What is a fibroid in the uterus. What are the causes of myoma disease? How to treat uterine fibroids - one of the latest studies

uterine fibroids- a chronic disease of the uterine body, manifested by the growth of one or more tumor-like nodes in its muscular layers. As a result, the size of the uterus increases, its shape is deformed. This leads to an unpleasant symptom - pathological bleeding, frequent urination, pain in the lower abdomen and pelvic region, impaired reproduction. But it doesn't always happen... signs of uterine fibroids in women depends on the number of nodes, as well as their size. In more than half of the cases, myomatous nodes are small and do not manifest themselves.

The disease is very common. According to statistics, by the age of 45, up to 70-80% of women suffer from fibroids.

Treatment tactics depend on the stage of the tumor, the rapidity of its growth, and the age of the patient. Includes conservative and surgical methods. Asymptomatic course requires only regular monitoring by a gynecologist.

Causes of the disease

Myoma is a hormone-dependent disease. This means that the nodes grow in response to the influence of female sex hormones, in particular, progesterone and estrogen. Therefore, it occurs only in women of reproductive age. However, it most often develops in the late reproductive and premenopausal period. Nodules of small and medium size with the onset of menopause tend to regress, or, as they say, dissolve. In women after the onset of menopause, fibroids may appear in response to taking estrogen-containing drugs.

There is no scientific evidence that would reliably confirm that the cause of the development of fibroids is a hormonal disorder. In many patients, nodes occur against the background of normal hormonal parameters. This means that this hormone-dependent disease is not hormone-dependent.

Some hereditary dependence was revealed, however, it is also impossible to talk about the direct influence of the hereditary factor of this disease.

There are risk factors:

• later than menarche;
• a large number of abortions;
• copious menstrual flow;
• inflammatory diseases of the genital area;
• ovarian cysts;
• prolonged illiterately selected contraception;
• hepatic dysfunction;
• lack of childbirth and lactation by the age of 30;
• excess weight;
• disorders of carbohydrate metabolism;
• sedentary lifestyle;
• stress.

However, to date, it is impossible to reliably determine the cause of fibroids and the likelihood of its development in a particular woman.

Classification of myoma formations

The body of the uterus consists of a muscular layer and a mucous membrane that lines its interior.

Myomatous formations are localized in the muscular connective tissue. The focus of their growth growth is one defective cell, which undergoes certain changes and begins to divide at a faster rate than neighboring ones.

As a result, a myomatous node appears - a local accumulation of chaotically intertwined smooth muscle fibers. On average, its dimensions range from a few millimeters to several centimeters. However, sometimes neoplasms of very large sizes occur. Some reach a weight of several kilograms.

Myoma cells practically do not degenerate into malignant ones. This happens in less than 1% of cases.

Attention! Even the rapid growth of fibroids is not a sign of its malignancy.

Myoma of the body of the uterus can be located in different layers. According to these characteristics, nodes are divided into the following types:

• Submucosal or submucosal - grows into the uterine cavity. It can protrude inward completely, half or less.
• Intramural or intermuscular - located inside the wall of the organ.
• Subserous or subperitoneal - protrudes from the outside (into the peritoneum).

Among these species, there is a fibroid that grows on a leg.

Symptoms of uterine fibroids

Although the disease has a high degree of distribution, however, about 35-40% of patients experience severe symptoms - in the rest it is asymptomatic.

Myoma manifestations:

• Profuse and prolonged menstruation.
• Clots in menstrual blood.
• Sensation of pressure in the region of the bladder.
• Frequent urination.
• Pain in the lower abdomen.
• Enlargement of the abdomen.
• Pain during sexual activity.

With large neoplasms, complications arise.

Frequent is the development of anemia caused by heavy and prolonged menstrual bleeding.

Reproductive disorder - usually occurs when the node is located intramurally. In this case, difficulties arise with the onset of pregnancy, since the nodes prevent the fixation of the fetal egg on the uterine mucosa. It can also cause miscarriage.

A rare complication is dysfunction of nearby organs: the bladder and rectum.

Diagnostics

A doctor can suspect uterine fibroids, based on the patient's complaints, and after a gynecological examination, in case of an increase in the size of the organ.

Previously, the degree of development of the disease was correlated with the weeks of pregnancy, based on how much the patient's uterus was enlarged. This has happened since the time when there was no ultrasound diagnostics. Now the definition of the type “fibroids corresponding to 8-9 weeks of gestation” serves as a marker of the size of the fibroids, but not a diagnostic criterion.

It is possible to reliably diagnose the disease only by the results of an ultrasound examination. Ultrasound imaging allows you to accurately determine the size of the nodes, their location and type. It is necessary that when registering the result, the uzist doctor should make not only a description of the nodes, but also a schematic drawing of the uterus with their location and an indication of the size of each.

This is important for the attending physician when planning further treatment. For example, to understand exactly how neoplasms need to be removed. Or is it possible for a patient to become pregnant with such an arrangement of nodes.

Since ultrasound cannot always cope with too large formations and a greatly enlarged uterus, in some cases an MRI is prescribed in addition to ultrasound.

Hysteroscopy is one of the complementary diagnostic tools. This is an endoscopic examination, when a probe with a camera is inserted into the uterine cavity and it is examined from the inside. This method is rarely needed.

Treatment of uterine fibroids

Uterine artery embolization (UAE)

This is a minimally invasive and fairly safe method, which consists in blocking the flow of blood to the myomatous nodes. As a result, they do not receive nutrition and regress within a few hours.

In this case, no cuts are made. A substance containing emboli - small balls that, like a cork, block the blood flow, is injected into the femoral artery using a tube.

This is a completely organ-preserving method. The rate of serious complications when using it is about 1%.

