Uterus fibroma is one of the most common gynecological diseases. It is noted that this pathology is found in young women of childbearing age, in about 20% of cases, and the older a woman becomes, the higher the risk of this disease occurring in her.
In women under the age of 20, fibroma is diagnosed in 20%, at the age of 20 to 30 years, the tumor develops in 30%, and up to 40 years it is found in 40%. Fibroma is also associated with the race of a woman, the representatives of the Negroid race develop the disease more often than European women.
What is uterine fibroma
Fibroma of the uterus, as well as fibroids or fibroids of the uterus, are benign tumors that originate in the muscle tissue of an organ and differ only in their histological structure.
Thus, uterine fibroma is a tumor formed by connective tissue, which gives it density (fibroids, in contrast to fibroids, are more elastic). Fibroid tumors or fibroids, in addition to the uterus, can also develop in other organs: the ovaries, mammary glands, and skin. The size of the tumor may not exceed a few millimeters or reach 30 cm.
Classification of fibroid tumors
Uterine fibroids can be single or multiple. When there is one node, as a rule, it reaches a considerable size, they talk about the uterus fibromus. The fibrous node is located in the connective tissue pseudocapsule. In the case of several nodules they speak of multiple uterine fibroids.
The uterine wall consists of three layers. The thickest layer is the middle one, which is represented by smooth muscle (myometrium). Outside the uterus is covered with a serous membrane (the inner leaf of the peritoneum) - this layer is called perimetry. The inner layer is represented by the mucosa (consists of the epithelium) shell and is called the endometrium. Depending on the location of the tumor formation, the following types of fibroids are distinguished:
- intramural (interstitial) fibroma - the formation grows within the muscle layer and occurs in 70% of cases of fibroid tumors,
- submucous (submucous) fibroma - grows inside the uterine cavity, is located under the endometrium and is observed in 22 - 30% of all fibroid tumors (submucosal fibroma leads to a deformation of the uterine cavity and is distinguished by vivid symptomatology: bleeding, pain by the type of contractions),
- subserous fibroma - while the tumor begins to grow outwards, under the serous membrane,
- stalked fibroma - as a type of subserous tumor, in which a leg appears (in some cases long enough), and may be complicated by bending or twisting the leg, which is accompanied by severe pain,
- intraligamentary or ligamentous fibroma - located between the leaves of the uterine ligament,
- parasitic fibroma - is rare and is characterized by attachment to neighboring organs, for example, to the cervix. Cervical fibroma is found in 5% of cases of all fibroid tumors.
Depending on the histological examination, the following morphotypes of fibroids are distinguished:
- simple - the tumor grows slowly, proliferative processes are absent,
- proliferating - increased activity of cell division, characterized by rapid growth, the number of pathological mitoses reaches 25%, but there are no atypical cells,
- Predsarcoma - revealed many foci of atypia.
The causes of fibroids
At present, the causes of uterine fibroma are not precisely defined, although there is a link with hormonal shifts in genetic predisposition.
It is noted that uterine fibroma never develops in girls before puberty and in menopausal women. In the mechanism of tumor development play a role as fluctuations of estrogen and progesterone, which increases the number of cell divisions in the formation. But even in the presence of both conditions, the uterine fibroid tumor does not always develop.
Certain predisposing factors have been identified that “spur” the onset of education:
- late formation of menstrual function
- artificial and spontaneous abortion,
- first birth at 30 years or more
- intrauterine manipulations (installation and removal of the IUD, hysteroscopy),
- childbirth complicated by inflammation of the uterus
- long-term use of combined oral contraceptives,
- chronic inflammatory diseases of the uterus and appendages,
- hormonal dysfunction of the ovaries,
- rare sex life or lack of it,
- obesity or overweight
- sedentary lifestyle,
- thyroid pathology,
- diseases of the cardiovascular system (hypertension),
- fibrocystic mastopathy.
According to statistics, only every fourth woman with uterine fibroma has clinical symptoms. The clinical picture of a fibroid tumor depends on many factors. First, the age of the woman and the age of her tumor. Secondly, on the location of fibrous nodes, their number, growth direction and premorbid background. And, of course, from the presence of concomitant gynecological and somatic diseases.
The main features of this pathology include pain, disorders of the cycle with uterine bleeding, infertility and disruption of the work of nearby organs.
Fibroma of the uterus provokes the growth of the endometrium, which often leads to its hyperplasia. In the early stages of fibroma development, menstrual irregularities manifest themselves in the form of heavy, prolonged menstruation (menorrhagia), which causes the patient to consult a doctor.
As the tumor progresses, such disorders become more pronounced, and acyclic hemorrhages (metrorrhagia) join them. Chronic blood loss leads to anemization of women, which is accompanied by fatigue and weakness, dizziness and pale skin and mucous membranes.
The nature of menstrual bleeding depends on the localization of fibrous nodes in the uterine wall. In the case of subserous arrangement of fibrous nodes in 50% or more in women moderate menstruation occurs. With interstitial location of the nodes in most patients, menstruation becomes abundant. And in the case of submucous fibroma of the uterus, menstruation becomes abundant and long, and after a while, painful already in the early stages of tumor development. As the submucosa grows, acyclic bleedings due to the capture of a large area of the uterine cavity join.
In addition, the duration and increase in blood loss in the case of interstitial and submucous fibroids are due to a decrease in uterine tone and a violation of its contractile function. Also on the nature of uterine bleeding is influenced by the necrotic changes occurring in the fibrous nodes. Violation of the menstrual function contributes to the expansion of the uterine veins.
The nature of pain in uterine fibroids is determined by the localization of nodes and their size. If the tumor is large, then there is a high probability of malnutrition in the node, which is accompanied by degenerative changes. Acute malnutrition of a tumor is accompanied by a clinical picture of an acute abdomen. The body temperature rises (up to 39 and higher), the pains become acute and unbearable, symptoms of peritoneal irritation appear, in the general blood test there is an accelerated ESR and leukocytosis. If the effect of the conservative treatment of uterine fibroma is absent, an emergency operation is performed.
Pain syndrome in patients with fibroma has a different origin and nature. As a rule, patients complain of pain in the lower abdomen and in the lumbar region. With subserous and interstitial fibromas, constant pains of a nagging character are observed, which is associated with stretching of the peritoneum. Intense and prolonged pain due to the rapid growth of the node.
If the fibroid tumor is large and is characterized by slow and gradual growth, there are aching or nagging constant pain throughout the cycle.
Submucous fibroma is characterized by the appearance of cramping pain during menstruation and indicates a long-existing tumor. If the fibrous node is located on the anterior wall of the uterus, the pain is given to the bladder. And with the localization of the node on the posterior uterine wall, they are radiating into the rectum.
In the case of an intraligamentary tumor, pains occur in the area of the cervix, which is associated with the pressure of the tumor on the nerve plexus, which is localized in the inner throat of the cervix.
Violation of the work of related bodies
With a significant amount of fibroid tumors, especially with intraligamentous fibroma, the ureters are compressed and impaired, which leads to the expansion of the cup-pelvis system and hydronephrosis of the kidney. If the fibrous node presses on the bladder, urination becomes more frequent.
With the localization of the fibrous node on the back of the uterus is a compression of the large intestine, which is accompanied by flatulence and constipation. Difficulties with defecation and pain arising in the process are observed with the posterior location of the nodes. You may also experience pain during intercourse.
In uterine fibroma, primary infertility occurs in 30% of patients. The inability to become pregnant due to hormonal disorders, which were the cause of the tumor. Infertility can also be caused by the location of fibrous nodes. For example, if the nodes overlap the mouth of the fallopian tubes, the chances of conception are sharply reduced. With the submucosal location of the tumor, implantation of a fertilized egg or further development of the embryo becomes impossible.
Pregnancy on the background of fibroids
Is uterine fibroma dangerous during pregnancy? Definitely difficult to answer. As already noted, in the presence of this disease, problems with conception and implantation are possible. If the size of the tumor is insignificant, then the pregnancy, as a rule, is uneventful. But uterine fibroma may increase during gestation, although after giving birth it returns to its original size.
Fibroid tumors of considerable size, especially submucous, have an adverse effect on the course of pregnancy. The node occupies most of the uterine cavity, which does not allow the fetus to fully develop. When the size of the uterus fibroma is 10 or more weeks, there is a high probability of late miscarriage or premature birth.
In addition, large nodes contribute to improper location of the fetus, which complicates both the course of pregnancy and childbirth. With the cervical location of the tumor creates an obstacle to the birth of the head of the fetus and increases the risk of bleeding during childbirth. Therefore, for large tumors, pregnancy, as a rule, ends with operative delivery.
Diagnosis begins with a thorough history and patient complaints. During the gynecological examination, an enlarged uterus is palpated, with a bumpy and dense surface. The primary examination does not allow differentiation of fibroids from fibroids or sarcoma, so the doctor will prescribe an additional examination:
This method allows you to see the uterine mucosa, to determine the submucous fibroids, even small sizes. If there are suspicious areas of the mucous membrane, a piece of tissue is taken (biopsy) followed by a histological examination. Interstitial fibroma is defined as a protrusion above the uterine wall and has a smooth surface and a pale pink color.
