Uterine fibroids: when to operate?
Myoma is the most frequent tumor in women. It is not cancer and its transformation into cancer is very rare. Its origin is the muscle fiber itself that constitutes the uterine body (myometrium), which initiates a proliferation reproducing exactly the same muscle fiber, with architecture modified for oval structures, as if they were small "wool skeins" that develop inside the myometrium . Its location is of extreme importance for evaluating the need to operate or not. We can find the nodules of myoma in 3 positions:
- sub mucous: well next to the endometrium (internal tissue of the uterus, which menstruates every month)
- intra-murals: inside the myometrium
The most frequent complaints related to the appearance of fibroids are: increased menstrual flow, which may lead to clots, lower belly pain or sexual intercourse, increased abdominal volume and difficulties in get pregnant. The means to diagnose fibroids are: through routine gynecological examination, transvaginal ultrasonography, where we can clearly see the location and size of them.
Hysterosalpingography, contrast test to delineate the uterine cavity and tubal permeability may also be used. evidence of filling defects in the uterine cavity, which should be clarified in most cases with video-hysteroscopy - an examination that, through an optics and coupled camera, films the entire internal path of the cervix and uterine body, showing if this failure is a sub mucosal myoma, or other changes, which should also be treated.
Once the diagnosis is made, when to operate?
Surgery is not always necessary. The evaluation of your gynecologist will be paramount to tell you when to do clinical treatment or to operate. In general, there are cases where there are many symptoms, such as monthly bleeding, leading to anemia, colicky pains that are not controlled with antispasmodics, or those very bulky uteri (over 300 cubic centimeters)
Is it necessary to always withdraw the uterus completely?
Clinical treatment with drugs that decrease the development of myoma (specific hormones for this) is possible for those small fibroids or when it is desired to preserve the patient from surgeries. This is because the drug does not "dissolve" myoma, but it atrophies its development, and growth may again occur with stopping the drug.
Sometimes this time is enough, for example, for the patient to enter menopause and the natural fall of the hormones invades fibroids, or even give the patient time to treat and become pregnant, delaying a decision to have surgery. Nowadays, preference has always been given to less aggressive, more conservative, surgeries that may resolve the situation.
Myomectomies (withdrawn only from myoma) are always our choice when thinking about preserving the patient's reproductive future - those who are being treated for pregnancy or have not gotten pregnant until the age of 40, this is because the new techniques of Assisted Reproduction have greatly improved the chances of pregnancy, even in women over 35 years. Another option is myomectomy by video-hysteroscopy, where the sub-mucosal myomas can be removed without cutting in the abdomen, but using footage from the uterine cavity and surgical equipment that "scrapes and coagulates" myoma through the inner part of the uterus.
In those cases where fibroids are very bulky, and the reproductive future is no longer targeted, hysterectomy (removal of the uterus) is the surgery that will solve these problems. We must remember that this surgery does not affect the woman's femininity at all, not modifying her sexual pleasure (sometimes even improving, knowing that she will not get pregnant any more).The important thing is that you make your regular visit to the gynecologist and discuss with him all the possibilities of treatment and thus find out the most appropriate!