Myomectomy (Fibroid Removal Surgery) in Ankara
Considering that one in four women encounters fibroids at some point in their lives, we can understand that it is a fairly common public health problem. The incidence of fibroids in women over the age of forty is around 40%. Approximately two-thirds of these women are not even aware of the presence of their fibroids.
Uterine Fibroids (Myomas) are benign tumors formed by the abnormal growth of the uterine muscle layer. They are also known as leiomyomas. Often, more than one fibroid of various sizes is found in different parts of the uterus.
Where are Fibroids Located?
There are many situations requiring Myomectomy in Ankara. Fibroids can be located in different regions of the uterine muscle layer. Their names and the symptoms they cause vary according to their location:
Subserosal Fibroids: Located near the outer membrane of the uterus.
Intramural Fibroids: Located in the middle of the uterine muscle layer.
Submucosal Fibroids: Located near the inner lining of the uterus (endometrium).
How Fast Do Fibroids Grow?
The growth rate of fibroids varies from person to person; however, fibroids tend to grow especially in women of reproductive age. Rapid growth is seen in fibroids due to hormonal effects (Estrogen & Progesterone) during pregnancy. After pregnancy, they mostly return to their former sizes. After menopause, fibroids gradually shrink, and even very small ones may become invisible on ultrasonography.
Women with fibroids during their reproductive years must undergo a gynecological examination at least once a year. Close monitoring of fast-growing fibroids is especially important. Since there is a possibility of becoming cancerous (Leiomyosarcoma), although small (less than 1%), check-ups every six months are essential for these types of fast-growing fibroids.
Symptoms of Uterine Fibroids
Menstrual Irregularity & Bleeding: The most common symptom is bleeding irregularity. Especially in fibroids located near the inner lining of the uterus (Submucosal), heavy clotting, prolonged bleeding (Menorrhagia), and spotting between periods are warning signs.
Pain: Intense groin, back, and sometimes leg pain. Pain is a frequently heard complaint in rapidly growing fibroids and those over 5 cm. Also, in the case of Red Degeneration (hemorrhage inside the fibroid), the patient may apply to the doctor with severe acute pain, sometimes requiring emergency surgery.
Pressure Symptoms: Fibroids located near the bladder can cause frequent urination or urinary incontinence problems. Fibroids located towards the back of the uterus can press on the rectum (large intestine) and cause chronic constipation.
Anemia: Fibroids are detected in most women who apply to the doctor due to chronic anemia and iron deficiency.
Do Fibroids Cause Infertility?
Depending on their location, fibroids can lead to infertility. Especially fibroids located near the inner layer of the uterus (Submucosal) make it impossible for the embryo to implant in this region. As a result, either pregnancy cannot occur at all, or miscarriages may occur. The main cause is identified as fibroids in about 3% of patients who cannot have children.
Are Fibroids Harmful in Pregnancy?
Early Stage: Fibroids near the inner lining can lead to miscarriages.
Late Stage: Fibroids growing rapidly due to pregnancy hormones can cause severe pain and preterm labor due to the load they create.
Delivery: Fibroids located near the cervix (birth canal) can block the baby’s exit path, making normal vaginal delivery impossible and necessitating a Cesarean Section.
Does Every Fibroid Require Surgery?
In the past, it was decided to operate on every fibroid exceeding 5 cm. However, today, due to the widespread use of organ-sparing treatments, there is an approach towards monitoring fibroids that do not create symptoms and do not show a tendency for rapid growth. Considering that fibroids will gradually shrink after menopause, even asymptomatic fibroids of 7-8 cm in diameter can be observed without surgery with strict follow-up.
Is medical treatment (drugs) possible? Some drugs (GnRH agonists) can cause shrinkage in fibroids by putting the patient into temporary menopause, but this effect disappears completely shortly after the drug is discontinued, and the fibroid returns to its former size. Therefore, there is currently no drug that provides a permanent solution in fibroid treatment.
Surgical Methods for Myomectomy in Ankara
When deciding on the form of treatment, factors such as the patient’s age, desire for children, and the presence of a disease preventing surgery are taken into consideration.
1. Open Surgery (Laparotomy): Usually reserved for very large or multiple fibroids. It allows for the complete removal of fibroids or, in some cases, the uterus (Hysterectomy).
2. Laparoscopic Myomectomy (Closed Surgery): In this minimally invasive method, only fibroids are removed through small holes, leaving the uterus and ovaries intact. The patient stands up in a much shorter time compared to open surgery and can return to daily life faster. Not every fibroid may be suitable for closed surgery; your gynecologist will decide this.
3. Hysteroscopic Myomectomy: This is a technique applicable to Submucosal fibroids that protrude 50% or more into the uterine cavity. It is performed through the vagina without any incision. It is a technique that provides more comfort and faster recovery for the patient compared to other methods.
Pregnancy After Myomectomy
Subserosal & Submucosal: There is usually no harm in getting pregnant 3 months after these surgeries.
Intramural: In fibroids covering the inside of the uterine muscle layer, it will be sufficient to wait between 6 months to 1 year, depending on the size of the operation, to allow the uterine wall to heal strong enough for pregnancy.