Computed and magnetic resonance imaging is carried out with the aim of final confirmation of the disease and exclusion of uterine sarcoma or fibroma or ovarian cystoma (in the case of the subserous node).
It is performed in difficult cases when there is no possibility to distinguish the uterine fibroid tumor from the tumor-like formation of the ovary.
How to treat uterine fibroids? Tactic treatment is determined by the size and location of the tumor and the duration of the disease, the presence / absence of clinical manifestations, comorbidity, the patient's desire to become pregnant and rapid growth or lack of it (rapid growth is indicated by increasing the fibroma over 12 months for 4 or more weeks).
Fibroma of the uterus of small size (5 - 6 weeks) does not need treatment. In this case, dispensary observation is recommended (gynecological examination every 3 months and an ultrasound examination annually).
Conservative therapy is prescribed in the following situations:
- the size of the uterus does not exceed 12 weeks,
- low symptom course (no menorrhagia and metrorrhagia, minor pain syndrome),
- woman's desire to get pregnant,
- there are contraindications for surgery,
- subserous node on a broad base and interstitial fibroma.
The basis of conservative therapy is hormone therapy:
This group of drugs suppresses the secretion of pituitary gonadotropins, and in the ovaries reduces the production of estrogen (danazol, gestrinone).
These drugs normalize the growth of the endometrium in case of its hyperplasia. The effectiveness of gestagens in the treatment of fibroid tumors is low and they are prescribed for small nodes, which are accompanied by endometrial hyperplastic processes (norcolute, dufaston and utroestan).
Analogs of GnRH
Preparations of this group (zoladex, buserilin) cause hypoestrogenism. By reducing the estrogen content, the blood supply to the uterus is reduced, in particular, to the fibroma nodes, which helps to reduce their size. These drugs have a temporary effect and are prescribed 3 months before surgery.
Also, patients are advised to follow a specific diet with a full protein content and foods rich in iron. At the same time, iron preparations and sedatives are prescribed, for the relief of pain, nonsteroidal anti-inflammatory drugs (indomethacin, nise) and painkillers are recommended.
The operation in the case of uterine fibroids is performed in the following situations:
- large fibroma (more than 12 weeks),
- a rapid increase in the size of the uterus (4 weeks or more per year),
- failure of conservative treatment,
- severe symptoms (pain, bleeding, leading to anemia, disruption of the work of adjacent organs),
- malnutrition (necrosis) of the node,
- subserous node on the leg, and in case of its torsion - emergency surgery,
- submucosal arrangement of the fibroid node, the “nascent” node,
- cervical fibroids,
- endometrial hyperplasia, adenomyosis or other tumors of the genital sphere against the background of uterine fibroma.
What will be the surgical treatment depends primarily on the location of the fibroid site and on the properties of the tumor. It also takes into account the desire of a woman to preserve reproductive function and the presence of concomitant gynecological pathology. The presence of uterine fibroma does not always mean removal of the organ. As a rule, sparing minimally invasive operations are performed:
Through the laparoscopic approach, subserosal and intramural fibromas are removed. In the case of the location of a node or nodes in the thickness of the myometrium, they are enucleated (husked) from the muscle wall, and when the subserous node is removed, the formation is removed along with the leg. This operation allows you to save the uterus, which is especially important in women of childbearing age (not only menstruation, but also the ability to bear pregnancy).
Ultrasonic Ablation or FUS
The site is evaporated by high-frequency ultrasound, the procedure is monitored by MRI.
Radical surgical treatment consists in removal of the uterus - hysterectomy and is carried out in patients with multiple and large fibromas and not wishing to preserve reproductive function.
Possible options for hysterectomy:
Treatment of folk remedies
Folk remedies that are used for uterine fibroids, it is usually herbal therapy. Herbal medicine is used as an addition to the main course of treatment with drugs and only with the approval of the doctor. Herbal medicine inhibits the growth of fibroma, reduces the severity of symptoms (bleeding, pain), has anti-inflammatory and resolving effect:
Prepare a tincture of celandine on the basis of vodka, which begins to take with one drop, daily adding one at a time. Drink infusion course, until the total number of drops reaches 35.
Whole plant is used entirely (leaves, stems, roots and flowers). Strawberries are brewed like tea and drunk instead of another liquid.
Complications depend on the location of the fibroid tumor. It is possible to twist the legs of the subserous node, as a result of which the food in it is disturbed, which requires an immediate operation. Necrosis of the interstitial or submucous nodes, the clinic of which proceeds with a picture of "acute abdomen" and also requires emergency surgical intervention, is not excluded. In the case of the location of the fibroid node submucosal, perhaps its birth, accompanied by cramping pain and bleeding.
Консервативная миомэктомия позволяет сохранить репродуктивную функцию, а наступление беременности отмечается в 40 – 60% случаев.
No, the risk of uterine fibroma degeneration into cancer is very low and does not exceed 1%.
Specific prevention, both fibroids and uterine fibroids do not exist. But it should exclude provocative factors, which include numerous abortions, uncontrolled intake of oral contraceptive pills, inflammatory processes of the appendages and the uterus. You should lead a healthy lifestyle, give up bad habits, fight obesity, regularly visit a gynecologist and annually undergo an pelvic ultrasound.
Not. All women who underwent conservative myomectomy are registered with a gynecologist before menopause. During the operation, only the eye visible nodes are removed, so that the appearance of new ones and their growth are possible.
Types of fibroids
Fibroma is a benign tumor. Like fibroids, it originates in the wall of the uterus, and then can grow towards the outer (serous) membrane, towards the uterine cavity, or grow inside the muscles. The difference between these tumors lies in their structure. Fibroids are formed from muscle cells, and fibroma from connective tissue cells. Such a tumor is most often found in women of 20-40 years old, but it can begin to develop at a later age.
Depending on the direction of growth, the following types of fibroma of the uterus are distinguished:
- Interstitial fibroma (does not extend beyond the muscles of the organ wall). This type is most common.
- Submucous is the second most common. Fibroma grows towards the uterine cavity, increasing, protruding from under the mucous membrane, reducing the volume and disrupting the development of the endometrium. Particularly dangerous germination of the tumor in the neck.
- Subserous fibroma. It grows towards the outer shell, bulges into the abdominal cavity.
- Stalked. This fibroma is a type of subserous, but is located entirely in the abdominal cavity, and is connected with the body of the uterus by a thin leg.
- Stitched (intraligamentary) fibroma. Develops between the ligament plates, through which the uterus is connected to the wall of the pelvis.
- Parasitic fibroma. Breaking away from the serous membrane, it falls on other organs of the small pelvis and begins to develop there.
Fibroma of the uterus is formed when a small vessel is blocked in the uterine wall. Around this place begins to grow connective tissue, forming a capsule. Fibroma can be single or multiple, when nodes of different size, localization and degree of "maturity" grow.
Stages of development and types of fibroids
There may be 3 types of uterine fibroma, each of which corresponds to a certain stage of its development.
Simple fibroma. At the first stage, a tumor germ is formed from dividing cells of the connective tissue and a slow increase in the neoplasm up to 3 cm in diameter.
Proliferating. In the second stage, the tumor "matures". Cells actively divide, but without atypical changes in structure. New growth is growing rapidly.
Predsarcoma. At the third stage, the growth of fibroma stops and its “aging” begins, during which a multitude of deformed (atypical) cells appear.
In some cases (especially during menopause), the fibroma shrinks and may even disappear. This is different from a malignant tumor. But the possible reappearance of nodes, if the causes of the disease are not eliminated.
The consequences of the formation and growth of fibroma can be:
- menstrual disorders and infertility
- twisting of the stem of stalked fibroma, impaired blood supply to the node, tissue necrosis, the occurrence of peritonitis and sepsis,
- separation of stalked fibroma, its transition into a parasitic form,
- the occurrence of hemorrhage in the abdominal cavity with the separation of fibromas from the wall,
- squeezing of neighboring organs, disruption of their work,
- malignant degeneration of fibroids.
Addition: Due to tumor growth, an increase in the size of the abdomen occurs, as during pregnancy. There are even cases of medical errors when these two states are confused. For convenience, the tumor size is calculated both in centimeters and in the obstetric weeks of pregnancy. A large tumor is considered to be larger than 10 weeks (more than 6 cm in diameter).
Fibroma of the uterus often becomes the reason for the impossibility of conception, not only because of the hormonal disorders against which it is formed. This is a mechanical obstacle in the path of sperm, if it is located close to or in the neck. A submucous tumor blocks the entrance to the fallopian tubes.
If the pregnancy has occurred, then submucous neoplasms are a particular danger for its preservation. A sharp hormonal surge, which occurs during pregnancy, sometimes provokes tumor growth. This reduces the volume of the uterine cavity, which prevents the normal development of the fetus. It may be located incorrectly, which subsequently will prevent its progress through the birth canal. Fibroma in the cervix prevents the passage of the baby’s head into it.
In some cases, such a tumor causes ectopic pregnancy, miscarriage, or premature birth. Most often, in the presence of an internal tumor, childbirth is carried out using cesarean section. At the same time, the nodes in the organ cavity are removed.
