What is Myoma?
Myomas are benign tumoral formations originating from the uterine muscle tissue. They can usually appear singly or in large numbers and can range in size from a few millimeters to the size of an egg. Myomas, which can remain microscopic in size, can go unnoticed for years without causing any symptoms in most women. These nodules, which grow in response to the body’s estrogen and progesterone hormones, are among the most common benign gynecological tumors in women of reproductive age.
What are the Types of Myoma? (Submucosal, Intramural, Subserous, etc.)
Myomas are classified according to their location within the uterine wall. Submucosal myomas are close to the surface of the uterine lining and can narrow the inner space, causing abnormal bleeding and infertility. Intramural myomas are embedded in the uterine muscle layer; they generally expand the uterine volume, causing symptoms of pressure, increased menstrual cramps, and a feeling of swelling in the abdominal area. Subserous myomas grow close to the outer surface of the uterus, press on neighboring organs, and can cause various complaints such as urinary urgency, constipation, or back and leg pain. Pedunculated myomas rarely develop; these can cause sudden cramps and acute abdomen as a result of rotation around the stem.
Why Does Myoma Occur?
Genetic predisposition, hormonal changes and environmental factors play a role in the development of myoma. While the risk increases in women with a family history of myoma, high levels of estrogen and progesterone trigger lesion growth in the follicular phase. Some studies have shown that metabolic factors such as vitamin D deficiency and obesity are also effective in the formation of myoma. The most common mechanism is the proliferation of stem cells in the uterine tissue through genetic mutations, replacing healthy myometrium with myoma nodules.
What are the symptoms of myoma?
Myomas are often silent; however, as they grow, the primary symptom is long and heavy menstrual bleeding. In submucosal types, severe blood loss that can impair quality of life and iron deficiency anemia may develop. Intramural and subserous myomas cause lower abdominal or lower back pain independent of menstruation and a feeling of pelvic pressure. Large myomas push the bladder forward and can cause functional disorders such as frequent urination, constipation and pain during intercourse. Although rare, myoma stem torsion, characterized by sudden pain and intra-abdominal bleeding, is among the conditions that require emergency surgery.
How Are Myomas Diagnosed? (Ultrasound, MRI, Hysteroscopy)
The basic tool for diagnosing myoma is transvaginal ultrasonography; in this method, the structures of the uterus and ovaries are examined in detail, and the size and location of the myoma are clarified. If necessary, the textural characteristics of the myoma, the presence of a peduncle, and the relationships between neighboring organs are evaluated in more detail with magnetic resonance (MR) imaging. In cases of suspected submucosal myoma, the uterine cavity is directly visualized with hysteroscopy, and a definitive diagnosis is made through biopsy of crusted nodules. In women who complain of heavy bleeding before menopause, blood counts and hormone tests also support the diagnosis.
Effects of Fibroids on Pregnancy
Myoma size and location play an important role in women planning pregnancy. Submucosal myomas make embryo implantation more difficult and increase the risk of recurrent miscarriage. Intramural myomas impair uterine contractile function and are associated with preterm birth, placental location anomalies, and an increased rate of cesarean section. Subserous myomas usually do not directly affect pregnancy; however, large masses may cause mechanical intra-abdominal compression. Myomas may grow with the increase in estrogen during pregnancy and may trigger pain or bleeding episodes during pregnancy. Therefore, pre-pregnancy myoma evaluation and, if necessary, planning for myomectomy reduces the risk of complications.
When Should Myomas Be Removed?
The surgical removal of myomas (myomectomy) or the use of other treatment methods depends primarily on the severity of the patient’s complaints and the size and location of the myoma. If iron deficiency anemia develops due to abnormal bleeding, menstrual cramps disrupt the quality of life, pelvic pressure symptoms (frequent urination, constipation, low back pain) increase, or if there is a fertility plan, it is recommended that the myomas be removed. Submucosal myomas narrow the intrauterine cavity and may prevent embryo implantation; in this case, they should definitely be removed before seeking pregnancy. Myomas that exceed 5 cm in size and grow rapidly should be closely monitored for the possibility of malignant transformation, and surgical intervention should be considered if they cause symptoms.
What are the Treatment Methods for Myoma? (Medication, Myomectomy, Embolization)
Medical treatment primarily involves drugs that regulate hormone levels. GnRH analogues temporarily suppress estrogen production, shrinking the volume of the myoma and both controlling bleeding and reducing the size of the uterus before surgery. Progestin and selective estrogen receptor modulators can also alleviate symptoms in some cases. In the surgical approach, myomectomy; provides selective removal of the myoma by laparoscopic, hysteroscopic or open method, preserving the uterus and preserving the chance of fertility. Uterine artery embolization is a radiological method; the vessels feeding the myoma are blocked with minimally invasive catheters, aiming to shrink the lesion and reduce symptoms. The specialist decides which method to choose, considering the location of the myoma, the patient’s age, desire to have children and accompanying diseases.