There are pronounced side effects. These are painful sensations in the lower abdomen for several hours, which require relief with an anesthetic drug. Nausea, vomiting, fever, urination disorders may occur for several days.

The method is indicated for women of reproductive age with fibroids that have severe symptoms.

Surgical methods

The largest number of surgical operations in the field of gynecology falls on uterine myoma. The nodes on the uterus and the uterus itself are surgically removed if other types of treatment have been ineffective.

Myomectomy

Removal of myomatous nodes with preservation of the organ.

The method of operation usually depends on the type of nodes:

1. Hysteroscopic. In this case, no incision is made. Removal is performed with a resectoscope, which is inserted through the vagina. This type of operation is possible only with a submucosal location of the nodes.
2. Laparoscopic. The operation is performed using a laparoscope through several punctures in the abdominal cavity.
3. BUT bdominal. Incisions are made in the abdomen and uterus. This type of operation is used for multiple myoma. Although this is the most invasive intervention with a long recovery period, it also belongs to the organ-preserving operations.

The most appropriate is the removal of medium-sized macroscopic myomas (from 2 to 5 cm in diameter) until they have grown to large sizes. This significantly complicates their treatment, and may lead to the need for a hysterectomy.

Hysterectomy (complete removal of the uterus)

An extreme measure, which should be resorted to only in case of severe symptoms and very large organ sizes, and also if other methods do not work.

The operation is also performed by laparoscopic, hysteroscopic or abdominal methods.

Usually used for women over 40 who already have children.

All of these types of surgical intervention are performed under general or epidural anesthesia.

Medical therapy

Contraceptives. They can reduce the amount of bleeding and temporarily stabilize the growth of small nodes.

Drugs that cause temporary menopause. In the process of application (usually 6 months), the nodes decrease, but after the abolition, they quickly grow to their former, and sometimes to large sizes. Complete regression of fibroids is possible only with its very small size.

Mirena intrauterine device. Due to the effect on the endometrium, it removes the symptom - heavy menstrual bleeding.

These drugs are symptomatic and do not have a lasting therapeutic effect.

Other Methods

Cryotherapy(freezing nodes).

FUS ablation(remote evaporation with a narrowly focused ultrasonic beam).

These are new methods with little evidence. Therefore, they are not widely used.

Attention! Dietary supplements, including indole, leeches, reflexology, herbal medicine - do not treat uterine fibroids.

Modern approaches to treatment

Which methods will be used by the doctor depends on many factors.

The modern concept of treatment of uterine fibroids:

• Uterine fibroids require treatment only if indicated.
• Therapy should not be harder than the disease itself.
• The approach to treatment should be as organ-preserving as possible.
• Treatment should provide the most lasting effect.
• Orientation to preserve reproductive function, even if a woman is not planning a pregnancy now.

Symptoms and treatment of fibroids are interconnected. When choosing a therapy, you need to answer the following questions:

• Does fibroids interfere with a woman's life.
• What and where nodes are found.
• Are they growing.
• Whether the woman plans pregnancy and when.
• The age of the patient.

Since fibroids do not degenerate into cancer, and in about 60% of cases they do not manifest themselves in any way, or the symptoms are insignificant, it is not worth exposing a woman to treatment, and even more so to surgical intervention. The recommendations of some doctors to remove fibroids just because they exist are completely unjustified, not to mention the removal of the entire organ. From radical treatment, the health of the patient may suffer more than from small fibroids.

However, if the nodes grow steadily from measurement to measurement, this is also a reason for treatment.

But if a woman is in premenopause, while the growth of fibroids and symptoms are moderate, the doctor may choose to wait and see.

After the onset of menopause, the production of sex hormones stops and the fibroids degrade. With heavy periods in this case, the Mirena spiral can be prescribed as a symptomatic treatment.

If a woman is planning a pregnancy, it is important to understand how the nodes can interfere with this - whether they deform the shape of the uterus, whether they interfere with the attachment of a fertilized egg to its walls, whether rapidly growing nodes interfere with the development of the fetus. If these factors are excluded, it is possible to become pregnant with myoma.

If neoplasms lead to infertility and miscarriage, treatment is necessary - embolization or myomectomy. It is important to bear in mind that fibroids are a disease with a possibility of recurrence. Therefore, it is advisable to carry out such an intervention if a woman is planning a pregnancy in the short term. If she is going to postpone it for a few years, there is a chance that the nodes will grow again.

Prevention

For the prevention of the disease, it is important to exclude everything that puts a woman at risk - stress, anemia, venous congestion in the pelvic area, illiterate contraception, inflammation, abortion.

So preventive measures the measures will be:

• normal sleep;
• proper nutrition;
• maintaining optimal weight;
• physical activity;
• regular sex life;
• timely treatment of diseases of the female genital area;
• maintaining pregnancy and breast-feeding at least 4-6 months.

Also, for the prevention of fibroids, it is important to realize the childbearing function in time. It is optimal if the first birth occurs at about 22 years old, and the second at 25 years old. Late first births lead to premature aging of myocytes (muscle cells), and therefore to a decrease in the ability of the uterus to stretch and contract, and to a tendency to form knots.

Uterine fibroids are not just amenable to correction, but it does not belong to dangerous diseases. In order for fibroid therapy to be most effective, it is important to identify it in time. Therefore, regular visits to the gynecologist also belong to preventive measures.

Myoma is a benign tumor that grows from the connective tissue on the walls or in the uterine cavity. The incidence rate by the age of 35 is 35-45% among the total female population. The peak incidence occurs in the age group of 35-50 years.

Uterine fibroids can range in size from a small nodule to a tumor weighing about a kilogram, when it is easily determined by palpation of the abdomen. Signs of the disease may not appear immediately. The more it is started, the more difficult the treatment and the greater the likelihood of complications.