If the tumor is small and does not grow, it is not removed during pregnancy. The indication for surgery is rapid growth and an increased risk of complications.
Reasons for the formation of fibroma
The main cause of fibroma in the uterus is considered hormonal disorders. Any factors leading to an increase in the blood level of estrogen against the background of a decrease in the level of progesterone contribute to the appearance and growth of the neoplasm. Hormonal failure can have a different origin:
- Pathology in the uterus (uterine version). The production of hormones in the ovaries occurs normally, but their effect on the development of the tissues of the uterus is weakened due to a decrease in the sensitivity of the receptors located in them. This condition occurs as a result of damage to the endometrium during abortions and curettage, as well as its insufficient development (hypoplasia).
- Ovarian dysfunction (ovarian variant). The ratio of estrogen and progesterone is disturbed due to the occurrence of inflammatory and infectious diseases of the ovaries, as well as the formation of cysts.
- Disruption of pituitary hormone production (central variant). The production of hormones in the ovaries is disrupted due to malfunction of the hypothalamic-pituitary system of the brain. The ratio of FSH / LH deviates from the norm, which leads to a hormonal shift. The cause of the disruption of the pituitary gland may be brain injuries, stress experienced by the woman, postponed neurological diseases, disorders of the autonomic nervous system. In some cases, heredity plays a role.
Factors contributing to hormonal disruptions are diseases of the thyroid and pancreas, liver. An excess of estrogen can be formed as a result of prolonged use of hormonal drugs.
Endometrium underdevelopment is caused by cardiac and vascular pathologies, congenital abnormalities in the development of the uterus, and later puberty. Intrauterine device, abortion, diagnostic procedures, complicated labor can provoke the growth of uterine fibroma.
Often the disease appears in obesity, metabolic disorders, diabetes. Such tumors are formed on the background of diseases of the mammary glands (for example, mastopathy).
One of the first signs of the disease is the occurrence of menstrual abnormalities: menses become profuse and painful. This is due to the fact that tumor growth contributes to the pathological proliferation of the endometrium.
With an increase in nodes, the uterus tone decreases, its contractility, due to which menstruation becomes longer and irregular, intermenstrual uterine bleeding occurs.
Abdominal and lower back pain
Twisting the leg, its separation, compression of the nerve endings and impaired blood circulation lead to severe pain in the abdomen, not associated with the arrival of menstruation. Localization of pain, as a rule, depends on the location of uterus fibroma nodes.
In the presence of subserous and interstitial tumors, there is a pulling pain in the pubic region and in the lower back, which is associated with stretching of the uterine wall and peritoneum. For submucous fibromas, spasm-like pains in the lower abdomen are characteristic, increasing during menstruation, giving to the bladder and rectum.
They can occur as a result of menstrual disorders, and as a result of trauma to the tumor. Excessive blood loss leads to symptoms of anemia (dizziness, weakness, fainting, interruptions in heart rhythm).
Impact on the pelvic organs
The pressure of the tumor on the bladder is manifested by difficulty urinating. An inflammatory process occurs that can spread to the kidneys. The temperature may rise, the appearance of pus in the urine. If the node is on the back wall, then it presses on the rectum. This causes flatulence and constipation.
It is carried out in cases where the size of the nodes do not exceed 12 weeks, there are no uterine bleeding and severe pain, the tumor is located in the uterine wall or in the abdominal cavity. They try to resort to this method in treating young patients when it is necessary to preserve the full structure of the uterus so that a woman in the future can become pregnant and bear the child.
The main method is replacement therapy to restore the natural ratio of estrogen and progesterone in the body. Used drugs based on natural and synthetic hormones.
Progestins (drugs containing progesterone). By lowering the level of estrogen in the blood, they inhibit the growth of the endometrium. Fibroma of the uterus stops growing, also prevents the emergence of new nodes. For this are used duphaston, urozhestan, norkolut.
To normalize the menstrual cycle and reduce the intensity of menstruation (eliminate anemia) are used combined oral contraceptives (COC) containing hormones in small doses (regulon, yarin, zhanin). The Mirena intrauterine device has the same effect as COC.
At the same time, anti-inflammatory drugs, vitamins, iron preparations are prescribed during treatment.
Analogs of GnRH (buserilin, zoladex). In some cases, drug therapy is carried out before surgical removal of uterine fibroma in order to reduce estrogen levels, reduce blood circulation in the uterus and achieve temporary stabilization of the tumor state. For this purpose, preparations based on the pituitary hormone (GnRH) are used.
Treatment with hormonal drugs gives effect after 3 months.
Surgical treatment is carried out when the size of the fibroma nodes exceeds 12 weeks, the tumor grows faster than 4 weeks a year, there are pains, bleeding. Be sure to remove the tumor with a thin leg, as well as located near the pelvic organs.
Operations are also performed if the nodes are located in the cervix, the tumor occurs against the background of the pathological growth of the endometrium. The complexity of the surgery depends on the size of the tumor, its localization, the age of the patient.
Fibromectomy - removal of a tumor by a laparoscopic method through punctures in the peritoneum (low-impact method that does not leave scars on the body), laparotomic (through an incision above the pubis). Submucous fibromas are removed by vaginal penetration into the uterine cavity through the hysteroscope tube and the subsequent unscrewing of the tumor.
EMA - blocking the access of blood to the tumor by introducing gelatin into its vessels. Due to the deterioration of the blood supply, the tumor is reduced.
FUS ablation. Fibroma of the uterus is destroyed by ultrasound.
If there are many large nodes, they are eliminated along with part of the body of the uterus, or the uterus is removed completely. There are various options for uterine amputation: with preservation of the cervix and the adjacent part of the uterus, complete removal of the organ, removal of the uterus bottom (defundation) with preservation of its body and cervix.
It is not recommended to engage in any self-treatment. The most accurate way to detect tumor sites early is prophylactic ultrasound.
Types of uterine fibroids
The classification of fibroids is based on the location of the tumor within the uterus. Submucous fibromas grow inside the uterus, under its shell. With the growth of submucous fibroma of the uterus, spasms and pain occur, often severe bleeding occurs. Subserous fibroids are formed outside the uterus, on its outer shell. Fibroid tumors of this type are asymptomatic until they grow to the size that impedes the functioning of neighboring organs.
Interstitial fibroids of the uterus - a type of fibroid tumors that form in the walls of an organ. Gynecology encounters them most often. The growth of interstitial fibroids leads to an increase in the size of the uterus. Ligamentous fibromas are located between the supporting ligaments of the uterus. Removal of such fibroid tumors is associated with a high risk of damage to other organs or blood vessels.
Stem-like fibroids of the uterus are formed as a result of the appearance of the stem in sub-serous tumors. The growth of stalked fibroma of the uterus is accompanied by a bend of the leg and severe pain. Rarely encountered parasitic uterine fibroids are characterized by the addition of a fibroid tumor to other organs. In some cases, cervical uterine fibroids develop.
Causes of Uterine Fibroma
The etiological moments in the development of uterine fibroids are not precisely defined. Most researchers point to the connection of uterine fibroma with increased hormonal sensitivity to estrogen and hereditary predisposition. However, even with these factors, uterine fibroma may not always develop.
Additional conditions contribute to the emergence of uterine fibroid tumors - late menarche, artificial termination of pregnancy in women’s history, lack of childbirth by the age of 30, complicated labor, frequent diagnostic curettage, estrogen-containing hormonal means for contraception or menopause treatment, concomitant chronic female diseases, lack of regular sexuality, etc. Often, extragenital background for the development of uterine fibroma is overweight, arterial hypert nziya, obesity, thyroid diseases, diabetes, lack of exercise, stress and the like. d.
Representatives of the Negroid race are more susceptible to the appearance of fibroids than women of the European race. The frequency of occurrence of uterine fibroids correlates with age: in women under 20, fibroid tumor is diagnosed in 20%, up to 30 years - in 30%, up to 40 years - in 40% of cases.
Fibromas of the uterus are hormone-dependent in nature, therefore they do not develop in girls in the premenarch and in women in the postmenopausal period. The growth of existing uterine fibroids can increase with the development of pregnancy when estrogen synthesis increases. After birth, as a rule, there is a decrease in fibroid nodes to their original state. In postmenopausal women with a decrease in the level of estrogen, the growth of uterine fibroids stops, and it significantly decreases or disappears completely.
Symptoms of uterine fibroids
The majority of 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 fibroma can be characterized by copious prolonged menstruation (menorrhagia), up to bleeding, which leads to anemia. In some cases, bleeding from the uterus is acyclic (metrorrhagia).
Menorrhagia accompanied by severe pain and abdominal cramps, the release of blood clots. With stalked fibroma of the uterus, pain often occurs in the intermenstrual period. In uterine fibroids, a woman may feel discomfort or heaviness in the pelvic region, caused by the pressure of fibromatous nodes on adjacent organs. Often marked pain in the lower back and perineum, due to the compression of nerves going to the lower extremities.
When uterine fibroma as a result of pressure on the bladder, urge to urinate becomes more frequent, when squeezing the ureter may develop hydronephrosis, pressure on the wall of the rectum is manifested by constipation, pain during defecation. A woman with uterine fibroma may experience painful intimacy.
