Fibromatosis treatment. What is uterine fibroids and how is it treated? What it is

When a woman goes for an ultrasound scan, she really wants to hear that everything is in order with her organs. And if during the study the doctor pronounces unfamiliar words like “echostructure” and “echogenicity”, which are also accompanied by the epithets “increased”, “heterogeneous” or “focal”, it scares. But if he diagnoses fibromatosis, it causes panic.

What does the term "fibromatosis" mean?

To understand what this condition is, you need to briefly consider the structure of the uterus.

The uterus consists of three layers. The inner layer is called the endometrium. Due to its structural features, it is sometimes called a mucous (mucosal) membrane. There is also an outer layer - perimetry; its second name is the serous membrane. Between them lies the most massive layer - muscle (myometrium). It consists of three layers of muscles running in different directions: longitudinally, transversely and in a circle. Between these layers, as well as between individual bundles, there are small areas (“separators”) of connective tissue.

Now, based on a brief digression into the anatomy, we will tell you what it is - uterine fibromatosis. This is the name of the state when the connective tissue “separators” in the muscle layer of this organ grow and displace normal muscle cells.

Such a change in the structure of the uterus can be observed:

1. In one or more areas, as a result of which small thickenings develop in the myometrium (the nodular form of the disease). This is not yet a uterine fibroids in the full sense of the word, but a condition that, if left untreated, may result in its formation.
2. Over the entire length or most of the muscle layer. This is diffuse fibromatosis. It rarely degenerates into, but leads to an increase in size and dysfunction of the organ.

The prevalence of pathology is difficult to assess: in 1/3 of cases it is diagnosed already with the formed myoma. Prior to that, it is found in women who routinely undergo gynecological ultrasound every year, or are planning a pregnancy.

Is the disease dangerous?

Fibromatosis is an ultrasound diagnosis. He says that with the development of certain conditions in the body, fibroids can develop from altered areas of the myometrium. But even in its absence, the replacement of normal muscles with connective tissue leads to:

• loss of increased blood volumes during menstruation, due to which chronic anemia develops. This condition is accompanied by weakness, fatigue, increased heart rate;
• problems with conception: growing nodes disrupt the structure of the endometrium, so it becomes more difficult for the embryo to implant;
• problems with pregnancy and childbirth.

If you start treatment on time, all these complications can be avoided. Despite these data, some women consider fibromatosis or a variant of age-related changes in the myometrium, or wait for the onset of menopause, when there is a chance of its spontaneous disappearance, so they are in no hurry to treat it. It is they who subsequently discover with surprise that they have fibroids, which often by this time can only be cured by surgery.

Reasons for the development of fibromatosis

No specific cause of the development of the disease has been identified, but the relationship between the occurrence of fibromatosis and hormonal imbalance is observed in all women.

Scientists believe that in order for myometrial cells to begin to be replaced by connective tissue, the concentration of estrogens in the blood must be increased, and the content of progesterone and its metabolites must be reduced. Therefore, uterine fibromatosis can be observed in combination with: in both of these states, just such a ratio of hormones can be traced.

The risk of developing pathology increases if:

• a woman lives in a state of chronic stress;
• leads an irregular sex life;
• have had more than one induced abortion, curettage, hysteroscopy, or biopsy of a portion of the uterus with myometrial capture;
• is obese (subcutaneous fat, especially in the abdomen, is a source of estrogen);
• close relatives had adenomyosis, fibromatosis or;
• the woman never gave birth;
• the first menstruation began before the age of 10;
• often suffers from inflammatory diseases of the reproductive organs, including those caused by STIs;
• has chronic liver disease, since it is this organ that is responsible for the utilization of estrogens.

Pathology is usually detected after childbirth. Sometimes it is detected during planned ultrasounds during pregnancy. With menopause, uterine fibromatosis rarely develops: during the period of extinction of the reproductive function, the ratio of hormones will be the opposite of what is necessary for its development. On the contrary, with the onset of menopause, the muscular layer of the uterus tends to return to normal (there are often cases of the disappearance of even fibroids or adenomyosis).

How the disease manifests itself

The replacement of muscle tissue with connective tissue does not have any symptoms for a long time and is often a find on gynecological ultrasound. Pathological changes in the myometrium are found in women "over 35". In girls 20-30 years old, fibromatosis almost never develops.

The first symptoms of uterine fibromatosis are a change in the volume of discharge during menstruation (more than 80 ml of blood is lost, and the menstruation itself lasts longer than the due date).

Obvious signs of the disease appear when fibromatous nodes larger than 1.5 cm are formed. In this case, the pain of menstruation, their long duration and an increase in the volume of blood lost are noteworthy. In addition, a woman may notice that blood-colored mucus appears between periods, and sometimes the same pain in the abdomen, as during menstruation, worries. Sexual intercourse can become painful. With a significant increase and compaction of the uterus, problems arise with defecation and emptying of the bladder.

Fibromatosis and pregnancy

In most women with mild forms of the disease, the ability to conceive and bear a child does not change. In 3% of cases, pregnancy with uterine fibromatosis becomes impossible. This may be due to various factors:

• when individual growths of connective tissue disrupt the blood supply to the endometrium, as a result, the embryo cannot be implanted in such a shell;
• fibromatous nodes, forming near the fallopian tubes, can squeeze them. As a result, the egg cannot pass into the uterus and be fertilized;
• if the connective tissue replaces the muscle in the cervical region, this prevents spermatozoa from entering the uterine cavity.

Carrying a fetus with fibromatosis can also be complicated: the altered myometrium in some cases interferes with the normal development of the membranes, which can cause an early abortion. In addition, the disease can lead to a change in the shape of the uterine cavity and, as soon as the fetus and its membranes fill all the free space (this will not necessarily be the time when the child can be born viable), either or malformations of the fetus will begin.

Changes in hormonal balance during pregnancy can lead to the formation of fibroids. This can cause displacement of the placenta, its complete or partial detachment. If fibroids began to develop in the cervical region, it becomes a serious obstacle to the birth of a child in a natural way.

Natural childbirth with fibromatosis can be dangerous. Since instead of a muscle in larger or smaller areas there is only connective tissue that cannot contract, labor activity worsens. For the same reason, in the postpartum period, there is a risk of bleeding, which can lead to the death of a woman if she does not remove the uterus on an emergency basis.