Let's take a closer look at what kind of disease it is, what are the characteristic signs and symptoms, and what is prescribed as a treatment for a woman.

Myoma: what is this disease?

Uterine fibroids (fibromyoma, leiomyoma) is the most common benign tumor of the uterus, hormone-dependent (develops with an increased content of female sex hormones estrogen).

Myoma certainly has signs of a tumor, but also differs from that, therefore it is more correct to correlate it with tumor-like formations. Despite the benign nature, fibroids can cause a lot of trouble, including uterine bleeding and complications during childbearing, so treatment must be approached responsibly.

The occurrence of uterine fibroids occurs usually in her body, but in rare cases it is also possible in the cervix. Fibroids that develop in muscle tissue are considered typical, and those that form in the neck or on the ligaments are considered an atypical form of the disease.

The myoma node begins its development from a growth zone located around a thin-walled blood vessel. In size, such growth can be either a few millimeters or several centimeters, most often in women there is a multiple fibroid, when several neoplasms are formed at once.

Causes

Myoma in the structure of gynecological diseases takes the 2nd place. Its frequency in reproductive age averages 16%-20% of cases, and in premenopausal age it reaches 30-35%.

Myoma appears as a result of a single cell mutation. Its further division and development of the tumor is affected by changes in the hormonal background in the body, a violation of the ratio of estrogens and progesterone. In, when the production of female sex hormones decreases, the tumor may disappear on its own.

The following reasons lead to uterine fibroids:

• Hormonal disorders - a sharp decrease or increase in the level or estrogens, which are clinically manifested by various menstrual disorders.
• Irregular sexual life, especially after 25 years. As a result of sexual dissatisfaction, the blood flow in the small pelvis changes, and stagnation prevails.
• Violation of the production of sex hormones in diseases of the ovaries
• Prolonged stress, hard physical work
• The presence of chronic infectious diseases, such as chronic pyelonephritis, chronic tonsillitis, etc.
• Diseases of the endocrine glands: thyroid gland, adrenal glands, etc.
• Violations of fat metabolism in the body (obesity).
• Mechanical damage, complicated births with ruptures, abortions, complications after surgery, the consequences of curettage.
• hereditary factor. The risk of developing fibroids in those women whose grandmothers and mothers had such a neoplasm increases significantly.

Women who have given birth have been shown to be less likely to develop knots. Often this neoplasm can appear during pregnancy. Especially if the first pregnancy is late.

Classification

Such formations have several classifications. In accordance with the number of nodes, uterine fibroids are of the following types:

• Single;
• Multiple.

In accordance with the sizes are found:

• Large;
• Medium;
• Small myomatous neoplasms.

Depending on the size of the myoma nodes, which are compared with the gestational age, there are

• small fibroids (5-6 weeks),
• medium (7-11 weeks),
• large sizes (more than 12 weeks).

Depending on the size and location of the nodes, there are 3 types of uterine fibroids:

• leiomyoma - consist of smooth muscle tissue;
• fibroma - consists of connective tissue;
• fibromyoma - consists of connective and muscle tissue.

By location relative to the muscle layer - myometrium - fibroids are classified as follows:

Interstitial uterine fibroids

It is located in the center of the myometrium, i.e. muscular layer of the uterus. It is characterized by large sizes. It is completely located in the thickness of the muscular layer of the uterine wall (found in 60% of all cases of the disease).

submucosal fibroids

What it is? Submucous, or submucosal - grows in the direction of the endometrium. If such a node is partially (more than 1/3) located in the myometrium, it is called intermuscular with centripetal growth (towards the uterine cavity). It can also have a leg or a wide base. Stem fibroids are sometimes able to "fall out" of the cervical canal, being twisted and infected.

subserous

Subperitoneal (or subserous) - the node is located under the mucous membrane of the outer layer of the uterus, near the peritoneum. Subserous fibroids are divided into the following types:

• "Type 0". A knot on a wide base - 0-A, a knot "on a leg" - 0-B.
• "Type 1". Most of the node is located in the serous membrane.
• "Type 2". Most of the tumor is located in the thickness of the myometrium.

stages

There are three stages of fibroid morphogenesis:

• Formation in the myometrium of the germ (active growth zone).
• Growth of an undifferentiated tumor.
• Growth and maturation of a tumor with differentiated elements.

The rate of development of myomatous nodes depends on many factors:

• The presence of chronic pathologies of the gynecological sphere;
• Prolonged use of hormonal contraceptives;
• The presence in the past of a large number of abortions;
• Prolonged ultraviolet exposure;
• Lack of childbirth and lactation in women after 30.

With the rapid growth of a myomatous tumor, a woman observes menorrhagic changes (abundance of bleeding during menstruation), anemic signs, and hyperplastic tissue changes occur in the uterus.

An increase in the size of the tumor does not always occur unambiguously, therefore, it stands out:

1. Simple. Slowly growing and oligosymptomatic uterine fibroids of small size, often single. Often, simple fibroids are diagnosed by chance.
2. proliferating. It grows rapidly, provokes clinical manifestations. Diagnosed as multiple uterine fibroids or single large.

Fibroids in young women are usually recommended to be treated, especially if the tumors are bothersome or interfere with pregnancy. Depending on the location of the node and its size, the doctor may first prescribe conservative therapy - medication, and if there is no effect, surgery.

The first signs in a woman

Myoma can be recognized only when it has reached a sufficiently large size. As the uterine fibroids grow, the first signs may occur:

• The appearance of sharp pains of a cramping nature not associated with menstruation in the lower abdomen;
• prolonged, heavy and irregular menstruation;
• constipation;
• bleeding;
• frequent urination;
• heaviness and constant pain in the lower abdomen;
• spotting during intercourse;
• lower back pain;
• an increase in the abdomen is not associated with a significant increase in weight;
• frequent miscarriages.

