Myomas generally need to be treated when they exceed 4-5 cm in size, are 3 or more in number, or cause symptoms. There is no medical (drug) treatment for myomas. Although medications or medicated intrauterine devices (IUDs) are occasionally used to regulate bleeding irregularities caused by myomas, the treatment of myomas is generally surgical; that is, the myoma must be surgically removed and sent for pathological examination.
So, how should myoma surgery be performed?
If the myoma has grown towards the inner cavity of the uterus, meaning it is a submucosal myoma, it is necessary to enter the uterus with very thin endoscopic instruments via hysteroscopy and remove the myoma piece by piece; this procedure takes a maximum of half an hour. After hysteroscopic myoma surgery performed under anesthesia, the patient can go home on the same day without needing hospitalization.
If the myoma is located in the muscle layer of the uterus, it is possible to remove these types of myomas through the navel using endoscopic instruments via laparoscopy. Laparoscopy is a closed surgery technique, and staying in the hospital for one night is sufficient. Since there are no sutures on the abdomen, post-operative pain is less, and the patient can return to daily activities more quickly.
Occasionally, myomas can be numerous. In the presence of more than 4-5 myomas, open surgery may be required because the procedure time with laparoscopy may be prolonged and it may not be possible to remove all of them. However, even in the presence of numerous myomas, the laparoscopic method should be considered first, and closed surgery should be preferred.
Are there situations that require the removal of the uterus during myoma surgery?
Very rarely, serious bleeding may develop during surgery, and if the bleeding does not stop, it may be necessary to remove the uterus. However, with the suturing materials and medications that ensure uterine contraction used today, such situations occur very rarely. Removing the uterus instead of the myoma may only be appropriate for women who are close to menopause and do not desire children.
What should be done to prevent the recurrence of myomas after surgery?
Generally, follow-up exams every 4-6 months are recommended after surgery. Only very small myomas of 1-2 cm may grow in the future and require surgery again. However, in cases of growth over time or rapid growth in a short period, it may be necessary to remove the uterus, and in this case, pathological evaluation is of great importance. Generally, rapid growth and transformation into cancer are not observed in myomas.
In summary, in myoma surgeries, it is appropriate to remove the myoma technically with hysteroscopy or laparoscopy depending on its location. Myoma surgeries today are operations performed with closed techniques that yield good results.