Uterine fibroma and pregnancy
Small asymptomatic uterine fibroids, as a rule, do not prevent the occurrence of pregnancy. The exception is fibroid tumors that block the fallopian tubes and block the path of spermatozoa, which makes fertilization of the egg impossible. The presence of uterine fibroma may adversely affect the course of pregnancy. Large nodes that reduce the free space of the uterus, do not allow the embryo to fully develop. Такие фибромы матки могут стать причиной поздних выкидышей или преждевременных родов с рождением недоношенного ребенка.
Large fibroids of the uterus can cause the wrong position of the fetus, which not only complicates the course of pregnancy, but also aggravates the birth act. In such cases, cesarean section is often performed. The most difficult and dangerous for the generic process is the presence of cervical fibroma of the uterus, which creates an obstacle to the passage of the head of the child and the threat of severe bleeding. Maintaining pregnancy in women with uterine fibroma requires increased attention and consideration of all possible risks.
Treatment of uterine fibroma
All women with uterine fibroids are subject to the supervision of a gynecologist or gynecologist-endocrinologist. Small asymptomatic uterine fibroids require control over dynamics. Waiting tactics can be indicated for patients with preclimacteric age. Conservative therapy is justified when the size of uterine fibroids is less than 12 weeks of pregnancy, subserous or interstitial arrangement of the nodes, the absence of meno - and metrorrhagia, pain syndrome, contraindication of surgical tactics. Drug therapy for uterine fibroids includes taking NSAIDs, iron supplements, vitamins, hormones.
The basis of conservative treatment for uterine fibroids is hormone therapy with various groups of drugs. To suppress the synthesis of ovarian steroids in uterine fibroids, androgen derivatives (gestrinone, danazol) can be used. Androgens take a continuous course of up to 8 months, as a result of which the size of uterine fibroids may decrease. The use of gestagens (didrogesterone, norethisterone, progesterone) allows you to normalize the growth of the endometrium in hyperplastic processes. The effectiveness of progestin in relation to fibroids is low, so their use may be justified in the case of small uterine fibroid tumors with concomitant endometrial hyperplasia. The course of treatment with gestagens lasts up to 8 months.
Good results in the treatment of uterine fibroma are shown by the use of the Mirena intrauterine hormonal system containing the gestagenic hormone levonorgestrel. Regular release of the hormone into the uterine cavity inhibits the growth of fibroma and has a contraceptive effect. The use of COC (ethinyl estradiol + dienogest, ethinyl estradiol + drospirenone) effectively slows the growth of small fibroid nodes (up to 2 cm). Treatment of uterine fibroma with combined preparations is carried out for at least 3 months.
The use of GnRH (goserelin, buserelin) analogues is aimed at achieving hypoestrogenism. As a result of their regular use, blood flow to the uterus and fibroid nodes decreases, causing a decrease in the size of the fibroids. The effectiveness of treatment with GnRH analogues is reversible, because after discontinuing their use, the nodes reach their initial size after 4-6 months. In gynecology, GnRH analogues are often used in the preoperative period in order to reduce the size of the nodes for their easier removal. Side effects from these drugs include hot flashes, pseudomenopause, vaginal dryness, mood imbalance, and osteoporosis. Surgical treatment of uterine fibroma is advisable in case of submucous growth, severe clinical symptoms (bleeding, pain, compression of neighboring organs), large nodules, a combination of fibroma with endometriosis or ovarian tumors, necrosis of the fibroid gland.
Conservative myomectomy by vaginal, laparoscopic or laparotomic access is considered as organ-preserving interventions in uterine fibroids. During the operation, the fibroids are enucleated while the uterus is preserved. In the case of submucous placement of the node, hysteroscopic myomectomy is resorted to without incisions through the flexible optical hysteroscope channel. Where possible, organ-preserving operations are performed for women who plan a subsequent pregnancy. The radical methods of uterine fibroma surgery 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 shown to patients who are not planning to have children.
A modern method of treating uterine fibroma is uterine artery embolization. As a result of the endovascular occlusion of the vessels feeding the uterine fibroma, the blood supply is blocked and the growth of the tumor node stops. Uterine fibroma embolization is a minimally aggressive and highly effective technique. In some cases, ultrasound ablation (FUZ) is used to treat uterine fibroma - “evaporation” of the node by high-frequency ultrasound under MRI control.
Complications and prognosis for uterine fibroids
The growth of uterine fibroma may be accompanied by a twisting of the leg of the node, necrosis of the node (usually submucous or interstitial), hemorrhage. Torsion of the fibroids proceeds with the clinic "acute abdomen." With necrosis, pain, fever, softening and tenderness of the node appear. The probability of malignant degeneration of uterine fibroids is extremely insignificant and does not exceed 1%. With pronounced bleeding, uterine fibroma causes anemia.
Complications associated with surgical treatment of uterine fibroids include postoperative infections, bleeding, adhesions in the pelvis, the formation of intrauterine synechiae. Pregnancy after conservative myomectomy occurs in 40-60% of patients. Also, conducting organ-preserving interventions does not preclude the development of new fibroid nodes.
Prevention of uterine fibroids
Specific methods for the prevention of uterine fibroma does not exist. However, the exclusion of provoking factors (abortion, uncontrolled intake of contraception, chronic inflammation, extragenital diseases, etc.) makes it possible to reduce the likelihood of uterine fibroma.
An effective way to prevent uterine fibroma is regular visits to the gynecologist and undergoing ultrasound.
Uterine fibroids: sizes and varieties
Neoplasms in the uterus can be single or 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 uterus develops on its outer walls in the direction of the abdominal cavity. Subserous fibroids do 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.
- Submucous fibroma. Formed in the submucosal layer. The characteristic symptoms of submucous fibroids are pain and irregular menstruation.
- Intramural fibroma. This type of neoplasm is most common. Formed in the inner layer and grows into the uterus, which leads to a significant increase in the latter. Fibroma in the uterus is accompanied by many symptoms: pain, cycle disturbance, disruption of the work of neighboring organs, etc.
- Fibroma of the cervix. The proliferation of fibromatous nodes occurs in the muscles of the neck. This type of fibroma is rarely observed - only 5% of the total number of cases.
The size of fibromyoma is considered to be in weeks of pregnancy. This is due to the fact that before, before the advent of ultrasound and similar diagnostic methods, the development of nodes could be recognized only during a gynecological examination. Because of 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 specific gestational age. The size of fibromatous nodes can be divided into small, medium and large. Fibroma is considered up to 12 weeks of gestation, the average is from 12 to 15 weeks, and large uterine fibroma is 16 weeks or more.
Uterine fibroids: causes
Fibroma of the uterus is directly related to hormonal disorders in the body. Hormonal disruptions are the most common causes of fibromyoma formation. During the luteal phase of the menstrual cycle, the lining of the uterus begins to rapidly increase in size, preparing the ground for a fertilized egg. If the pregnancy does not occur, hormonal activity is inhibited and menstruation occurs. Next is the constriction 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 further grows.
Hormones affect the change in the size of uterine fibroids. In the analysis in the cells of the neoplasm, receptors for sex hormones are detected, which are much more sensitive than in the cells of the unchanged tissues of the uterus. Fibromyoma is active in the period of increased estrogen in the body, then its size increases. Therefore, during menopause, fibroma does not grow and begins to regress.
In the development of fibroids plays a big role heredity. Practice shows that the presence of fibroids is not an isolated case among women of the same family. But it is impossible to say unequivocally that the disease will develop in the presence of this factor.
Uterine fibroids can occur as a result of injury to the myometrium. Frequent interruptions of pregnancy, complicated labor, diagnostic curettage, minimally invasive uterine surgeries (hysteroscopy, laparoscopy, etc.) contribute to the appearance of changes in the tissues.
Fibromyoma can also occur in chronic inflammatory and infectious diseases of the pelvic organs. Often the appearance of fibromyoma is associated with overweight, thyroid disease, hypertension, diabetes and stress.
Regardless of the cause, uterine fibromas are successfully eliminated by leading experts in this field, Candidate of Medical Sciences, endovascular surgeon Boris Y. Bobrov, and Candidate of Medical Sciences, Obstetrician-Gynecologist Dmitry Mikhailovich Lubnin. Doctors have extensive experience in treating uterine fibroids using uterine artery embolization. Doctors diagnose and advise on the most effective treatment tactics. To do this, you can make an appointment.
Symptoms of uterine fibroma: how to recognize the disease
At the initial stage, most women show no signs of fibroma of the uterus. In the future, with an increase in size, symptoms begin to appear. Sore fibroma of the uterus medium and large sizes. Small fibroids often do not cause discomfort. Fibroma symptoms will depend on the size of the nodes, their number, location, growth direction and location relative to other pelvic organs.
The presence of heavy menstruation, up to bleeding, is one of the symptoms that accompany uterine fibroma. Long bleeding can cause anemia. Sometimes bleeding from the uterus can occur in the middle of the cycle. Menstruation is accompanied by severe pain, spasms of the abdomen and the release of blood clots.