All these signs can be present in other gynecological problems. Therefore, they are not enough to make a diagnosis. The presence of a tumor can be said only by a thorough examination and ultrasound.

Symptoms of uterine fibroids

Often, uterine fibroids do not give any symptoms and are a find during a preventive examination by a gynecologist. Or it happens that the symptoms are quite smoothed and are often perceived as a variant of the norm.

The growth of uterine fibroids is accompanied by the appearance of symptoms, the most common of which are:

• Pain in the intermenstrual period, different in duration, arising in the lower abdomen, sometimes extending to the lumbar region, upper abdomen or legs;
• Menoria is an increase in menstrual flow. Heavy bleeding is dangerous because after some time this may result. More abundant bleeding indicates that the muscles of the uterus are contracting worse, in this case, medical assistance is required.
• Dysfunction of the pelvic organs, which are manifested by frequent urge to urinate and constipation. These symptoms occur with subserous pedunculated, cervical or interligamentous nodes, as well as with a large volume of the tumor.
• Growing feeling of heaviness, the presence of something foreign in the stomach. Sexual contact becomes painful (in the case of the location of the nodes from the side of the vagina). The belly grows, as during pregnancy. Sprain increases the pulling pain in the abdomen.
• Miscarriage, infertility - occur in 30% of women with multiple fibroids.

In the photo below, you can see myoma from different sides:

It is impossible to independently determine the presence of the disease. When the above symptoms and signs of uterine fibroids appear, it is imperative to undergo an examination by a gynecologist. These signs may be accompanied by more dangerous diseases, such as cancer of the uterus or ovaries, endometriosis.

Complications

Uterine fibroids pose a danger to a woman's health in terms of the development of complications of the disease. With regular monitoring by the attending gynecologist and careful attention to her health, a woman can significantly reduce the risk of complications.

Complications of uterine fibroids:

• necrosis of the myomatous node;
• the birth of a submucosal node;
• posthemorrhagic anemia;
• malignancy of the tumor;
• infertility;
• miscarriage;
• postpartum hemorrhage;
• hyperplastic processes of the endometrium.

In order not to encounter complications, it is necessary to start treatment of fibroids in a timely manner (immediately after detection). Surgical intervention is required quite rarely and is more often associated with already existing complications of the disease.

Myoma and pregnancy

Uterine fibroids are found in 8% of pregnant women undergoing pregnancy monitoring. In most women, during pregnancy, the dimensions remain unchanged or decrease.

Danger:

• development of placental insufficiency (changes in the structural and functional properties of the placenta, which can lead to impaired fetal development);
• the threat of termination of pregnancy at various times.

Most often, women with uterine fibroids are offered to give birth by caesarean section due to the risk of all sorts of complications, such as:

• untimely discharge of amniotic fluid (this is due to increased tone muscular layer of the uterus or malposition of the fetus);
• the risk of heavy postpartum hemorrhage;
• the risk of premature detachment of the placenta (most often this occurs if the fibroid is located behind the placenta).

During a caesarean, a woman can have the tumor removed immediately so that she can plan another pregnancy in the future.

Diagnostics

The first signs of fibroids are very similar to the symptoms of other gynecological pathologies. Therefore, in order to make a correct diagnosis, it is necessary to conduct a series of laboratory instrumental studies. Only a correct and timely diagnosis can be a guarantee of successful treatment and a speedy recovery.

Diagnostics includes:

• Gynecological examination. It is carried out on a gynecological chair with the help of the necessary tools. The size of the uterine body, the location of the ovaries, the shape and mobility of the cervix, etc. are taken into account;
• Ultrasound of the pelvic organs using a vaginal probe. For better visualization, the study is carried out with a filled bladder. The method is highly informative and allows you to identify the size of the tumor and its shape;
• Laparoscopy - used only when fibroids cannot be distinguished from an ovarian tumor;
• Hysteroscopy - examination of the cavity and walls of the uterus with the help of an optical apparatus-hysteroscope. Hysteroscopy is performed both with diagnostic and with therapeutic purpose: detection and removal of uterine fibroids of some localizations.
• Biopsy. In some cases, during hysteroscopy or laparoscopy, a small sample of tissue is taken, which is then examined in more detail under a microscope.
• Diagnostic curettage of the uterine cavity: it is indicated for all identified uterine fibroids in order to establish the pathology of the endometrium and exclude uterine cancer.

How to treat uterine fibroids?

How to treat uterine fibroids? The main goal of treating fibroids is to eliminate the cause of the disease and the harmful effects of the tumor on the surrounding tissues of the uterus, reduce its size, stop growth. Both medical and surgical methods are used.

As a rule, treatment tactics are chosen depending on the size, localization and clinical and morphological variant of the tumor, the hormonal status of the patient, the state of her reproductive systems, etc. menopause.

Unfortunately, conservative treatment of fibroids is effective only under certain conditions, namely:

• relatively small size of the node (the size of the uterus does not exceed a 12-week pregnancy);
• oligosymptomatic course;
• the desire of the patient to preserve the uterus and, accordingly, the reproductive function;
• inertial or subserous arrangement of nodes with an exceptionally wide base.

With a confirmed diagnosis of uterine fibroids, the following groups of drugs are used:

1. Combined oral contraceptives containing desogestrel and ethinyl estradiol. These medicines help suppress and relieve the first symptoms of fibroids in women. However, drugs in this group do not always help reduce tumors, so they are used only when the size of the node does not exceed 1.5 cm.
2. Androgen derivatives: Danazol, Gestrinone. The action of this group is based on the fact that androgens inhibit the synthesis of ovarian steroid hormones. As a result, the size of the tumor decreases. Apply up to 8 months continuously.
3. Antiprogestogens. Contribute to the cessation of tumor growth. Treatment can reach a six-month period. The most famous drug in this group is Mifepristone;
4. Antigonadotropins (Gestrinone)- prevent an increase in the size of uterine fibroids, but do not contribute to a decrease in existing sizes.