Diagnostics

Transvaginal ultrasound

Treatment of uterine fibromatosis can be prescribed only after this diagnosis has been made. This is possible according to the following research methods:

1. (more informative is the one performed by the intravaginal sensor). It "sees" an increase in the uterus due to the growth of the muscle layer, the deformation of its contours, the presence of intra-mural knots or seals.
2. . This is an examination of the uterine cavity using a special fiber-optic device - a hysteroscope. It is carried out under anesthesia.
3. is a painless but expensive procedure. It allows you to get a more accurate image of the uterus than ultrasound.

If the doctor has doubts about the good quality of the process developing in the myometrium, a biopsy is performed (tissue sampling). It is performed with hysteroscopy.

In addition, the hormonal profile of the patient is studied, for the correct choice of therapy.

Treatment

The doctor decides how to treat uterine fibromatosis, based on data on the form, prevalence and severity of the process obtained using instrumental examinations. The degree of pain, blood loss and hormonal imbalance is also taken into account.

If a woman does not feel pain, she does not have heavy bleeding, and fibromatosis does not progress during observation, she is prescribed weight loss (in the presence of obesity), sufficient physical activity, vitamins and immune-strengthening agents. There is a possibility that with the onset of menopause, fibromatosis will disappear.

In this case, after consulting with your doctor, you can use the treatment of folk remedies:

1. Boron uterus tincture. 10 g of grass insist a week in 100 ml of vodka. You need to drink 10 drops twice a day, dissolving them in more water. The course is 20 days, after which a break of 10 days is made, and the course is repeated.
2. Shepherd's purse juice. Take 2 tbsp. three times a day, then he can reduce the concentration of estrogen in the body.
3. Fresh potato juice. Take a tablespoon three times a day.
4. Tincture of small periwinkle. You need to take 50 g of it, grind it, pour 0.5 liters of vodka and insist, shaking occasionally, for 12 days. After that, strain and drink 1 tbsp. three times a day.

If fibromatosis progresses (in order to find out, ultrasound is performed every six months), drug treatment is prescribed. This is hormonal therapy, which is selected based on the hormonal status of the patient. This is how oral contraceptives are prescribed ("Zhanin", "Midiana", "Yarina"), which mimic the normal menstrual cycle.

Progesterone preparations "Duphaston" and "Utrozhestan"

Progesterone preparations (Dufaston, Utrozhestan) can be used. They stop both endometrial hyperplasia and the growth of connective tissue in the muscle layer. An alternative method is to install the intrauterine system "".

With heavy bleeding, iron preparations and sedatives are added to the therapy. Painkillers are prescribed to relieve pain.

Surgical intervention () is used only in the formation of myomatous nodes.

Uterine fibroids may also be called fibroids or fibromyomas. This is a benign neoplasm in the muscular layer of the uterus (myometrium). This pathology is quite common. According to statistics, uterine fibroids are diagnosed in 20-25% of women of reproductive age. The most common pathology occurs in women 35-45 years old.

Please note that this text was prepared without the support of our.

Uterine fibroma is a chaotically intertwined muscle fibers of the myometrium that form a knot. The development of pathology cannot be predicted. Upon learning about the presence of the disease, women are often concerned about the question: is uterine fibroids dangerous? At the beginning of the disease, a woman is not bothered by uterine fibroids, symptoms begin to appear after the nodes increase in size. The percentage of degeneration of a neoplasm into a malignant tumor is less than one, which reduces oncological concern. For treatment, you should contact the best specialists in this field, which you will find at. On our site you can get a medical. The site's expert advice favors the treatment of uterine artery embolization. This operation of uterine fibroids is the most gentle and effective.

Fibroma of the uterus: sizes and varieties

Neoplasms in the uterus can be single and multiple. Symptoms and the choice of therapy will depend on the number of nodes. The most effective treatment for multiple or single nodes is uterine artery embolization. According to localization, the following types of uterine fibroids are distinguished:

• subserous fibroma. Fibroma of the body of the uterus develops on its outer walls towards the abdominal cavity. Subserous fibromyoma does not affect the menstrual cycle and may not show symptoms for a long time. Increasing, it begins to put pressure on neighboring organs and disrupt their work.
• Interstitial fibroma. This species develops deep in the walls of the muscle layer. A distinctive symptom is a uniform increase in the volume of the uterus. The main symptom of interstitial fibromatous nodes is heavy bleeding.
• submucosal fibroma. Formed in the submucosal layer. The characteristic symptoms of submucosal fibroids are pain and irregular menstruation.
• intramural fibroma. This type of neoplasm is the most common. It is formed in the inner layer and grows into the uterine cavity, which leads to a significant increase in the latter. Fibroma in the uterine cavity is accompanied by many symptoms: pain, disruption of the cycle, disruption of neighboring organs, etc.
• Fibroma of the cervix. The growth of fibromatous nodes occurs in the muscles of the neck. This type of fibroma is rare - only 5% of the total number of cases.

The size of fibromyomas is usually considered in weeks of pregnancy. This is due to the fact that earlier, before the advent of ultrasound and similar diagnostic methods, the development of nodes could only be recognized during a gynecological examination. Due to fibroma, the uterus increases in size, which normally occurs only during pregnancy. Therefore, the size of fibromatous nodes is compared with the size of the uterus at a certain gestational age. By size, fibromatous nodes are usually divided into small, medium and large. A small fibroma is considered up to 12 weeks of pregnancy, an average - from 12 to 15 weeks, a large uterine fibroma - 16 weeks or more.

Fibroma of the uterus: causes

The disease of uterine fibroids is directly related to hormonal disorders in the body. Hormonal disruptions are the most common cause of fibromyoma formation. During the luteal phase of the menstrual cycle, the lining of the uterus begins to rapidly increase in size, setting the stage for a fertilized egg. If pregnancy does not occur, hormonal activity slows down and menstruation occurs. Next, there is a narrowing of the blood vessels of the myometrium to stop bleeding. All these processes occur under the action of hormones. If there is a violation of hormonal function, this leads to the formation of defective cells, from which fibromyoma grows further.

