fki s\u0131ras\u0131nda kanama, ili\u015fki s\u0131ras\u0131nda a\u011fr\u0131 ( disparoni) gibi sonu\u00e7lara yol a\u00e7abilmektedirler. Pel\u00advis\u00adte yer alan b\u00fcy\u00fck myom\u00adlar ise da\u00admar\u00adla\u00adr\u0131n ba\u00ads\u0131\u00ads\u0131na ba\u011fl\u0131 pel\u00advik kon\u00adjes\u00adyon ile bacaklarda \u00f6dem, \u015fi\u015flik ve va\u00adri\u00adk\u00f6z olu\u00ad\u015fum\u00adlara neden olmaktad\u0131r. Myomlar nadir de olsa myomun dejenerasyonuna veya sapl\u0131 myomlar\u0131n torsiyonuna (kendi etraf\u0131nda d\u00f6nmesine ba\u011fl\u0131 kan ak\u0131m\u0131n bozulmas\u0131) ba\u011fl\u0131 olarak akut a\u011fr\u0131ya sebep olmaktad\u0131r. Bunun ayr\u0131m\u0131n\u0131 yapmak ba\u015fka hastal\u0131klarla kar\u0131\u015fma ihtimali nedeniyle son derece \u00f6nemlidir. Rahmin i\u00e7inde veya duvar yap\u0131s\u0131nda bulunup rahim bo\u015flu\u011funun \u015feklini bozan myomlar k\u0131s\u0131rl\u0131\u011fa ve ayr\u0131ca tekrarlayan d\u00fc\u015f\u00fcklere sebebiyet vermektedir. Myomlar\u0131n yerine \u015fekline ve b\u00fcy\u00fckl\u00fc\u011f\u00fcne ba\u011fl\u0131 olarak k\u00f6t\u00fc gebelik sonu\u00e7lar\u0131na sebebiyet verebilmektedir. Bunlar; plasental ayr\u0131lma (dekolman), fetal geli\u015fim gerli\u011fi, erken do\u011fum. Nadiren de olsa bu t\u00fcm\u00f6rler polisitemi, hiperkalsemi ve hiperprolaktinemi gibi endokrinolojik bozukluklara sebebiyet vermektedir.<\/p>\n
The diagnosis of myomas is made clinically with the help of pelvic examination and pelvic ultrasonography. Detection of a large, irregularly shaped uterus on pelvic examination also; Myoma is diagnosed with the help of pelvic ultrasound along with the presence of symptoms. Among the imaging methods, ultrasound, MRI and hysteroscopy are the most commonly used modalities in diagnosis.<\/p>\n
Although it is accepted that myomas do not turn into uterine sarcoma (a type of malignant tumor originating from the uterine muscle and connective tissue), they have different variants. Their distinction is possible with detailed pathological examination. It is not easy to distinguish between sarcoma and myoma before surgery. However, as a result of clinical suspicion and ultrasonographic evaluation, contrast-enhanced MRI and some biochemical markers can be used for diagnosis.<\/p>\n
Son y\u0131llarda gebelik ya\u015f\u0131n\u0131n gittik\u00e7e artmas\u0131yla, gebe kad\u0131nlarda myomlara rastlanma ihtimali de artm\u0131\u015ft\u0131r. Beyaz kad\u0131nlarda \u0130lk \u00fc\u00e7 ay i\u00e7inde yap\u0131lan gebe ultrasonlar\u0131nda myom prevalans\u0131 %8\u2019i olarak bildirilmi\u015ftir. Gebelikte myomlar\u0131n boyutlar\u0131 \u00e7o\u011funlukla de\u011fi\u015fmez. B\u00fcy\u00fcme %30 oran\u0131nda g\u00f6r\u00fcl\u00fcr ve bu \u00e7o\u011funlukla ilk \u00fc\u00e7 ay i\u00e7inde olmaktad\u0131r. Gebelik \u00fczerine ender olarak olumsuz sonu\u00e7lara yol a\u00e7maktad\u0131r. Gebelikte myom dejenerasyonuna ba\u011fl\u0131 akut a\u011fr\u0131 ataklar\u0131 olabilmektedir. Bu\u00adnun so\u00adnu\u00adcu ola\u00adrak ge\u00adbe\u00adle\u00adrde kar\u0131n a\u011f\u00adr\u0131s\u0131 ve lo\u00adka\u00adli\u00adze ger\u00adgin\u00adlik or\u00adta\u00adya \u00e7\u0131k\u00admak\u00adta ve bunlara ek ola\u00adrak bu\u00adlan\u00adt\u0131, kus\u00adma, ha\u00adfif de\u00adre\u00adce\u00adde ate\u015f y\u00fcksekli\u011fi sap\u00adta\u00adna\u00adbi\u00adlir. Yatak istirahati, a\u011fr\u0131 kesici ve destek tedavi ile genellikle \u015fikayetler birka\u00e7 g\u00fcn i\u00e7inde gerilemektedir.<\/p>\n