FUS-ablation. One of the modern ways to deal with fibromyomas. In this case, the tumor is destroyed by ultrasound under the control of a magnetic resonance tomograph.

A woman receiving conservative treatment for uterine fibroids should be examined at least once every 6 months.

For such patients, a set of recommendations was developed:

1. It is strictly forbidden to lift heavy objects, which threatens with the omission of the uterine body and other complications;
2. Stresses that negatively affect the hormonal background are unacceptable;
3. Increase the consumption of fruits, berries, herbs, vegetables, as well as fish and seafood;
4. Walk more often (this helps to improve blood flow);
5. Refuse sports in which the load is directed to the abdominal muscles (you can do freestyle swimming and yoga);
6. It is also worth noting that patients with diagnosed fibroids should avoid heat exposure. This means that you need to give up prolonged sunbathing, visiting the bath, sauna and solarium, as well as hot showers.
7. 4 times a year undergo rehabilitation treatment with vitamins (select the complex together with the doctor).

Surgical treatment: operation

Mandatory indications for invasive therapy are:

• the size of the tumor is more than 12 weeks and it puts pressure on nearby organs;
• myomatous formations provoke profuse uterine bleeding;
• there is an acceleration in the growth of fibroids (by 4 weeks in less than a year);
• necrotic changes in the tumor;
• twisting of the leg of the subserous node;
• emerging submucosal fibroids (emergency laparotomy is indicated);
• combination of myomatous nodes with.

There are different options for surgical treatment of uterine fibroids. Three main areas can be distinguished among them:

• removal of the uterus with nodes entirely;
• removal of myomatous nodes with preservation of the uterus;
• surgical violation of blood circulation in fibroids, which leads to their destruction.

Depending on the type of fibroid, its location, size, the doctor chooses the type of surgery to remove the fibroid. Myomectomy is currently performed in 3 ways:,

• Laparoscopy - through small openings in the abdomen
• During hysteroscopy, a special instrument is inserted into the uterus through the vagina.
• Band surgery through an incision in the lower abdomen is very rare.

Rehabilitation after surgery

Rehabilitation of the female body depends on a variety of factors:

1. For example, if the operation was performed by an open method, then the recovery process is slower.
2. The patient is offered to limit physical activity, not forgetting that dosed walking can only bring benefits and will contribute to accelerated healing.

Compliance with proper nutrition

There is no special diet, just a healthy diet.

• First of all, it is a varied and balanced diet that meets the energy needs of a woman, with the inclusion of vitamins and microelements.
• Food is taken 5 times a day, overeating and long breaks between meals are not allowed.
• Healthy eating involves the exclusion of frying and the use of baking, stewing or boiling in cooking.

Folk remedies

Before you start using folk remedies with myoma, be sure to consult with your doctor.

1. Topically applied swabs with burdock root juice. Honey, sea buckthorn and St. John's wort oil, mummy are added to the juice, mixed thoroughly. The tampon is placed overnight for 21 days.
2. Sea buckthorn oil. To do this, make cotton swabs, moisten them in oil and put in the morning and evening. The course lasts 2 weeks. If necessary, it can be repeated.
3. Take 4 tsp. flax seed, pour half a liter of boiling water, and boil over low heat for 10 minutes. At this time, stir the broth. When it cools down, drink half a glass, 4 times a day. The course lasts 15 days, then 15 days - a break, and repeat the course.
4. Walnut partition tincture. You can buy it ready-made at the pharmacy and use it according to the instructions, or you can cook it yourself: pour 30 grams of partitions with vodka (1 glass) and insist in a dark place for 3-4 weeks. Take 30 drops 30 minutes before meals with a glass of water. Course - 1 month, 2 weeks break and can be repeated.
5. Prepare an infusion of several flowers by brewing them with a glass of boiling water for 10 minutes. Should be drunk in the morning before breakfast, for a long time. The term of admission is determined by the phytotherapeutist. Infusions of calendula are used for douching. This plant can be used internally as a tincture of pharmaceutical production.
6. Finely chopped grass of the upland uterus(50 g) pour 500 ml of vodka. Insist ten days in a dark place, shaking regularly. The first ten days take an infusion of a teaspoon once a day, the next ten days - a tablespoon. Then take a break for ten days and repeat the treatment.
7. A good result is the use of tampons soaked in medicinal fluids. Shilajit should be diluted with water in a ratio of 2.5:10. Soak a cotton pad in the prepared solution and place it in the vagina. In parallel, the mummy should be taken orally at a dose of 0.4 g. The therapy should last 10 days, after which a break of 1 week must be made. After you can repeat the course.

Forecast

With timely detection and proper treatment of uterine fibroids further forecast favorable. After organ-preserving operations in women in the reproductive period, pregnancy is likely. However, the rapid growth of uterine fibroids may require radical surgery to exclude childbearing function, even in young women.

Prevention

The main preventive measures are as follows:

• proper nutrition with a predominance of fresh vegetables and fruits;
• taking vitamins and microelements that contribute to the normal synthesis of sex hormones;
• active lifestyle, sports;
• regular sexual intercourse;
• annual preventive examinations at the gynecologist with ultrasound.

We found out what uterine fibroids are and what treatment is most effective. Remember, with regular visits to the doctor, in the event of a neoplasm, it will be found at the very beginning, while its size is small and the woman is not even aware of the presence of fibroids. Timely detection of the tumor will cure it without the use of surgical means and preserve the ability to bear children.