A woman may experience discomfort that distinguishes uterine fibroma. Symptoms and signs of pathology will be as follows:
- pain or heaviness in the lower abdomen,
- pelvic pain,
- lower back pain.
Pain symptom is caused by squeezing the nerves that pass to the lower extremities.
As a result of pressure on the bladder, a woman may experience such a symptom as frequent urge to urinate. Another symptom of fibromyoma pressure on neighboring organs is a violation of bowel movements (constipation, pain during bowel movements). A common symptom of fibroids is a feeling of discomfort during sexual intercourse.
There are several ways in which uterine fibroids are diagnosed. Ultrasound is considered the most simple, accessible and informative. Since small fibromyomas do not cause anxiety to a woman, it is impossible to detect them based on the symptoms. They can be diagnosed during a preventive study or in the diagnosis of another disease. Additional methods of instrumental examination are magnetic resonance imaging and radiography.
For the diagnosis prescribed additional studies, clarifying that the tumor is uterine fibroma. A blood test for hormones is prescribed to determine the hormonal background of the body, a complete blood count will show the presence of an inflammatory process (if any). When all data has been 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 emergence of new ones.
Uterine fibroma: menopause
In the period of menopause, the neoplasm, if not treated previously and did not show symptoms, in most cases begins to regress. This is due to the fact that the growth of fibroids depends on the 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 drug. Its action can have the opposite effect, and during menopause, fibroma begins to grow, even if it hasn’t behaved like this 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 interfere with conceiving and carrying a child. Problems with pregnancy occur in the following situations:
- the uterine node is located at the entrance to the fallopian tubes, which interferes with the movement of the sperm and makes fertilization impossible,
- intramural fibromatous nodes prevent the zygote from attaching,
- large fibromyomas do not allow the embryo to fully develop.
The use of uterine artery embolization allows to obtain positive results in the issue of restoration of reproductive function. During the procedure, the genitals are not injured, and the disease of uterine fibroids is effectively eliminated. After a short time, a woman can already plan a pregnancy.
What is dangerous uterine fibroma
If the fibromyoma has a leg, then torsion is dangerous. When the knot is increased in size, the leg may be twisted and pinched. This is accompanied by severe sharp pain, bleeding, necrosis of the node. Symptoms of "acute abdomen" develop. Symptoms of necrosis are pain, fever, tenderness of the node.
Fibromyoma with severe bleeding causes iron deficiency anemia. Typical symptoms of anemia: weakness, dizziness, pallor and dry skin.
During pregnancy, large fibroids cause abnormal fetal position, 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 in the uterus is called a mass or tumor, but benign. It consists of connective tissue, and usually occurs in the walls of this muscular organ.
The basis of fibroma is a single fibromatous node in the uterus. Such a seal may be single, and then they say - "fibroma", or a single fibroid tumor.
In the same case, if there are a lot of such nodes, they say “uterus fibromatosis,” which translated means an increased, significant amount of fibrosis, fibrous tissue in the uterus, but not in one place, but in a “small node” way.
Uterine fibroma is a mature tumor. This means that when it is detected, the doctors hardly worry that this is an intermediate stage and that it will be reborn into something.
Fibroma is very rare, and these isolated cases "do not significantly spoil medical statistics." Consider what are fibroids, for what reasons they develop, how to manifest, how to be treated, and how these tumors affect the course of pregnancy.
Usually, indications for surgical treatment are:
- submucosa, or submucous growth, which most often causes bleeding,
- compression of adjacent organs
- large tumor size,
- combination with endometrial hyperplastic processes.
Of urgent indications, torsion of the fibroma is usually the most common, and as a result, node necrosis.
Most often, surgeons try to preserve the uterus, if the clinical situation and the desire of the patient allows, and perform fibromectomy. It can be performed in various ways: through the vagina, through the incision of the anterior abdominal wall or laparoscopically. Normally a single node is husked and removed.
In the event that a woman does not plan to become pregnant, then you can perform a more radical intervention, for example, completely remove the uterus or perform its amputation. The same is done with diffuse fibromatosis, when there are too many nodes or following indications.
В настоящее время в оперативную гинекологию пришли методы сосудистой хирургии, когда проводят окклюзию сосудов, которые питают фиброзный узел. В результате в узле нарушается кровообращение, и его рост прекращается. Sometimes, with the appearance of well-marked nodes, ultrasonic techniques can be used, or even laser evaporation of the node under the control of tomography or ultrasound.
Now we know how to treat fibroids. The main thing is to always contact a gynecologist, and not try to perform the treatment of fibroids with folk remedies. As a result, you can miss the precious time and provoke the development of complications. We list them again:
- torsion of the legs, when acute abdominal pain occurs, the base tension of the anterior abdominal wall,
- it is necrosis when severe pain occurs, then it subsides and arises
- peritonitis clinic fever and clinic with softening or mating of the node,
- bleeding, which is rarely life-threatening, but quite often debilitating and causing anemia.
What is dangerous uterine fibroma? As already mentioned, the transformation of fibroids into cancer happens very rarely, not more than one percent of the cases, but still these cases are not excluded. Therefore, it will be very important to get a biopsy of the fibromatous site to make a final conclusion.
With regard to the onset of pregnancy, in the case of small formations and conservative treatment with hormones after their disappearance, there are usually no problems with bearing the child.
If the patient lives with fibroma and is not treated, then uterine fibroma is a mechanical obstacle to fertilization. In addition, a large knot can squeeze the uterus in such a way that it makes unbearable conditions for the development of the embryo, resulting in miscarriage.
The most dangerous thing for a pregnant woman is the presence of an undiagnosed large fibroma in the area of the cervix, which will prevent the spontaneous birth of the baby and may cause a sudden complication in childbirth.
Main characteristics of pathological education
Women often look for the answer to the question - uterine fibroma: what is it? This neoplasm is found in every second woman and has often served as the reason for the removal of the uterus. Modern gynecology offers patients drugs and low-impact surgical interventions that help control the disease.
The tumor in its early stages is located inside the muscle layer. In the future, depending on the location of its main mass, these types of fibromas are distinguished:
- submucosa, growing in the uterus,
- intramural, or intermuscular,
- subserous, lying on the surface of the uterus and growing in the direction of the abdominal cavity,
- fibroid cervix.
The most correct name for fibroma is uterine leiomyoma, which is a type of mesenchymal tumor. It can be very small, not causing any unpleasant manifestations, or grow to gigantic proportions. The neoplasm is growing slowly.
Causes and provoking factors of development
The exact causes of uterine fibroma are still unknown. As a rule, the tendency to this disease is inherited. 2-3 times more often the disease occurs in women of African descent.
The tumor grows in response to the stimulation of the uterus by the female sex hormones - estrogen secreted from any healthy woman. Therefore, fibroma can appear even at a young age (about 20 years). However, after menopause, when the ovaries stop producing estrogen, fibroma often decreases in size.
Factors that increase the risk of developing a tumor:
- excess weight,
- first menstruation before the age of 10,
- African American origin.
Experts recognize a certain role and emotional factors. Psychosomatics is a branch of medicine that establishes a connection between the inner world of a patient and his diseases. It is possible that the appearance of uterine fibroma occurs with a long effect on the patient of such emotions:
- constant stress
- abortion decision,
- dissatisfaction with intimacy with a partner,
- anxiety and fears.
It must be remembered that a woman’s health is connected not only with external or hormonal influences, but also with her mental state. Peace of mind - one of the conditions for a healthy lifestyle.
Even if the tumor has reached a large size, symptoms of uterine fibroids are often absent. A tumor is often detected during a routine examination by a gynecologist.
The main signs of the disease:
- Copious menstrual bleeding (menorrhagia) with blood clots.
- Frequent urination or urge to it, caused by the pressure of the tumor on the bladder.
- Constipation due to compression of the rectum.
- The feeling of heaviness, fullness of the abdomen.
- Uterine fibroid pain usually occurs during menstruation, in the later stages it becomes constant, aching, in the lower abdomen or lower back.
- Increased abdominal circumference, which sometimes requires changing the size of clothes while maintaining the same weight.
- Infertility or miscarriage.
- An education in the uterus, discovered by a doctor during a two-handed gynecological examination or ultrasound.
When a small tumor is quite possible normal pregnancy. However, it happens that the disease causes infertility or miscarriage. At the location of the node near the mouth of the pipe appears a mechanical obstacle to the germ cells. Cervical ganglion often causes miscarriage. Large education can cause impaired fetal development. Fibroma of the uterus during pregnancy usually does not change its size, but such patients need more careful monitoring.
The issue of delivery is solved in each case individually.
When do I need to see a doctor urgently?
Sometimes there are situations when you can not do without urgent medical care. Is fibroma dangerous? Yes, in addition to problems with pregnancy, it can become a source of bleeding or death (necrosis) of the tumor site.
It is necessary to consult a gynecologist if there are such signs:
- irregular menstrual cycle, heavy periods, bleeding between periods,
- increasing pain in the pelvis or abdomen,
- fever or sweating at night
- increase in abdominal circumference,
- inability to get pregnant.
Call the "Ambulance" is necessary in such cases:
- menstrual bleeding, which requires more than 3 sanitary pads per hour,
- severe or prolonged pain in the pelvis or abdomen,
- dizziness, chest pain and shortness of breath in combination with vaginal bleeding,
- bleeding from the vagina with reliable or possible pregnancy.