Hormones affect the size of uterine fibroids. When analyzed in the cells of the neoplasm, receptors for sex hormones are found, which are much more sensitive than in the cells of unchanged uterine tissues. Fibromyoma is active during the period of increasing estrogen in the body, then its size increases. Therefore, during menopause, fibroma does not grow and begins to regress.

In the development of fibroids, heredity plays an important role. Practice shows that the presence of fibroids is not an isolated case among women of the same family. But it cannot be said unequivocally that the disease will develop in the presence of this factor.

Fibroma of the uterus can occur as a result of trauma to the myometrium. Frequent abortions, complicated childbirth, diagnostic curettage, minimally invasive uterine surgeries (hysteroscopy, laparoscopy, etc.) contribute to the appearance of changes in tissues.

Fibromyoma can also occur in the chronic course of inflammatory and infectious diseases of the pelvic organs. Often the appearance of fibroids is associated with overweight, thyroid disease, hypertension, diabetes and stress.

Regardless of the cause, uterine fibroids are successfully eliminated by leading specialists in this field, Candidate of Medical Sciences, endovascular surgeon Boris Yuryevich Bobrov and Candidate of Medical Sciences, obstetrician-gynecologist Dmitry Mikhailovich Lubnin. Doctors have extensive experience in the treatment of uterine fibroids using uterine artery embolization. Doctors diagnose and advise on further treatment tactics. For this you can.

Signs of uterine fibroids: how to recognize the disease

At the initial stage, most women do not show signs of uterine fibroids. In the future, with an increase in size, symptoms begin to appear. Fibroma of the uterus of medium and large sizes hurts. Small fibromyomas most often do not cause discomfort. Symptoms of fibroma will depend on the size of the nodes, their number, localization, direction of growth and location relative to other organs of the small pelvis.

The presence of heavy menstruation, up to bleeding, is one of the symptoms that accompanies uterine fibroids. Bleeding of a long nature can lead to anemia. Sometimes bleeding from the uterus can occur in the middle of the cycle. Menstruation is accompanied by severe pain, abdominal cramps and the release of blood clots.

A woman may feel the discomfort that distinguishes uterine fibroids. Symptoms and signs of pathology will be as follows:

• pain or heaviness in the lower abdomen;
• pain in the pelvic area;
• pain in the lumbar region.

The pain symptom is caused by compression of the nerves that pass to the lower extremities.

As a result of pressure on the bladder, a woman may feel such a symptom as frequent urge to urinate. Another symptom of fibromyoma pressure on neighboring organs is a violation of defecation (constipation, pain during bowel movements). A common symptom of fibromyoma is a feeling of discomfort during intercourse.

There are several ways in which uterine fibroids are diagnosed. Ultrasound is considered the simplest, most accessible and informative. Since small fibromyomas do not cause concern to a woman, it is impossible to detect them based on symptoms. They may be diagnosed during a prophylactic examination or during the diagnosis of another disease. Additional methods of instrumental research are magnetic resonance imaging and radiography.

To make a diagnosis, additional studies are prescribed to clarify that the neoplasm is uterine fibroma. A blood test for hormones is prescribed to determine the hormonal background of the body, a general blood test will show the presence of an inflammatory process (if any). When all the data is collected, the doctor determines the best way to treat the patient. Embolization of the uterine arteries not only eliminates all fibromyoma nodes, but also prevents the appearance of new ones.

Fibroma of the uterus: menopause

During menopause, the neoplasm, if it was not treated earlier and did not show symptoms, in most cases begins to regress. This is due to the fact that the growth of fibroids depends on female sex hormones, the production of which decreases during menopause. Sometimes fibromyoma regresses to complete resorption.

To eliminate the symptoms of menopause, a woman is prescribed a hormonal medicine. Its action can have the opposite effect, and during menopause, the fibroma begins to grow, even if it has not behaved this way before. In this case, the woman is shown embolization of the uterine arteries, which will quickly and comfortably eliminate the pathology.

Fibroma of the uterus during pregnancy

Women of childbearing age are often interested in whether uterine fibroids can interfere with pregnancy. A small fibromyoma without symptoms usually does not prevent conception and childbearing. Pregnancy problems occur in the following situations:

• the uterine node is located at the entrance to the fallopian tubes, which interferes with the movement of the spermatozoon and makes fertilization impossible;
• intramural fibromatous nodes prevent the zygote from attaching;
• a large fibromyoma does not allow the embryo to fully develop.

The use of uterine artery embolization allows to obtain positive results in the issue of restoring reproductive function. During the procedure, the genitals are not injured, and the disease of the uterus is effectively eliminated. After a short period of time, a woman can already plan a pregnancy.

What is dangerous uterine fibroids

If the fibromyoma has a leg, then the danger is its torsion. With an increase in the size of the node, the leg can twist and be infringed. This is accompanied by severe sharp pain, bleeding, node necrosis. Symptoms of an "acute abdomen" develop. Symptoms of necrosis are pain, fever, soreness of the node.

Fibromyoma with severe bleeding causes iron deficiency anemia. Characteristic symptoms of anemia: weakness, dizziness, pallor and dryness of the skin.

During pregnancy, a large fibromyoma causes an incorrect position of the fetus, which complicates the course of pregnancy. Such neoplasms cause systematic miscarriages, miscarriage and premature birth. Fibroma of the cervix prevents the child from passing through the birth canal.

Fibroma of the uterus: treatment

When a woman is diagnosed with uterine fibroids, one should not jump to conclusions. It is necessary to consult a qualified doctor who will deal with this issue in detail. First, it is necessary to identify the cause of the disease, otherwise the nodes will develop again. The patient reports her symptoms to the doctor, after which he appoints a series of studies. Based on the data obtained, the doctor determines further treatment tactics.

Small nodes that do not grow and do not cause discomfort to a woman are treated conservatively. In this case, monophasic hormonal preparations are used. The name of the tablets for uterine fibroids is specified by the attending physician. He will select the active ingredients that are most suitable for this particular patient, since hormonal drugs have side effects. Symptoms of a reaction to hormone therapy will be nausea, vomiting, headaches, dizziness, general malaise, discharge from the genitals, weight gain.

If fibromatous nodes develop as a result of pituitary disorders, treatment with gonadotropin-releasing hormone agonists is used. Their action allows you to reduce the size of nodes by half. The effectiveness of drugs decreases if there are several fibromatous nodes in the uterus.