Uterine fibroids, or leiomyoma, is a benign hormone-dependent (estrogen- and progesterone-dependent) tumor of the myometrium (the muscular membrane of the uterus), which develops from smooth muscle cells and contains fibrous connective tissue in varying amounts. Despite significant progress in early diagnosis, removal of the uterus for fibroids (hysterectomy) is still a fairly common method of treatment.

Relevance of the topic

Myoma in the structure of gynecological diseases takes the 2nd place. Its frequency in reproductive age averages 16%-20% of cases, and in premenopausal age it reaches 30-35%. Recently, due to the increase in the number of "aggressive" gynecological and obstetric treatments and the improvement in the quality of diagnostics, there has been an increase in the number of women with myomatosis younger than 30 years.

Basically, the growth of leiomyoma occurs slowly - on average over 5 years. But sometimes there is a rapid growth of the tumor, in which within one year or faster it increases by an amount corresponding to the 5th week of pregnancy.

It can be the cause (if localized in the uterine part of the fallopian tube), spontaneous abortions, premature birth, incorrect position of the fetus, heavy postpartum uterine bleeding and other complications in childbirth and the immediate postpartum period.

Significant sizes of fibroids, in which surgery is indicated, correspond to 14 weeks of pregnancy. But in most other cases, radicalism in treatment (hysterectomy) is not justified. It is based on the traditional opinion that the uterus performs only a reproductive function, after which it can be removed without consequences for the body.

This opinion is erroneous, since there is practically no risk of transformation of leiomyoma into a malignant tumor, but after hysterectomy, menstrual and reproductive functions are lost, and many women develop pronounced vegetative-vascular, psycho-emotional disorders and accelerate the decrease in bone mineral density.

At the same time, conservative treatment of uterine fibroids, as well as the use of non-invasive and minimally invasive methods of treatment in the early stages of tumor development, make it possible to stop its growth, induce regression and prevent violations of the reproductive function of the uterus. But if the indications for surgical treatment are clearly developed and defined, then the use of conservative methods is still debatable.

Causes of uterine fibroids and mechanisms of its development

Causes

There are various theories about the causes of leiomyomas. For example:

1. Some scientists believe that this formation is not a tumor, but a consequence of focal hyperplasia (growth) of the myometrium. It can occur in those areas where there is a complex interlacing of muscle fibers - along the lateral surfaces of the neck, in the area of ​​​​the fallopian tubes, along the middle uterine line. These areas are called risk zones for the development of dystrophic disorders.

   Under the influence of any unfavorable factors, hypoxia (lack of oxygen) develops in the smooth muscle fibers of the myometrium. The areas mentioned above are especially affected. Hypoxia leads to a violation of the differentiation of muscle cells, as a result of which they have the ability to divide and grow against the background of normal synthesis and secretion of sex hormones. Such a constant unregulated growth of undifferentiated muscle fibers leads to the formation of fibroids.

2. Under the influence of growth factors and sex steroids, a mutation of normal muscle cells occurs, followed by their neoplastic transformation in the presence of favorable conditions for this. At the same time, the molecular disturbances that contribute to this transformation have not been fully established.
3. Smooth muscle fibers in the embryonic period go through a long stage of development - from 14 to 30 weeks. Since during this time they are still poorly differentiated, they are easily subject to mutations under the influence of external causes (negative environmental influences) or maternal factors (growth factors, tropic hormones, sex steroids, etc.). Mutated tumor cells (progenitor cells) are found in the myometrium and begin to develop under the influence of estrogens after the first menstruation. Their development takes place over many years. This theory is currently the most substantiated.

Pathogenesis

Various concepts of tumor development mechanisms have also been proposed. Thus, the theory of peripheral hemodynamic disorders and water-electrolyte disorders suggests that the development of a tumor is based on a decrease in the sodium-potassium coefficient. The reason is a local decrease in the elasticity of the walls of blood vessels, which leads to their overflow with blood, slowing down the outflow and accumulation of potassium ions.

Another concept of fibroid formation is the effect of estrogens on the mechanisms of programmed cell death (apoptosis) through the BcI-2 protein, which inhibits them. Estradiol suppresses the influence of BcI-2, and in myoma - significantly lesser degree than in normal myometrium.

AT last years multiple interrelated mechanisms have been established. The main ones are:

1. Changes in sex hormones (estrogen and progesterone) that affect mutated smooth muscle cells.
2. Increased sensitivity of tissue receptors that are affected by sex hormones.
3. Change in the processes of formation of new blood vessels in the tumor area.

Their principle is as follows. Progesterone, acting on mutated cells, causes them to grow. The conditions for the implementation of its action are created by estrogens. In addition, they inhibit the regulated processes of programmed cell death, which contributes to the growth of the latter.

The influence of sex hormones is not direct, but through the stimulation of certain protein growth factors, which include:

• epidermal (EGF);
• insulin-like-1 (IPFR-1);
• transforming-beta (TGF-beta);
• heparin-binding epidermal (HSEFR);
• vascular endothelial (VEFR-A);
• fibroblast growth factor (FGF-2).

For the first four factors, a characteristic property is a pronounced stimulation of mitosis (division) of cells, for the rest and angiogenin - modulation of angiogenesis (formation of the vascular network) in the tumor, which is necessary for its development.

The latest results of studying the pathogenesis of the disease made it possible to supplement the treatment of uterine fibroids with medications, with the help of which in many cases it is possible to avoid hysterectomy or prevent relapses after minimally invasive surgical treatment.