So that severe complications do not develop, timely diagnosis and treatment of uterine fibroids is necessary.
The effectiveness of traditional medicine
Non-drug treatment of folk remedies is ineffective and leads to delay with the start of medication or surgery.
Often, to avoid hormonal treatment or surgery, women turn to homeopathic remedies. They must be selected by a specially trained specialist, and the effectiveness of such drugs has not been proven.
Enthusiasts of this method believe that homeopathy for fibroids:
- restores the balance of the processes of excitation and inhibition in the nervous system, which slows down tumor growth,
- reduces blood supply to the node
- enhances the production of gestagens, relatively reducing the concentration of estrogen - fibroma growth factors,
- reduces the degree of blood loss and the severity of anemia.
Popular homeopathic remedies:
Remember that taking medications that have not passed the official tests, a woman sets up an experiment on her health with unpredictable consequences.
Drug therapy for fibroma
Drug treatment of uterine fibroids without surgery is prescribed for small bleeding or abdominal pain, if the size of the node does not exceed 3 cm in diameter. It may include one or more of the following drugs:
- Nonsteroidal anti-inflammatory drugs (Ibuprofen), which have analgesic effects.
- Oral contraceptives that reduce the amount of blood lost during menstruation, and alleviate pain.
- Gonadotropin-releasing hormone agonists - drugs that inhibit the production of estrogen in the pituitary gland. A decrease in estrogen levels leads to a decrease in the size of the fibroids. This type of medication is often used in preparation for surgery to reduce the size of the node and blood loss. Within 3 months of taking these drugs, fibroma is reduced by 2 times. However, with a long course of treatment, the woman has symptoms of estrogen deficiency, resembling menopause: hot flashes, bone fragility, vaginal dryness.
- The anti-hormonal drug Mifepristone is prescribed to reduce the size of the fibroids before surgery. It reduces the intensity of pain in the pelvis and lower back, normalizes urination. Side effects are also associated with the suppression of estrogen production. The drug also causes a miscarriage, so it must be used with extreme caution in patients planning a pregnancy.
- The drug Danazol causes a complete cessation of uterine bleeding, that is, artificial menopause. This is a male sex hormone (androgen). It has serious side effects, including weight gain, muscle cramps, reduction in the size of the mammary glands, acne, unwanted hair growth, oily skin, mood swings and depression, a decrease in “good” cholesterol, and signs of liver dysfunction.
When using the last three groups of drugs, menstruation stops. Treatment of uterine fibroma with menopause leads to the fact that menstruation is not renewed. In young women, combined estrogen-progestin drugs are subsequently used to restore the cycle.
If the patient does not plan to become pregnant in the near future, she can be offered the installation of Mirena helix, which provides a contraceptive effect and local release of gestagens, to restore hormonal background. Smoking women, especially those aged 35 years or older and at risk for thrombosis, are advised to administer the contraceptive drug Charozetta.
Surgical removal of uterine fibroma has both its risks and benefits. Therefore, the decision about the operation is made individually, depending on the characteristics of each patient.
Surgery to remove uterine fibroids is called "myomectomy." It can be performed using hysteroscopy, laparoscopy or with open access to the abdominal cavity. The choice of intervention technique depends on the location and size of the education.
Removal of the uterus (hysterectomy) - is the most common operation in fibroma
In submucosal variants, removal with a hysteroscope from the inside through the uterus is shown. For subserous tumors, laparoscopic removal is performed. With multiple intermuscular nodes, a conservative myomectomy is performed: the incision is made in the lower abdomen, and the nodes are carefully husked from the muscular wall of the uterus.
To reduce blood loss and reduce the amount of surgery before intervention, a course of gonadotropin releasing hormone agonists is prescribed.
Myomectomy is much less likely to be accompanied by damage to the rectum or bladder. This operation preserves the organ, and after it pregnancy is possible.
The most common operation for fibroids is the removal of the uterus, or hysterectomy. Depending on the size of the tumor, it can be carried out through the vagina or through the abdominal cavity. In some cases, laparoscopy is used.
Laparoscopy is not used in such situations:
- uterus more than 18 weeks
- low lying nodes on the back wall,
- tying knots.
Before the operation, gonadotropin releasing hormone agonists are often prescribed. The consequences of the operation to remove the uterus - irreversible infertility and the absence of menstruation.
Hysterectomy is prescribed in such cases:
- node growth over 4 weeks per year
- suspected malignant tumor - sarcoma,
- fibroma size over 16 weeks
- her postmenopausal growth,
- neck knot,
- the impossibility of organ-sparing surgery.
Hysterectomy is accompanied by less blood loss than myomectomy. If uterus cancer or damage to the ovaries is suspected, appendages are additionally removed.
Even with the preservation of appendages in half of the patients, post-hysterectomy syndrome appears, resembling the symptoms of menopause. Therefore, hormone replacement therapy is prescribed.
A new approach with promising results - uterine artery embolization. Manipulation implies cessation of the arterial blood supply to the fibroma. The procedure is performed by inserting a thin tube (catheter) into the femoral artery. Under the control of special x-ray equipment determine the characteristics of the uterus blood supply. The smallest plastic particles, the size of a grain of sand, are injected into the artery that feeds the fibroma. This material blocks the blood supply to the fibrous node, as a result of which the latter is reduced in size.
The method is more suitable for women who do not want to be operated, with the ineffectiveness of other methods or contraindications to surgery. The body is preserved, and further pregnancy is possible.
With a large node, embolization can be carried out as a preparatory stage before myomectomy, in order to reduce the diameter of the fibroid and facilitate its removal.
Laparoscopic uterine artery occlusion is carried out with the introduction into the abdominal cavity of small instruments and cessation of blood flow through the vessels. However, the blood supply to the fibrous node does not stop completely. Such an intervention can reduce blood loss during subsequent myomectomy. In addition, after it, the thickness of the myometrium decreases, and the nodes stand out well in the uterine cavity, which facilitates their removal.
The newest method of treatment is the action of focused ultrasound under the control of magnetic resonance. At the same time, MRI is used to direct a beam of ultrasonic rays that heat and destroy the center of fibroma.
There are other modern technologies that allow the destruction of submucosal nodes without surgery, for example, cryomiolysis (freezing) or electromyolysis (destruction of the node using electric current). They are used for small solitary formations.
The duration of disability depends on the scope and method of the operation:
After surgical treatment for 1 month, it is recommended to wear compression stockings and take Dipyridamole, Pentoxifylline or Aspirin to prevent thrombosis. Iron preparations are prescribed to restore hemoglobin levels in the blood. If necessary, hormone replacement therapy is added.
During the following years, it is better for the patient to avoid a long stay in the sun, visiting baths and saunas, massaging the lower back and gluteal areas.
Prevention and prognosis
Uterine fibroids prevention measures:
- avoid overweight after 18 years
- to give up smoking,
- regular medical examinations.
The success of treatment depends largely on the severity of the disease and the method of therapy.
Can I get pregnant with uterine fibroma?
Yes, it is quite possible. This increases the risk of abortion. However, many women with small tumors safely bear children.
If fibroma is detected at the age of over 35 years of age, at the same time the processes of ovulation deterioration are already underway, which increases the likelihood of problems with conception.
Fibroma rarely turns into a cancer. More often it occurs in postmenopausal women. The main sign of malignancy in this case is a rapidly growing tumor, which requires surgical intervention.
Uterine fibroma - the main symptoms:
- Low back pain
- Hand shake
- Uterine bleeding
- Pain during sexual intercourse
- Increased abdomen
- Pelvic pain
- Abdominal pressure
- Pain in the back of the legs
- Bladder pressure
Fibroma of the uterus is a mature, benign tumor of a type characterized by a connective tissue structure and location in the region of the walls of the uterus. Fibroma of the uterus, the symptoms of which are directly related to its increase in size, is diagnosed by means of a standard gynecological examination, ultrasound, CT and MRI.
Fibroid-like tumors can form in any organ. Thus, the most frequent areas of formation of fibroids are the ovaries, mammary glands, skin and uterus. When considering fibroma of the uterus in particular, singularity of consolidation in it or the presence of nodal clusters is noted. The course of the disease is asymptomatic, the nature of it is gradual.
As for the size of the formation, it can be from a few millimeters to several centimeters in diameter. It is noteworthy that uterine fibroma in extremely rare cases is prone to subsequent malignancy.
Uterine fibroid classification
Classification is based on the specific location in the uterus fibroids. In particular, the following types of concentration are distinguished:
- Submucous fibroids. Their growth occurs under the shell of the uterus, while the growth process provokes the appearance of characteristic pain and spasms. Often, bleeding occurs.
- Subferous fibroids. Formed from the outside of the outer lining of the uterus. Tumors of this type develop without any symptoms until the moment when they reach the size that interferes with the functioning of the adjacent organs.
- Interstitial fibromas. They are a type of uterine tumors that form directly in the walls of this organ.The most common type of fibroids in gynecology, due to the growth of which there is an increase in the size of the uterus.