With the ineffectiveness of conservative therapy, surgical treatment is used:

• Myomectomy - uterine fibroids and fibroids are removed by laparoscopic or laparotomy access. The operation does not guarantee the absence of a recurrence of the disease.
• Hysteroresectoscopy is indicated if submucous nodes develop. They are removed, but the cause of the pathology is not eliminated.
• Hysterectomy is a radical amputation of the uterus. Appointed extremely rarely.

To date, the safest and most effective is uterine artery embolization. This is a minimally invasive procedure that does not require significant preparation of the patient, prolonged hospitalization and the use of general anesthesia. Embolization of the uterine arteries allows you to save all the functions of the body. Fibromyoma significantly decreases in size, stops growing and resolves over time. Embolization of the uterine arteries is applicable for both single neoplasms and multiple ones. The procedure allows you to prevent the recurrence of fibroids and fibromyomas in the future.

Embolization of the uterine arteries is a worthy alternative to surgical intervention. It is safe, with its use there is no negative impact on the reproductive system, negative consequences in the future and complications are reduced to zero. The effectiveness of the procedure has been confirmed by numerous studies and positive feedback from patients. Full restoration of blood circulation in the pelvic organs resumes after a few months.

Bibliography

• Lipsky A.A.,. Gynecology // Encyclopedic Dictionary of Brockhaus and Efron: in 86 volumes (82 volumes and 4 additional). - St. Petersburg. 1890-1907.
• Bodyazhina, V.I. Textbook of gynecology / V.I. Bodyazhina, K.N. Zhmakin. - M.: State publishing house of medical literature, 2010. - 368 p.
• Braude, I.L. Operative gynecology / I.L. Braude. - M.: State publishing house of medical literature, 2008. - 728 p.

Uterine fibroma is a disease known as uterine leiomyoma, a common, non-cancerous growth of the endometrial lining of the uterus. Fibroids are muscle cells, tissues, ranging in size from a pea to 12.7-15.24 cm wide.

Fibroids are diagnosed in 25-30% of women. Although the pathogenesis is not well understood, fibroma depends on individual fibroid cells and not on the metastatic process. Fibroids are considered the most common benign solid tumors of the female genital tract. Although often asymptomatic signs can cause infertility, pain, bleeding. Gynecology is the field of study of uterine fibroids. The ICD-10 code (this is a classification of diseases that is approved by WHO) uterine fibroids has D25.

Fibroids can outgrow the blood supply and degenerate. Degeneration has been described as hyaline, myxomatous, calcifying, cystic, fatty, red (during pregnancy only), or necrotic. The patient often appears concerned about fibroid cancer, with sarcomatous changes occurring in less than 1% of patients. The connective tissue tumor is benign.

Myoma happens:

• intramural (uterine wall);
• submucosal (under the lining of the uterus);
• subserous (under the outer surface of the uterus).

The reasons

The cause of uterine fibroids is unknown. The hormones produced in the ovaries (estrogen, progesterone) are believed to play a role in development according to OWH. Researchers believe that growth is influenced by ovarian hormones. Fibroids rarely occur before a woman goes through pregnancy and menopause.

Fibroids are more common in women with obesity and menopause. Cigarette smoking was recognized as a provoking factor.

The onset of symptoms

Often women do not experience symptoms. Submucosal fibroids alter the ability of the uterus to control menstrual bleeding leading to heavy periods associated with blood clots, which causes cramps. The difference is that they typically do not cause pain or extra bleeding between periods.

Nodular and subserous fibroids, unlike others, as a rule, do not lead to severe periods.

Symptoms of uterine fibroids:

• chronic pressure;
• symptom of difficult bowel function;
• pain in the lower back and pain in the pelvis;
• pain during sex;
• clothes feel tight.

According to the listed signs, it is possible to recognize fibroids.

Fibroids can lead to anemia, fatigue, and blockage of blood vessels and nerves, causing sharp and severe pain.

Fibroids are dangerous by increasing the risk of infertility. During pregnancy, it threatens with recurrent spontaneous abortion.

Diagnosis

A Critical Review of the Surgical Treatment of Fibroids compares the available techniques for myomectomy. Statistical analyzes reveal the advantages of laparoscopic and hysteroscopic approaches.

While open myomectomy results in limited morbidity similar to hysterectomy, the differences in laparoscopic myomectomy result in significant medical, social, and economic benefits for the patient, with less postoperative pain and short recovery times.

Sam and Mettler published the first paper on laparoscopic myomectomy in 1980. Today, the uterine outgrowth is enucleated according to this method. Standard laparoscopic surgery is complemented by robotic support and an abdominal entry, often modified to NOS (natural orifice surgery) and natural transluminal endoscopic orifice surgery called single port entry.

Individual nodes may not be palpable during the examination by a gynecologist. Thus, the specialist will not be able to make an accurate diagnosis.

Ultrasound is recognized as the standard method for the detection of benign uterine tumors. This helps to see the localization and size of the nodes, plus to distinguish cancer from fibroids.

Additionally, hysteroscopy, laparoscopy are used.

The examination should show a neoplasm in the ovary and uterine appendages. Data on the period and results of the ultrasound examination are required in order to make an accurate diagnosis.

Complications

Women with subserous uterine fibroids are predicted to have a favorable pregnancy, but this does not reduce the risk of complications. Complications: premature birth in a pregnant woman, the shutter of the child in position, during childbirth, there is a risk of the need for a caesarean section. Selected women experience pain during the 1st and 2nd trimester during pregnancy.

Consequences and complications may arise due to the location of the fibroids in the uterus. They range from intermittent bleeding to continuous bleeding for a number of weeks, from single episodes of pain to severe pain, from dysuria and constipation to chronic spasms of the bladder and intestines. Peritonitis is extremely rare.

The difficulty of laparoscopic and hysteroscopic myomectomy differs in achieving satisfactory hemostasis using appropriate sutures. Hysteroscopic myomectomy requires an operative hysteroscope and an experienced gynecological surgeon to operate on the connective growth in the uterus.

Sometimes fibroids can distort and block the fallopian tubes, making it difficult for sperm to pass from the cervix into them.

Treatment

Gonadotropin-containing hormone (GnRH) is used to relieve the symptom of pain.