Provoking factors

As a result of epidemiological studies, the main risk factors that trigger the mechanisms for the development of leiomyomas have been established:

1. Genetic - the probability of the formation of uterine fibroids is much higher in women whose closest relatives (mother, sister) suffered from the same diseases. Moreover, their tumors appear at a younger age and become larger in comparison with others.
2. Early onset of menses.
3. Absence of children. An increase in the number of full-term pregnancies correspondingly reduces the risk. In women with three children - by 50-90%.
4. Excess body weight against the background of low physical activity. Obesity in childhood and adolescence affects significantly less than that after puberty.
5. The presence of arterial hypertension before the age of 35, accompanied by the use of antihypertensive drugs for 5 years.
6. Prolonged and chronic psycho-emotional stress, frequent and prolonged stressful conditions.
7. Repeated episodes of artificial termination of pregnancy, especially by surgical method, and frequent diagnostic and therapeutic curettage.

The factors listed in paragraphs 2-5 increase the risk of developing fibroids by 2 times or more.

Types of uterine fibroids

It arises and develops in the muscular layer of the uterus. There are 3 stages in its development:

• I - formation of a zone of active growth at the location of small vessels; these zones are characterized by high permeability of the vascular wall and tissues, as well as a high level of metabolic processes, which contributes to the further development of the tumor;
• II - the tumor is distinguishable in the form of a nodule only microscopically; it consists of fibers that do not have obvious signs of difference from neighboring tissues;
• III - it is determined already macroscopically in the form of a formed dense node with clear boundaries, the capsule of which is formed by the surrounding tissue elements; leiomyoma consists of muscle spindle cells, collected in a bundle and oriented in different directions; they already differ from normal smooth muscle fibers of the myometrium by their significantly larger size, high density of nuclei, and the content of individual thin muscle fibers (myofibrils) in the cytoplasm.

Classification

Depending on the number of nodes, multiple and single (only in 16% of cases) fibroids are distinguished.

Types of uterine fibroids depending on localization

According to the nature of growth, they are divided into 5 types:

1. Intermuscular, interstitial, or intramural uterine fibroids. It is completely located in the thickness of the muscular layer of the uterine wall (found in 60% of all cases of the disease).
2. , or submucosal - grows in the direction of the endometrium. If such a node is partially (more than 1/3) located in the myometrium, it is called intermuscular with centripetal growth (towards the uterine cavity).
3. Subserous, or subperitoneal fibroids - located completely or partially under the serous (outer) membrane of the uterine wall, that is, under the peritoneum. It is divided into three types: "0 type", when the tumor is completely located under the serosa; "Type I" - more than half of the tumor under the serous membrane, and the rest of its volume - in the thickness of the myometrium; "Type II" - more than half of the node is located interstitially. The zero type is subdivided into 2 subtypes - "0-A" (knot on a wide base) and "0-B" (knot on a leg).
4. Retroperitoneal tumor - the growth of the node occurs from the cervix or lower parts of the uterine body outward, where the peritoneum is absent.
5. Intraligamentary, or interligamentous - between the sheets of the wide uterine ligament.

The first three species differ significantly in morphological structure and degree of ability to increase. Submucous tumor and interstitial uterine fibroids are true, since the ratio of parenchyma (functioning tissue) to stroma (connective tissue cells, nerves, vessels and extracellular substance) is 1:2, and in subserous nodes - 1:3. Therefore, the latter are called fibromyomas. The degree of activity of metabolic processes in a submucosal tumor is much higher, which means that the rate of its growth is also higher.

Depending on the localization in relation to the uterus, a tumor is corporal, or the body of the uterus (94%), and cervical (16%).

Types of uterine fibroids in accordance with the cellular composition:

1. Simple - grows like a simple benign local growth of healthy muscle cells. Cell division (mitosis) is absent in it.
2. Proliferating is also benign, but the number of muscle cells in it is much larger compared to an equivalent volume of simple leiomyoma. In addition, in the absence of cell atypia in the proliferating formation, their mitotic activity is determined, but it does not exceed 25% of all tumor cells.
3. Presarcoma. This type of fibroids is characterized by the presence of multiple foci of growth in the node, in which the number of mitoses is up to 75%. Cells have signs of atypia, their nuclei are heterogeneous. In some areas of the node there are cells with multiple and large nuclei with intense color.

Clinical symptoms of uterine fibroids and contraindications for it

In half of women with fibroids, the disease develops without any manifestations and is detected by chance during examination by a gynecologist or ultrasound of the pelvic organs. The clinical signs are quite varied. The main ones are:

1. Pain of varying nature and intensity in the lower abdomen. They can be aching or pulling (in 25-30%), which is associated with pressure on the nerve plexuses and / and stretching of the serous membrane (peritoneum). With a rapid increase in the tumor, the pain becomes more pronounced and constant. Torsion of a subserous formation on a stalk or an acute disturbance of blood flow in the myoma nodes with the development of their necrosis (necrosis) causes acute paroxysmal pain, which may be accompanied by weakness, vomiting, and fever. Cramping pain during menstruation usually occurs with a submucosal location of the node.
2. Acyclic bleeding, more characteristic of intramural or subserous localization, as well as prolonged and heavy menstruation, usually occurring in the presence of a submucosal node. Blood loss leads to the development of anemia, headaches, fatigue and weakness, to degenerative changes in the myocardium.
3. Dysfunction of the pelvic organs, which are manifested by frequent urge to urinate and constipation. These symptoms occur with subserous pedunculated, cervical or interligamentous nodes, as well as with a large volume of the tumor.
4. The presence of a dense formation above the bosom.
5. Miscarriage, infertility - occur in 30% of women with multiple fibroids.

Principles of treatment

Despite the high prevalence of the disease, a clear algorithm for managing such patients has not been developed. There are many different opinions and contradictions in treatment tactics, which boil down to 3 main areas:

1. Expectant tactics.
2. Conservative treatment of uterine fibroids.
3. Active patient management.

Expectant tactics

It can be applied to a small number of patients. These include women who have no manifestations of the disease, the size of the tumors correspond to terms of less than 10-12 weeks of pregnancy, the reproductive function has already been realized and pregnancy is no longer planned in the future. In addition, such patients should be able to be under constant dynamic monitoring using ultrasound, cytological control of the endometrium and cervical mucosa, as well as monitoring the blood levels of tumor markers.