- Interlinked fibroids. The localization of this type of fibroids is concentrated in the area between the supporting uterine ligaments. When this type of tumor is removed, there is a serious risk of damage to other types of organs, as well as to blood vessels.
- Fibromas stalked. This type of formation appears due to the formation of the stem in the sub-serous tumors. The growth of this type of fibroids occurs when the leg is bent, which is accompanied by the occurrence of severe pain.
- Fibromas are parasitic. In this case, we are talking about joining to other organs of a fibroid tumor, which in some cases provokes the development of cervical fibromas.
Uterine fibroma: symptoms
In most cases, women with uterine fibroma do not experience any symptoms provoked by this education, and they often do not need treatment at all. At the same time, every fourth patient of childbearing age experiences fairly pronounced symptoms of having fibroids. The location, number, size and type of fibroids determine the specific symptoms in each individual case.
Among the most common symptoms are the following manifestations:
- Prolonged and heavy bleeding. They can also be accompanied by pain in combination with blood clots.
- Anemia on the background of heavy bleeding, requiring emergency medical care (generally manifested in various intensity variants, in this case is pronounced, accompanied by symptoms such as dizziness, low blood pressure, severe weakness, fatigue, hand shake).
- Pressure, pain in the pelvic area. These manifestations occur due to pressure exerted on the pelvic region of the fibroma.
- Pain arising in the posterior region of the legs. Here, again, pain occurs because of the pressure exerted on the pelvic region and, accordingly, the legs.
- Pressure in the bladder. This symptom provokes the need for increased urination, urinary retention or incontinence.
- Intestinal pressure. Due to this symptom may occur constipation, as well as flatulence.
- Pain in the lower back.
- An increase in the abdomen, often mistakenly attributed to pregnancy or weight gain.
- Feeling of fullness, pressure in the lower abdomen.
- Pain during sexual intercourse.
In addition to the above symptoms, uterine fibroma can also trigger a disorder in reproductive function, leading to infertility or premature birth.
Is uterine fibroma dangerous for a woman?
Many patients not only try to find out what is uterine fibroma, but how dangerous it is for a woman. Studies show that the transformation of a tumor into a malignant one is extremely rare.
- Usually, the neoplasm slowly grows in size and can reach the size of the fetus for a period of 20 weeks, but it is not cancer.
However, the risk to life is still there. Fibroma is a knot that can be attached to the wall of the uterus with a thin leg. Tumor growth often provokes torsion of this leg and necrosis of the neoplasm itself. If you do not go to a doctor in time, the woman may die from peritonitis, sepsis or internal hemorrhage.
Among the more dangerous uterine fibroids can be distinguished anemia, which develops if the tumor reaches a large size and begins to reduce the concentration of hemoglobin in the blood.
Signs and symptoms of uterine fibroma
In some women, the presence of fibroma may not manifest in any way, especially if it is of small size. But during an ultrasound examination, the doctor diagnoses a neoplasm with the following symptoms:
- Increasing the size of the uterus.
- The proliferation of connective tissue in the place where the node is fiboma.
- Heterogeneous echostructure of a thickened portion of the uterine wall.
- The lack of clear contours of the tumor (with its diffuse growth).
When the fibroma significantly increases in size, the woman begins to notice the symptoms of the pathology of the structure of the uterine muscle layer:
- Abundant menstruation.
- Constant feeling of heaviness in the pelvis, which increases during menstruation.
- Pain in the perineum, extending into one of the lower limbs.
- Low back pain.
- Pain during intercourse, especially with deep and intense penetration of the penis.
- Frequent constipation due to compression of the rectum.
Symptoms and signs of uterine fibroma should be evaluated in combination, and as an additional diagnostic procedure, the doctor should prescribe hysteroscopy, MRI and diagnostic curettage.
Varieties of the disease
Depending on the location, there are several types of fibroids, which suggest different treatment tactics.
Submucous fibroma - located under the mucous membrane and has a direction of growth inside the uterus. Clinical symptoms manifest themselves: cramping pain, loss of a node in the vagina, a rapid increase in the neoplasm in volume.
On palpation, fibroma is defined as a dense and mobile node. Removal of such uterine fibroids is possible only by surgery.
Subserous fibroma - located on the outer side of the uterine wall, the direction of tumor growth - in the abdominal cavity. For a long time has no symptoms, does not violate the reproductive function of women.
With small sizes, drug treatment of fibroma is prescribed, with a significant increase in the node shows surgery.
Intramural Fibroma - located in the middle muscle layers of the uterine wall. It is the most common type of fibroids that are diagnosed in women. May have a direction of growth in the uterine cavity, and in the direction of the peritoneum.
For a long time does not show pronounced symptoms, but can be the cause of miscarriage, if the node is large enough and led to the deformation of the uterus.
Stitched fibroma - located between the sheets of the wide ligament. Almost always, this tumor is benign and asymptomatic in the initial stages of its development. One of the reasons for its appearance is the absence of pregnancies in the history and hormonal disorders in the body.
Depending on its size, it can be cured both in a medical way and with the help of a surgical intervention.
Stalked fibroma - a special type of tumor, which is formed not as an independent proliferation of connective tissue, but as a branch from the main focus of the subserous-type neoplasm.
Types of removal operations
For large tumors, which in their volume exceed the size of a 12-week gestation, only surgical intervention is shown in order to completely remove the neoplasm. The operation that eliminates fibroma of the uterus must be performed within the next weeks, as it squeezes the intestines, bladder and ureters, preventing the woman's body from functioning normally.
A small tumor can also be removed if it brings strong pain, if its legs are twisted or if the tumor is necrosis of the tumor.
It is performed in the presence of submucous fibroma, which grows deep into the uterus. The operation is performed by transcervical administration of the resectoscope. If the tumor prolapses at least 50% into the uterine cavity, then the chances of success of such a minimally invasive intervention will be high.
For smaller tumors, the quality of surgical treatment will depend on the professionalism of the doctor. Removal of uterine fibroma is performed by leading to the base of the tumor loop-electrode and its subsequent excision. The doctor then coagulates the resulting wound.
It is carried out in cases where fibrous subserous type is detected. The operation is performed by laparoscopy. In the lower third of the abdomen, in the navel, the surgeon makes incisions through which he places the chamber and the necessary surgical instruments into the abdominal cavity.
Since subserous fibroma tends to grow into the side of the peritoneum, it will not be necessary to make incisions when it is excised from the uterus.
The essence of the method is to remove the nodes using ultrasound. The connective tissue that the tumor consists of is heated to 60 degrees in a second, which leads to the destruction of collagen and vascular structures. After 10 seconds of exposure to the ultrasound beam, tissue necrosis is formed.
In order to eliminate a neoplasm, a doctor needs to produce 35 - 45 point effects along the entire perimeter of the pathologically altered area - this is quite enough for the entire node to stop growing and begin to regress.
After removal of uterine fibroma, sexual rest is shown for 30 days from the time of FUS ablation or hysteroscopic myomectomy. If the operation is performed conservatively, then you should refrain from sexual intercourse for 2 months.
Fibroma and fibroids: what is the difference?
The national manual for gynecologists defines fibroma as a benign hormone-sensitive proliferate consisting of altered uterine cells. Myoma, leiomyoma, fibromyoma - all these terms are stated as synonyms. In the international classification of diseases of fibroids and fibroids go together under the code D25. In clinical practice, the use of any of these terms is permitted. For convenience of perception, it is possible to designate all such formations of the uterus as leiomyfibromas.
Benign uterine neoplasms: myoma, leiomyoma, fibromyoma - are among the most common tumors.
The only difference between fibroids and fibroids is the composition of the tumor cells. Conditionally tumors can be divided into three groups:
- Myoma - a tumor consisting predominantly of muscle cells,
- Fibromyoma is a formation in which muscular and connective tissues are present in approximately equal amounts (or even with a predominance of the latter),
- Fibroma - a node of connective tissue cells.
All these subtleties matter only for the histologist studying the microscopic examination under a microscope. In fact, it is possible to determine the type of tumor only after its removal and study in the laboratory. As long as the tumor is in the uterus, its structure does not matter to the doctor. The principles of diagnosis and treatment of fibroids and fibroids do not have significant differences.
It is believed that the node with a predominance of connective tissue is less amenable to conservative treatment and often degenerates into a malignant tumor, however, reliable statistical data on this problem has not been received.
The causes of fibroma: where does the disease come from
Benign tumors of the uterus - is the lot of women of late reproductive age, as a rule, have already given birth to children or have undergone abortion.
Women of late reproductive age are most susceptible to the emergence of tumors.
In most cases, fibroma is detected after 35 years, although the progression of the disease is also possible at a younger age. In adolescents, uterine neoplasms are practically absent. Fibroma may behave differently in menopause, and this largely determines the tactics of management of elderly patients. The article "Uterine fibroids with menopause" will help to understand the nuances of pathology during menopause.
Fibroma is practically not formed in old age. Primary detection of the disease after 75 years is possible, but most often it occurs in women not previously examined. The tumor occurs in childbearing age, and to menopause quite often regresses. The growth of fibroids in the elderly and senile age is a likely sign of its malignant degeneration.