Asymptomatic fibroids do not require treatment. A woman should be examined periodically (every 6 to 12 months) by a gynecologist.

For symptomatic fibroids, treatment includes medical options, including suppression of ovarian hormones, to stop bleeding. Opportunities are not optimal and limited. Physicians should consider medical clinical management and discuss other options prior to performing surgery. Agonists (GnRH) are sometimes given before surgery to shrink fibrous tissue. These drugs often stop menstruation and allow blood tests to increase. In the perimenopausal period, it is acceptable to wait, because the mature outgrowth decreases in size after menopause or is able to disappear.

Fibroids

A number of drugs are used to relieve symptoms, reduce fibrous growth, or both:

• agonists (GnRH);
• exogenous progestins;
• antiprogestins;
• selective estrogen receptor modulators (SERMs);
• danazol.

Agonists (GnRH) are often the drugs of choice. For large fibroids, they can reduce fibrous size and bleeding.

These drugs are able to reduce the production of estrogen. Agonists (GnRH) are most useful if given preoperatively to reduce fibrous and uterine volume, the operation becomes more technically feasible and reduces blood loss. In general, the drugs mentioned should not be used in the long term. Growth of recovery to pretreatment size within 6 months is common, and bone demineralization is possible. To prevent a situation where drugs are used for a long time, doctors should give the patient additional estrogen.

Exogenous progestins may partially suppress estrogen stimulation of uterine fibrotic growth. Progestins may reduce uterine bleeding but may not reduce fibroids in the same way as agonists (GnRH). These drugs can be taken every day (continuous therapy). Such therapy often reduces bleeding and provides contraception.

Progestin therapy causes a muscle layer to grow in some women's wombs. A levonorgestrel-releasing intrauterine device (IUD) may be used to reduce uterine bleeding.

Danazol, an androgenic agonist, can suppress fibrotic growth in the early stages, but has a high rate of adverse effects (weight gain, acne, edema, hair loss, flushing, vaginal dryness), so it is less commonly taken.

Surgery for fibroids

Surgery is usually reserved for women in the following cases:

• Rapidly growing tumor-like formation of the small pelvis.
• Recurrent uterine bleeding unresponsive to medical treatment.
• Severe or persistent pain or pressure under the skin (requires opioids to control or is intolerable to the patient).
• A large uterus that has a mass effect in the abdomen, causing urinary bowel symptoms, or compressing other organs, causing dysfunction (eg, hydronephrosis).
• Infertility (if pregnancy is desired).
• Recurrent spontaneous abortions (if pregnancy is desired).
• Sizes for mimoma surgery.
• Other factors conducive to surgery are the completion of the birth of the child and the expressed desire of the patient to choose the exact treatment.

Myomectomy is done laparoscopically or without automated methods.

A hysterectomy can also be done laparoscopically, vaginally, or by laparotomy (an incision in the abdomen).

Most indications for myomectomy and hysterectomy are similar. Patient choice is important, but people should be well informed about the expected difficulties and complications of myomectomy versus hysterectomy.

Piecemeal removal is done during a myomectomy or hysterectomy. Remove piecemeal, including cutting fibroids or intrauterine tissue into small pieces so as to be removed through a smaller incision (eg, laparoscopically). It is extremely rare for women undergoing surgery for uterine fibroids to have an unsuspected, undiagnosed sarcoma or other uterine cancer. If piecemeal removal is done, malignant cells may be disseminated into the peritoneum. Patients should be advised that if piecemeal removal is used, there is a small risk of dissemination of cancer cells.

If women desire pregnancy or wish to preserve the uterus, a myomectomy is used. In about 60% of women with infertility due to fibroids, myomectomy restores fertility and can become pregnant after about 14 months. However, hysterectomy is often required or preferred by the patient.

This is a more accurate treatment. After myomectomy, new fibroids sometimes begin to grow again, and approximately 25% of women with myomectomy find a hysterectomy approximately 4-8 years later.

Patients have other pathologies that make surgery more complicated (extensive adhesions, endometriosis).

Hysterectomy reduces the risk of other disorders. This includes cervical intraepithelial neoplasia and others.

New treatments may relieve symptoms, but the duration of symptom relief and the effectiveness of treatments in restoring fertility have not been evaluated.

• High intensity focused echography.
• Cryotherapy.
• radiofrequency amputation.
• Magnetic resonance-guided focused ultrasound surgery.
• Detection on x-ray.
• Uterine embolization of the artery.

Uterine artery embolization aims to induce infarction of fibroids throughout the uterus while preserving normal uterine tissue. Women recover faster after the procedure than after a hysterectomy or myomectomy, but complication and return visit rates tend to be higher. Treatment failure rate is 20-23%, in such cases treatment with hysterectomy is required.

Choice of treatment

To treat fibroma, factors are taken into account:

• Asymptomatic fibroids: no treatment required.
• Post-menopausal women: expectant management test, after menopause fibroids get smaller.
• Symptomatic fibroids provided if pregnancy is desired: uterine artery embolization, another new technique (high intensity focused echography) or myomectomy.
• Severe symptoms when other treatment has failed, especially if pregnancy is not desired: hysterectomy, possibly preceded by medical treatment (with GnRH agonists).

Treatment of uterine fibroids with folk remedies

Treatment of uterine fibroids with folk remedies is a fairly popular treatment method aimed at eliminating unpleasant symptoms, as well as reducing bleeding.

For treatment, only natural plant components are used, for example, calendula, which is brewed and taken orally.

Other remedies may be blue iodine with milk, walnuts, flaxseeds. But before you self-medicate, you need to consult a doctor.

Calendula (2 tablespoons) is poured into an empty bottle, left in the dark for two weeks, shaken daily. Gradually juice appears. At the end of the period, filter the resulting mixture. Drink 1 tbsp. spoon 3 times a day.

Homeopathy helps to get rid of symptoms and tumors so as not to undergo hormonal treatment. From this, balances in the central nervous system are restored. The concentration of estrogen decreases. A qualified homeopath selects preparations. But this does not always achieve a certain effect.

Prevention

1. Regular visits to the gynecologist.
2. Dieting (inclusion of vitamins in the diet).
3. Diet involves healthy eating. Fried foods, alcohol, overeating should be excluded.
4. Exclusion of bad habits - smoking.
5. Check hormone levels.
6. Use contraception.

