Uterus Myomlarının Epidemiyolojisi
Özet
Uterin myomlar (leiomyom), uterusun myometriyum tabakasındaki düz kas hücreleri ve fibroblastlardan kaynaklanan, kadın genital sisteminin en sık görülen iyi huylu tümörleridir. Genellikle üreme çağında ortaya çıkan bu neoplasmlar, kadınlarda yüksek görülme oranları sebebiyle sağlık sistemleri üzerinde ciddi operasyon yükü oluştururlar. Gerçek insidans ve prevalansı semptom göstermeyen vakalar nedeniyle net belirlenemese de 45 yaş üstü kadınlarda yaşam boyu myom geliştirme riski %60’ın üzerindedir. Hastalığın etnisite, yaş, genetik, hormonal faktörler, obezite ve yaşam tarzı gibi geniş bir risk yelpazesi bulunur. Siyahi kadınlarda görülme sıklığı, büyüme hızı ve semptom şiddeti beyaz kadınlara kıyasla belirgin şekilde daha yüksektir; bu durum genetik ve mikro-RNA ekspresyonlarındaki farklılıklarla açıklanmaktadır. Genetik çalışmalarda en sık somatik MED12 gen mutasyonu saptanmıştır. Östrojen ve özellikle progesteron hormonu myom büyümesinde kritik rol oynarken, parite ve emzirme süreci riski azaltmaktadır. Ayrıca obezite, hipertansiyon, diyabet, kırmızı et tüketimi ve alkol kullanımı myom riskini artıran diğer unsurlar arasındayken; vitamin D, meyve-sebze ağırlıklı beslenme ve düzenli egzersiz koruyucu etki göstermektedir.
Uterine myomas (leiomyomas) are the most common benign tumors of the female genital tract, originating from smooth muscle cells and fibroblasts in the myometrium layer of the uterus. Typically emerging during reproductive years, these neoplasms impose a significant burden on healthcare systems due to high rates of surgical interventions. Although their exact incidence and prevalence are difficult to establish due to asymptomatic cases, the lifetime risk of developing myomas exceeds 60% in women over the age of 45. The disease presents a broad spectrum of risk factors, including ethnicity, age, genetics, hormonal factors, obesity, and lifestyle choices. Black women exhibit significantly higher prevalence, faster growth rates, and more severe symptoms compared to white women, a disparity attributed to genetic variations and micro-RNA expressions. Genetic studies frequently identify somatic mutations in the MED12 gene. While estrogen and particularly progesterone play a critical role in myoma growth, parity and breastfeeding reduce the risk. Additionally, factors such as obesity, hypertension, diabetes, red meat consumption, and alcohol intake are linked to increased risk, whereas vitamin D, fruit- and vegetable-rich diets, and regular exercise demonstrate protective effects.
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