Is It Possible to Treat Myoma Without Surgery?
Uterine artery embolization is currently the most commonly used nonsurgical method of myoma treatment. Under local anesthesia, the uterine arteries are selectively occluded with a thin catheter carrying radiopaque material from the groin; the myoma tissue undergoes ischemia and shrinks by 50–70% over time. The patient can usually return home the same day, and pain control is provided by oral analgesics post-procedure. Approaches such as radiofrequency ablation and MR-guided focused ultrasound (MRgFUS) are also in the research phase; they aim to create local necrosis by applying focused heat energy to the tissue. These methods are not yet used as widely as embolization because they are not yet within the equipment and experience of every center.
Myoma Treatment Prices 2026
In 2026, the average annual cost of medical treatment with GnRH analogs in Türkiye is between ₺12,000 and ₺18,000. Laparoscopic myomectomy package fees, including surgery, anesthesia, hospitalization, and postoperative check-ups, are around ₺45,000 and ₺60,000; hysteroscopic small submucosal myoma removal is in the range of ₺25,000 and ₺35,000. While uterine artery embolization package prices range from ₺40,000 to ₺55,000, MRI-guided focused ultrasound applications cost between ₺50,000 and ₺70,000. Myomectomy and embolization may be partially or fully covered for certain indications in state or university hospitals that have an SGK agreement; A co-payment may be required for special treatments. Since installments, ease of payment and package coverage vary by clinic, it is recommended to contact the patient advisory unit of the relevant center for exact pricing.
Frequently Asked Questions
Can Myoma Turn Into Cancer?
Myomas detected by myomectomy or histopathological examination are benign neoplasms originating from the uterine smooth muscle, and malignant transformation is very rare. Although cases that can be confused with uterine smooth muscle cancer called “leiomyosarcoma” have been reported in the literature, these are considered to be independent, aggressive tumors rather than long-term follow-up of myomas. The cancerous rate of myomas over the years is less than 0.1%. Therefore, in the absence of regular ultrasound follow-up and alarm signs such as rapid growth, abnormal vascularization, or postmenopausal bleeding, the cancer risk of myoma is not a primary concern in practice.
Do Myomas Cause Menstrual Irregularities?
Submucosal and large intramural myomas can disrupt the menstrual cycle due to their proximity to the endometrial surface and cause excessive and prolonged bleeding. The increase in intrauterine volume caused by myoma triggers endometrial tissue thickening and prevents regular emptying of uterine contractions, which manifests itself as spotting or painful bleeding episodes between menstrual periods. On the other hand, small subserous myomas usually do not affect the menstrual cycle. When the history of menstrual complaints and transvaginal ultrasound findings are evaluated together, the role of myoma in menstrual disorders becomes clear.
Should Every Myoma Be Removed?
The size, location and symptoms of myomas determine the need for treatment. Asymptomatic, small and subserous myomas can be followed with active surveillance; immediate removal of these myomas is unnecessary due to both the risk of surgery and complications such as adhesions that may occur in the future. However, if there is heavy bleeding, anemia, compression symptoms, rapid growth or fertility plan, surgical or interventional removal of the myoma is recommended. This decision should be made after a multidisciplinary evaluation between a specialist gynecologist and a radiologist team, taking into account the patient’s quality of life, age and desire to have children.
Do Myomas Cause Infertility?
Submucosal myomas grow into the uterine cavity, preventing favorable endometrial contact for embryo implantation and increasing the risk of recurrent miscarriage. Intramural myomas, on the other hand, can disrupt both sperm transport and embryo placement by thickening the myometrium and disrupting the uterine contraction pattern and platelet aggregation. Subserous myomas generally do not directly affect fertility. In women with infertility problems, removal of myomas significantly increases the success rate of in vitro fertilization and other assisted reproductive techniques. In patients with no fertility plan or near menopause, the effect of myoma on infertility is considered less of a priority.
Will Myomectomy Relapse After Surgery?
After myomectomy, follicular myoma stem cells that are not left behind can proliferate rapidly and new myoma nodules can develop over the years. Depending on the extent of the surgical technique and the genetic predisposition of the patient, the recurrence rate varies between 15% and 35%. After uterine artery embolization, myoma size decreases significantly, while symptomatic recurrence is reported at a rate of 10% to 20%. In cases with a high risk of recurrence, combinations of hormone therapy or embolization can be considered before surgery. Periodic checks are provided with follow-up ultrasonography, and if necessary, a second intervention is planned in a timely manner.