Psychosomatics of fibroids

Psychosomatics strongly influences the course of the disease. If you often experience stress, overeat, then this will aggravate the situation, and the cure of the disease will proceed more slowly.

Modern research shows that there is a connection between the psychological state and the development of uterine fibroids. This must be taken into account in the treatment and explained to women, because with psychological help you can achieve good results, to the point that the fibroma can shrink without the use of surgical methods.

Factors affecting the development of a psychosomatic state:

• not wanting pregnancy and making decisions about abortion;
• lack of pleasure from sexual contact;
• stress associated with resentment;
• low self-esteem;
• lack of self love.

These psychosomatic factors trigger a destructive program. From this, the internal state worsens, various diseases appear, which include uterine fibroids. A miscarriage also often affects the psychosomatics of the disease. Long-term depression appears, from which fibroids develop.

Fibroma of the uterus is a serious disease. The course of the disease depends on the control of one's own health. It is required to be calmer about everything, not to worry about trifles. Then the disease may disappear altogether.

- a benign mature tumor that has a connective tissue structure and originates from the walls of the uterus. Clinical manifestations of uterine fibroids are directly related to its growth and may include menstrual disorders, pain and pressure in the lower abdomen, dysuric disorders, constipation, and back pain. Uterine fibroids are diagnosed based on the results of a gynecological examination, ultrasound, ultrasound hysterosalpingoscopy, CT and MRI. Treatment of uterine fibroids can be conservative (medication), surgical (organ-preserving or radical), minimally invasive (endovascular).

General information

Tumors of the fibroid type can occur in various organs: the most common are fibromas of the ovaries, uterus, breast, and skin. Fibroma of the uterus can be represented by a single seal or nodular clusters; it grows asymptomatically and gradually. The size of uterine fibroids varies from a few millimeters to 20-30 or more cm in diameter. Fibroids of the uterus are practically not prone to malignancy.

The reasons

The etiological moments in the development of uterine fibroids are not precisely defined. Most researchers point to the connection of uterine fibroids with increased hormonal sensitivity to estrogen and hereditary predisposition. However, even with these factors, uterine fibroids may not always develop. Additional conditions contribute to the occurrence of fibroid tumors of the uterus:

• late onset of menarche;
• artificial termination of pregnancy in the woman's history;
• no childbirth by the age of 30;
• complicated childbirth;
• frequent diagnostic curettage;
• taking estrogen-containing hormonal agents for contraception or the treatment of menopause;
• concomitant chronic female diseases;
• lack of regular sexual life, etc.

Often, an extragenital background for the development of uterine fibroids is overweight, arterial hypertension, obesity, thyroid disease, diabetes mellitus, physical inactivity, stress, etc. Representatives of the Negroid race are more prone to developing fibromas than women of the European race. The incidence of uterine fibroids correlates with age: in women under 20 years of age, a fibroid tumor is diagnosed in 20%, up to 30 years - in 30%, up to 40 years - in 40% of cases.

Pathogenesis

Uterine fibroids are hormone-dependent in nature, therefore, they do not develop in girls in the premenarche and in women in the postmenopausal period. The growth of existing uterine fibroids may increase with the development of pregnancy, when estrogen synthesis increases. After childbirth, as a rule, there is a decrease in fibroid nodes to their original state. In postmenopause, with a decrease in estrogen levels, the growth of uterine fibroids stops, and it significantly decreases or disappears altogether.

Classification

The classification of fibroids is based on the location of the tumor within the uterus.

In most women with uterine fibroids, the disease proceeds without any manifestations, and only 15-25% develop clinical symptoms, depending on the location of the tumor in relation to the pelvic organs, the number, size and direction of growth of fibroid nodes. The presence of uterine fibroids can be characterized by profuse prolonged menstruation (menorrhagia) up to bleeding, which leads to anemia. In some cases, bleeding from the uterus is acyclic in nature (metrorrhagia).

Menorrhagia is accompanied by severe pain and abdominal cramps, the release of blood clots. With stalked uterine fibroids, pain often occurs in the intermenstrual period. With uterine fibroids, a woman may feel discomfort or heaviness in the pelvic area, caused by the pressure of fibromatous nodes on adjacent organs. Often there are pains in the lower back and perineum, due to compression of the nerves going to the lower extremities.

With uterine fibroids, as a result of pressure on the bladder, the urge to urinate becomes more frequent; when squeezing the ureter, hydronephrosis may develop; pressure on the wall of the rectum is manifested by constipation, pain during bowel movements. A woman with uterine fibroids may experience pain during intimacy.

Fibroma of the uterus and pregnancy

Small, asymptomatic uterine fibroids usually do not prevent pregnancy. An exception is fibroid tumors, which block the fallopian tubes and block the path of spermatozoa, which makes it impossible to fertilize the egg. The presence of uterine fibroids can adversely affect the course of pregnancy. Large nodes that reduce the free space of the uterine cavity do not allow the embryo to fully develop. Such uterine fibroids can cause late miscarriages or premature birth with the birth of a premature baby.

Large uterine fibroids can cause an incorrect position of the fetus, which not only complicates the course of pregnancy, but also aggravates the birth act. In such cases, a caesarean section is often performed. The most severe and dangerous for the birth process is the presence of cervical fibroma of the uterus, which creates an obstacle to the passage of the baby's head and the threat of severe bleeding. Pregnancy management in women with uterine fibroids requires increased attention and consideration of all possible risks.

Complications

The growth of uterine fibroids may be accompanied by torsion of the pedicle of the node, necrosis of the node (usually submucosal or interstitial), hemorrhage. Torsion of the fibroma stem proceeds with an "acute abdomen" clinic. With necrosis, pain, fever, softening and soreness of the node appear. The probability of malignant degeneration of uterine fibroids is extremely low and does not exceed 1%. With severe bleeding, uterine fibroids cause the development of anemia.

Complications associated with surgical treatment of uterine fibroids include postoperative infections, bleeding, pelvic adhesions, and intrauterine adhesions. Pregnancy after conservative myomectomy occurs in 40-60% of patients. Also, organ-preserving interventions do not exclude the development of new fibroid nodes.