Treatment should be decided according to many parameters such as the patient's age, symptoms, fertility expectation, number, location and size of myomas, as well as the patient's wishes. Asymptomatic, small-sized myomas can be monitored regularly at 6-12 month intervals. In this case, the patient should be informed about the symptoms he may encounter in the future and a record should be kept about the size and location of the myoma. If the patient is close to menopause and has mild to moderate myoma-related complaints, the patient may prefer follow-up without treatment. In such patients, with menopause, bleeding complaints will decrease due to the decrease in hormones, and the size of myomas will also decrease. There are many non-surgical treatment methods used in the treatment of myoma. The aim of medical treatment is to relieve symptoms, reduce the size of myoma to facilitate surgery, and control pain. None of the medical treatments cause the myoma to disappear, and when you stop taking the medication, the myomas regain their previous size. Levonorgestrel IUD may be preferred in myomas that complain of abnormal uterine bleeding but do not disrupt the uterine cavity. Surgical treatment options include abdominal (open) myomectomy, laparoscopic (closed) myomectomy, hysteroscopic myomectomy and laparoscopic or abdominal hysterectomy. Myomketomy should be considered as a safe alternative option for women who request preservation of their uterus.<\/p>\n
Myomectomy during cesarean section can be performed by experienced physicians; however, since the blood supply of the uterus increases significantly during pregnancy, it is necessary to know that bleeding from the myoma area carries risks that can lead to removal of the uterus.<\/p>\n
Laparoscopic myomectomy has advantages such as less blood loss, earlier return to normal life, and less postoperative pain compared to open myomectomy. However, the conditions for successful laparoscopic myomectomy are correct case selection and the presence of an experienced surgical team.<\/p>\n
Submucous myomas that cause abnormal uterine bleeding and infertility can be treated hysteroscopically.<\/p>\n
In cases where surgery is not suitable, endometrial ablation or uterine artery embolization are also among the treatment options.<\/p>\n
Myomektomi sonras\u0131 takiplerde yeni myomlar olu\u015fabilir; ancak bunlar\u0131n \u00e7ok az\u0131 \u00f6nem arz etmektedir. Yap\u0131lan ara\u015ft\u0131rmalarda daha \u00f6nce bir adet myom nedeniyle opere olan birisinin %11 ihtimalle ikinci bir operasyona ihtiya\u00e7 duyacakt\u0131r. Birden fazla myom nedeniyle opere edilen birisinin ise %26 ihtimalle ikinci bir operasyona ihtiya\u00e7 duyacakt\u0131r.<\/p>\n
Although myomas are usually detected in patients presenting with abnormal bleeding, myomas are also common in women without complaints. The presence of myomas can be detected at an early stage through annual gynecological examinations, and the treatment modality can be determined according to the growth course and\/or patient characteristics.<\/p>\n
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Dr. Mustafa\u00a0<\/strong>\u00a0\u00c7a\u011flayan<\/strong> <\/p>\n Contact Us For Appointment:<\/strong><\/p>\n Telephone line: 0392 444 3548 (ELIT)<\/a><\/p>\n
\nGynecology and Obstetrics Specialist<\/em><\/p>\n