Risk factors for uterine tumors are all conditions in which there is a shortage of progesterone and a relative increase in estrogen:
- Long reproductive period (menarche up to 12 years and menopause after 45 years),
- Lack of childbirth or late first child (after 30 years),
- Numerous artificial abortions and / or miscarriages,
- Inflammatory diseases of the uterus,
- Short period of breastfeeding after childbirth (less than 6 months),
- Uncontrolled intake of high estrogen drugs,
- Overweight - adipose tissue as a depot of sex hormones.
In the development of fibroids, special attention is paid to traumatic childbirth or abortion. It is believed that damage to muscle tissue leads to its improper accretion, the formation of coarse connective tissue fibers and the appearance of a tumor.
Uterine fibroids are twice as common in women of the Negroid race.
According to statistics, benign neoplasms are more common in women of African ethnicity.
The exact cause of the appearance of uterine tumors is not known. Until now, scientists have not even managed to find out whether fibromyoma is a congenital abnormality or tissue damage occurs after birth. Most gynecologists are inclined to believe that cell proliferation and the appearance of nodes in the body of the uterus occur already at reproductive age.
In recent years, psychosomatics is very popular, according to which all diseases are associated with any feelings of a person. According to this theory, fibromyomas occur among power-giving women who refuse to act as women or are dissatisfied with their implementation in this area. Resentment at a partner, fear of motherhood or fear of becoming a bad mother also lead to the appearance of uterine tumors. In women in menopause, the cause of fibroma is called a bad relationship with older children. Official medicine does not pay special attention to psychosomatics, so no reliable research on this topic has been conducted. For more information about the psychological causes of fibroids, you can find out in one of our articles.
Classification of uterine tumors
According to the location of the node there are the following options:
- Submucous or submucous - germinates from the myometrium towards the uterine cavity,
- Interstitial, or intramural - localized exclusively in the thickness of the muscle layer,
- Subserous - reaches the outer shell of the uterus,
- Intraligamentary - located between the ligaments of the uterus.
Types of myomatous nodes depending on the location.
Especially distinguished fibromas of the body and cervix. The latter require mandatory removal in the reproductive age, as they prevent conception and childbearing and can interfere with natural childbirth.
Particularly noteworthy is peduncular fibromyoma. This tumor is located outside the uterus and is connected to it only by a thin leg. It is a type of subserous fibroma. During the initial examination, it can be mistaken for an enlarged ovary or a tumor of the appendages.
In rare cases, the examination revealed another type of subserous fibroids - parasitic. The node is attached to adjacent organs and receives power from them. Diagnosis is difficult due to an atypical clinical picture. Often, laparoscopy, CT, or MRI is required to detect such a tumor.
The following types of uterine fibroma are distinguished by size:
- Clinically insignificant - up to 2 cm
- Small sizes - up to 2.5 cm or 5 weeks (relative to an enlarged uterus),
- Medium size - up to 5 cm or 12 weeks,
- Larger sizes - more than 5 cm or 12 weeks.
The answer about when to remove the pathology, and when it is permissible to wait, you will find in our article "The size of uterine fibroids for surgery."
You can see what uterine fibroma looks like in the photo.
Fibroma large size during surgery.
Actual for submucous tumors. Acute condition, accompanied by the appearance of cramping pain in the lower abdomen and bloody discharge. The intensity of the discharge can vary up to massive blood loss. It is not necessary to wait until the nascent node comes out on its own. Often this complication ends uterine reversal, the development of infection and sepsis, not to mention the risk of hemorrhagic shock on the background of bleeding.
Torsion of tumor legs
The most frequent complication of subserous nodes, especially peduncular. The tumor, connected to the body of the uterus with a thin leg, can twist, leading to ischemia of the tissues with their subsequent necrosis. On the development of necrosis says the appearance of severe pain in the lower abdomen and lower back. Confirm the diagnosis will help conventional ultrasound. Treatment is only surgical (removal of twisted fibroids).
Torsion of the tumor legs can be determined using ultrasound.
Rebirth in sarcoma
Malignant tumor of the uterus occurs in 2% of all cases of fibroids. The risk of malignancy increases with age. The following symptoms indicate the probability of rebirth:
- The rapid growth of the tumor - more than 4 weeks per year
- Activation of fibroids in menopause,
- Frequent uterine bleeding,
- Atypical Doppler blood flow.
In very rare cases, fibromyoma can develop into a malignant tumor, which is characterized by rapid and uncontrolled growth.
The final diagnosis can be made after histological examination.
It is not the fibroids itself that is bleeding, but the endometrium, which is rejected when the uterine muscle layer is not functioning properly. Frequent bleeding can also indicate the presence of comorbidities: adenomyosis, endometrial hyperplasia.
Схема диагностики: как выявляется проблема
Фибромный узел на матке хорошо виден при проведении УЗИ. Скрининговые исследования проводят один раз в год всем женщинам, начиная с возраста 25 лет. If a tumor is detected, it is recommended to repeat the ultrasound every 6 months.
With the introduction into practice of organ-preserving operations, the determination of not only the size of the node, but also its localization is of particular importance. For this purpose, more accurate diagnostic methods can be used: CT or MRI. With the help of computed tomography, the state of the nodes after uterine artery embolization (EMA) is also monitored.
In modern clinics, ultrasound is necessarily supplemented by dopplerometry — an assessment of blood flow in the vessels that feed the tumor. These parameters are important in the development of treatment tactics, in particular - in determining indications and contraindications to EMA.
Other diagnostic methods:
- Hysteroscopy - examination of the uterus under magnification. Allows you to identify submucous fibroids, as well as comorbidities. Birth submucous nodes can be removed immediately during the diagnostic procedure,
- Laparoscopy is the best method for detecting subserous, intralgamentary, peduncular and parasitic fibroids. The diagnostic procedure can also go to the treatment.
Laparoscopy is one of the most accurate methods for diagnosing all types of benign neoplasms.
According to the testimony appointed and other examinations:
- Blood test for hormones (important for infertility),
- Test for tumor markers.
Principles of therapy for uterine fibroids
The goal of treatment is to eliminate unpleasant symptoms, avoid the development of complications and restore reproductive function. In young women, doctors do their best to preserve the uterus, but this is not always possible. The sooner the patient turns to the doctor and starts treatment, the greater the chances of a favorable outcome of the disease.
Emergency care for bleeding on the background of fibroids is in the gynecological hospital. Conducted curettage of the uterus with the mandatory histological examination of the material. Further tactics are developed taking into account the data obtained.
Non-drug treatment is not effective. No methods - yoga, physiotherapy, acupuncture or auto-training - will not bring the desired result and will not allow to get rid of the uterus tumor. Traditional recipes based on herbs also do not work. Nor are various pseudoscientific methods considered. All that a doctor can do is to give recommendations on how to improve the overall tone of the body and maintain immunity:
- Diet: balanced nutrition with the restriction of spicy, spicy, fried foods. An increase in the ration of the share of vegetable products: fresh vegetables and fruits, whole grain cereals,
- Reception of vitamins taking into account age and a season,
- Physical activity,
- Weight control, weight loss if necessary.
Following the recommendations of the attending physician in maintaining immunity will help the woman recover from the treatment of the tumor.
Of course, these methods will not help to cure fibroids, but they will give strength to the body and allow for faster recovery from hormone therapy or surgery.
There is an opinion that it is impossible to sunbathe, to go to a solarium, sauna or swimming pool with fibroids. In fact, no scientific evidence of the harm of these measures has been received, so there is no strict prohibition.
Uterine fibroma - what is it?
Uterine fibroma is a benign tumor of the uterine wall, consisting of muscle fibers with the inclusion of connective tissue tissues. This rounded, dense, slowly growing formation — the beginning of its growth passes unnoticed — is often detected only when surgery is required.
The size of uterine fibroma is from pea up to 30 cm.
It never develops after menopause in adolescent girls, before puberty. Most often, fibroma is found in 30-40-year-old women.
A tumor has no tendency to degenerate into a malignant one, but, nevertheless, it does not disturb the natural life cycles of a woman. So what is it - uterine fibroma, and is it dangerous?
Depending on the location of the nodes, there are three types of fibroids:
- The most common fibromatous interstitial, it is intramural. Form when the nodes are located in the muscle tissue of the uterine wall.
- Subserous nodes are located under the outer lining of the uterus, irritating the peritoneum and exerting pressure on the adjacent internal organs.
- Less common is submucous fibromatous form, in which the nodes are turned into the uterus, preventing fetal bearing and causing dangerous abundant bleeding associated with detachment of the uterine mucosa.
Signs and symptoms of uterine fibroma
Symptoms of uterine fibroma in a woman manifest as:
- painful prolonged menstruation and bleeding between them,
- feeling of heaviness in the stomach
- back pain, groin and small pelvis,
- discomfort during intercourse,
- an increase in the abdomen
- frequent urge to urinate,
- constipation and hemorrhoids.
Fibroma of the uterus has symptoms and signs characteristic of many pathological processes in the pelvis, which makes it difficult to diagnose.
In case of infertility and miscarriages, doctors necessarily conduct an examination of the uterine wall, suspecting the development of fibroma.