Diagnostics

The initial detection of uterine fibroids usually occurs at a consultation with a gynecologist. With a two-handed vaginal examination, an enlarged uterus of a dense consistency with a bumpy surface is determined. With the help of transvaginal ultrasound of the small pelvis, the location of the uterine fibroma, its size, density and relation to neighboring structures are specified, and differentiation from ovarian cystoma is made.

Surgery

Surgical treatment of uterine fibroids is advisable for submucosal growth, severe clinical symptoms (bleeding, pain, compression of adjacent organs), large nodular formations, combination of fibroma with endometriosis or ovarian tumors, necrosis of the fibrous node.

Organ-preserving interventions for uterine fibroids include conservative myomectomy by vaginal, laparoscopic or laparotomic access. During the operation, the fibrous node is enucleated while preserving the uterus. With a submucosal location of the node, hysteroscopic myomectomy is resorted to without incisions through the channel of a flexible optical hysteroscope. Organ-preserving operations, if possible, are performed for women planning a subsequent pregnancy. Radical methods of surgery for uterine fibroids include supravaginal amputation of the uterus or complete hysterectomy. Removal of the uterus can be performed through the vagina, laparoscopic or open access and is indicated for patients who do not plan to have children.

The modern treatment for uterine fibroids is uterine artery embolization. As a result of endovascular occlusion of the vessels that feed the uterine fibroids, the blood supply is blocked and the growth of the tumor node stops. Uterine fibroid embolization is a minimally invasive and highly effective technique. In some cases, ultrasonic ablation (USA) is used to treat uterine fibroids - “evaporating” the node with high-frequency ultrasound under MRI control.

Prevention

There are no specific methods for the prevention of uterine fibroids. However, the exclusion of provoking factors (abortions, uncontrolled use of contraception, chronic inflammation, extragenital diseases, etc.) can reduce the likelihood of uterine fibroids.

An effective way to prevent uterine fibroids is a regular visit to the gynecologist and the passage of ultrasound.

Uterine fibromyoma is a true benign tumor of the uterus. It develops from muscle tissue. then we will analyze in more detail what it is and whether it is dangerous, we will talk about the causes, symptoms and methods of treating the disease.

What is fibromyoma?

Fibroma of the uterus is called a benign tumor, consisting of mature connective tissue. The disease is diagnosed in women 30-40 years old. More often the disease is found in African American women than in European women.

The tumor does not prevent a woman from becoming pregnant and giving birth safely. An exception will be tumors that are located in the area of ​​​​the fallopian tubes, thereby closing the entrance to them.

Large fibromatous nodes disrupt the normal position of the fetus, thereby can provoke a miscarriage or early birth, as well as interfere with the normal development of the fetus.

The most dangerous will be the localization of the fibroma on the cervix, since childbirth can be complicated by severe bleeding.

If a woman has a fibroma in a position, she must be under the supervision of doctors, and if possible, it is better to diagnose and treat fibroma before pregnancy.

With this disease, the method of childbirth is chosen individually in each individual case.

Depending on where the tumor is located, there are several types of fibroids:

• submucosal, located in the uterine cavity;
• intermuscular;
• subserous, located on the surface of the uterus and grows into the abdominal cavity;
• fibroma of the cervix.

Causes of uterine fibroids

The true causes of uterine fibroids are still unknown, but they note a connection with hormonal disorders and heredity.

The disease does not affect girls before puberty and women who have begun menopause.

If a fibroma is detected in a woman in menopause, then it was before the onset of menopause, but did not cause symptoms.

During pregnancy, the size of the fibroma may increase, and after childbirth, the tumor will return to its original size.

Based on this, we can say that female sex hormones play a role in the appearance of such a disease as uterine fibroids.

Factors that increase the risk of developing the disease:

• excess weight;
• African American origin.
• constant stress;
• late or too early formation of the menstrual cycle;
• a large number of abortions and intrauterine manipulations;
• no childbirth at the age of 30;
• long-term use without control of hormonal drugs containing estrogen;
• chronic inflammation of the reproductive system;
• other diseases - obesity, hypertension.

Symptoms

According to statistics, only every fourth uterine fibroma occurs with severe symptoms.

Often, the disease does not give clinical signs, even if the tumor has a large diameter (see photo above), and the disease can be detected by chance during a preventive visit to the doctor.

The main symptoms of the disease:

• profuse menstruation with blood clots;
• due to the fact that the neoplasm presses on the bladder - frequent trips to the toilet;
• constipation due to compression of the rectum;
• feeling of heaviness in the abdomen;
• pain during menstruation, but in the last stages of the disease, aching pain in the lower abdomen and lower back is permanent;
• the size of the abdomen may increase, which will even require a change of wardrobe, despite the fact that the weight has remained the same;
• with large sizes and a certain localization of fibroma, there may be a lack of pregnancy during planning, or not carrying a fetus.

Diagnostics

In order to avoid the development of severe complications, you should consult a doctor in a timely manner, who will prescribe the necessary examination, and, based on the results, decide how and with what to treat the disease.

It is not always possible to distinguish between fibroma and uterine myoma, especially when the connective tissue is pronounced in the myoma. For this purpose, a biopsy or histology of the removed tumor is done.

Types of diagnostics:

• Ultrasound of the pelvic organs helps to determine the presence of a tumor. An examination with a transvaginal sensor will be more informative, as it will be possible to examine fibromatous nodes.
• Hydrosonography. This type of diagnosis makes it possible in one hundred percent of cases to identify submucosal fibroma, determine its location, as well as diagnose concomitant diseases of the endometrium, determine the thickness of the uterine wall.
• Biopsy of the endometrium. It is carried out using a special instrument, which is carried into the uterine cavity through the cervical canal.
• Hysteroscopy- consists in examining the uterine cavity from the inside through a fiber optic camera.
• Hysterosalpingography. A radiopaque liquid is injected into the uterus and fallopian tubes, which makes it possible to see the internal contours.
• ultrasound, is usually prescribed before their embolization, in order to assess the intensity of blood flow in the tumor and its nodes. This method is also used to test the effectiveness of this intervention.
• Angiography- Examination of the vessels of the uterus after they have introduced a radiopaque fluid. The method of examination makes it possible to determine the malignant degeneration of fibroids and thereby change the treatment in a timely manner.
• MRI with or without contrast, will be useful in the presence of large tumors and in order to evaluate the effectiveness of the embolization performed.

Treatment of uterine fibroids

Before choosing a treatment for a fibroma, you should know its size and location.

In addition, how to treat fibroma will depend on what the symptoms and signs of the disease are, on the age of the woman, whether the patient is going to have a baby in the future, and also on her general health.

There are two types of treatment for uterine fibroids:

• Medical.
• Surgical.

Medical treatment

Therapy of the disease by means of drugs is prescribed in case of bleeding, pain in the abdomen, if the uterine fibroma has a diameter of no more than three centimeters, and also if there are contraindications for the operation or the woman refuses surgery.

Patients who are in the climatic period are offered observation, since with a decrease in the synthesis of female hormones, the tumor regresses.

Drug treatment is designed to eliminate pain, which is the result of bleeding, hyperplastic changes in the endometrium, which always accompany fibroids.

The doctor prescribes anti-inflammatory non-steroidal drugs, iron, analgesics, hormones that bring back to normal.

Treatment with hormonal drugs has its own contraindications and side effects, and therefore the need for taking and choosing the drug can only be determined by a qualified specialist.

Side effects of hormonal drugs:

• hot flashes;
• sensation of heat;
• emotional lability.

Taking hormonal drugs will be effective only for small tumors.

Since uterine fibroids are estrogen-dependent, drugs that reduce the effect of estrogens on fibroids are used to treat it:

• Antigonadotropins - reduce the production of gonadotropic hormones by the pituitary gland and estrogen by the ovaries, which reduces the hormonal replenishment of fibroids Danol, Nemestrane);
• Gestagens are drugs that lead to ( Jeanine, Yarina). They are used for tumors of small diameter, which are accompanied by endometrial hyperplasia and the presence of bleeding.
• Intrauterine device "Mirena";
• Analogues of gonadotropin-releasing hormones, which can reduce the number of estrogens. These drugs have a temporary effect, and therefore they are prescribed before a planned operation in order to reduce the diameter of the fibromyoma.

Surgical intervention

Removing a uterine fibroid carries some risk, but it also has benefits. The decision to perform an operation is considered individually, and depends on the condition of a particular patient.

The removal of uterine fibroids is called a "myomectomy". Such an operation is carried out using a hysteroscope, laparoscope or with open access to the abdominal cavity.

The choice of method will depend on where exactly the tumor is located and what diameter it is.

Hysterectomy

Hysterectomy is the most common operation for this disease. This method is used if:

• fibroid growth for more than four weeks per year;
• suspected malignancy - sarcoma;
• uterine fibromyoma has a size of more than 16 weeks;
• postmenopausal growth;
• fibroma is located on the cervix;
• there is no possibility to perform the operation and save the organ.

This method will have less blood loss than myomectomy. If suspected, then during the operation, the appendages are also removed.

Myomectomy

During a myomectomy, an incision is made in the lower abdomen, and the nodes are removed from the muscular wall of the uterus. This makes it possible to save the uterus and give birth to a child in the future.

During the operation, the bladder and rectum can be damaged, but these cases are quite rare. With subserous neoplasms, removal is performed through laparoscopy.

This operation is not carried out if:

• uterus more than 18 weeks;
• nodes are low located on the back wall;
• there are interconnecting nodes.

Even if the appendages are preserved in women, they occur, in connection with this, patients are prescribed hormone replacement therapy.

Embolization of the uterine arteries

The method of treatment is that the blood supply to the tumor is stopped. During the procedure, a thin tube is inserted into the femoral artery. Under the control of the apparatus, the features of the blood supply to the uterus are revealed.

Then, very small particles are placed in the artery that feeds the fibroid, which are designed to block the flow of blood to the fibrous node, and as a result, the node decreases in size.

This method will be most suitable for patients who do not want to have surgery, and other methods of treatment have not yielded results.

In this case, the uterus is preserved and in the future it is possible to give birth to a child. If the fibromyoma of the uterus is large, the procedure is performed as a preparatory procedure before myomectomy, in order to reduce the diameter of the fibroma.

FUS ablation

An innovative method based on the action of focused ultrasound under MRI control, which serves to direct a beam of ultrasonic rays, under the influence of which the fibroma is heated and destroyed.

There are also other methods of therapy that make it possible to destroy submucosal fibromas without surgical intervention:

• cryomyolysis - based on freezing the tumor.
• electromyolysis - fibroma is destroyed by electric current.

These treatments are used in the presence of small single tumors. After treatment, a woman should not stay in the sun for a long time, take a steam bath in baths and saunas, massage the lower back and buttocks.

The effectiveness of traditional medicine

Many women are afraid of diagnostic and therapeutic manipulations and try to treat the disease with folk remedies.

At the same time, uterine fibromyoma does not decrease in diameter and does not stop growing. And no infusions or decoctions of herbs will cure the tumor, so you should adhere to traditional methods of treatment and consult a doctor.

Nevertheless, it is still possible to use alternative methods of treatment, but only to reduce the symptoms of the disease. For example:

• decoction of nettle or oak bark reduces uterine bleeding
• reduces the inflammatory processes of the genital organs, which often accompany the disease.

Treatment with folk remedies not only has no effect, but also postpones taking medications or performing an operation.

Often, in order to avoid hormone therapy, patients choose homeopathy.

Despite the fact that the drugs should also be selected by a specialist, their effectiveness has not been proven.

Homeopathic remedies:

• Milife;
• Wild Yams;
• Aurum;
• Calcium;

Prevention

There are no measures to prevent the disease. But still, women who want to avoid the appearance of a tumor should exclude abortions, treat inflammation of the pelvic organs in time, and visit a specialist once a year, despite the fact that this is not necessary.

Forecast

The tumor is not malignant, grows slowly and can be asymptomatic for a long time. Late diagnosis of the disease leads to the detection of large fibromas (10-20 cm).

It happens that a woman who has uterine fibroids attributes the causes of heavy menstruation or bleeding to age-related changes or other diseases.

Higher education (Cardiology). Cardiologist, therapist, functional diagnostics doctor. I am well versed in the diagnosis and treatment of diseases of the respiratory system, gastrointestinal tract and cardiovascular system. She graduated from the academy (full-time), she has a lot of experience behind her. Specialty: Cardiologist, Therapist, Doctor of functional diagnostics. .