Contraindications for uterine myoma:

1. Prolonged exposure to the sun and a visit to the solarium.
2. Lifting weights over 3 kg, heavy physical exertion, especially on the abdominals.
3. Any kind of physiotherapy procedures on the pelvic area.
4. Wraps, massage of the abdomen.
5. Thermal baths, baths and saunas.
6. The use of cosmetic hardware techniques on the abdomen.
7. Load training on simulators.
8. Abortion and self-selection of oral contraceptives.

Conservative treatment of uterine fibroids

Taking hormonal drugs

A conservative tactic is to prescribe hormonal drugs, among which the most effective are analogues of gonadoliberin, or gonadotropin-releasing hormone (hypothalamic hormone). They are able to temporarily bind the corresponding receptors in the pituitary gland and eventually suppress its gonadotropic function. As a result, the synthesis of estrogens and progesterone decreases, the volume of the tumor decreases to 55%, bleeding and pain stop. However, these drugs, even with a short course of treatment (3-4 months), have side effects in the form of pronounced vascular reactions, a feeling of flushing, nausea, and a decrease in bone mineral density.

The relatively new drug Mifepristone is a synthetic steroid with a fundamentally different effect. It binds to receptors that progesterone acts on, blocking their function. For this reason, there is no decrease in the production of progesterone itself, and the side effects characteristic of previous drugs are much less pronounced with approximately equal efficiency.

Mifepristone is used at 50 mg daily for 2-3 months in order to prepare for surgery: it allows you to stop bleeding, relieve a woman from pain, normalize blood hemoglobin, halve the volume of nodes, which facilitates their removal with minimal blood loss. As an independent treatment, the drug is rarely used and for a longer course.

Clinical trials are currently underway on 2 drugs that block the action of growth factors. One of them, pirfenidone, causes fibrosis of the node; the action of the second, Interferon-alpha, is based on the suppression of vascular growth in the tumor.

FUS - MRI ablation

Another conservative method is a non-invasive method of focused ultrasound ablation of the myomatous node under the control of magnetic resonance imaging (FUS - MRI ablation). It is based on the passage of ultrasonic waves through biological tissues without damaging them. Focused on the tumor, they cause heating of its individual zones up to 55-90 o. Already at 60 o for 1 second, cells are destroyed due to the evaporation of water from them, damage to the vascular network, local destruction of the structure of proteins and collagen fibers.

However, this technique is still not perfect enough and is mainly used for the localization of fibroids in the bottom of the uterus and along its anterior wall. The procedure is contraindicated if the size of the nodes is less than 2 cm and more than 9 cm, with subserous pedunculated fibroids, infertility, unrealized reproductive function, etc.

Active tactics

It distinguishes two directions:

• minimally invasive manipulations;
• surgery.

EMA

Of the minimally invasive manipulations, bilateral selective arterial embolization is mainly used for uterine myoma. Its effectiveness is 98.5%, in contrast to surgical myomectomy, after which relapses are possible (up to 40%). The meaning of the procedure is to conduct (under local anesthesia) a special microcatheter into the uterine artery through the femoral and internal iliac arteries. After that, polyvinyl alcohol is introduced in the form of very small particles. It leads to occlusion (blockade) of the vessels that feed the myomatous nodes, the cessation of blood flow and their further wrinkling.

After the procedure, severe pain in the lower abdomen appears, lasting several hours. Sometimes embolization of vessels (rarely) can be complicated by the development of heart attacks in the uterus or abscesses, which will require removal of the organ. In addition, embolization is ineffective in subserous nodes, the long-term results of its use are still unknown, and the effect on the possibility of subsequent pregnancy has not been fully studied. In 5% of cases, there is an onset in women of childbearing age.

Surgery

Currently, on average, in 80% of women, surgery for uterine fibroids remains the main method of treatment. Surgical treatment can be of two types:

• conservative - removal of only single or multiple nodes (myomectomy);
• radical - subtotal hysterectomy (supravaginal amputation with preservation of the cervix and appendages) or total hysterectomy (extirpation), that is, removal of the uterus with the cervix.

Conservative removal of uterine fibroids by the laparoscopic method is preferable and is carried out with the size of the nodes less than 7-8 cm. However, the current availability of morcellators allows the removal of tumors up to 17 cm in size by the laparoscopic method. The morcellator is an electromechanical device that grinds the myomatous node in the abdominal cavity.

Absolute indications for surgery are:

1. The size of the tumor is more than 14 weeks of pregnancy or more than 10 cm (according to ultrasound).
2. Rapid growth in reproductive age or any growth in the postmenopausal period.
3. Submucosal location, accompanied by anemia as a result of prolonged and profuse menstruation.
4. cervical localization.
5. Subserous tumor on the leg.
6. Negative effect on the function of the pelvic organs (bladder, intestines).
7. The combination of fibroids with diseases of other genital organs requiring surgical treatment.
8. Nodule necrosis, usually accompanied by pelvic pain syndrome.
9. Infertility, if fibroids are the cause.

The choice of the volume of surgical intervention depends on concomitant diseases, the age of the woman and the planning of pregnancy in the future. The priority in the treatment of fibroids is the use of minimally invasive or conservative surgical organ-preserving methods.

Uterine fibroids are benign neoplasms that occur in women of childbearing age (most often between 30 and 45 years of age). At the same time, the muscle fibers of the uterus randomly increase, and a knot is formed, braided with densely altered vessels. The peculiarity of the tumor is that it is hormone-dependent - its development and growth depends on the level of sex hormones in the female body.

Uterine fibroids is one of the most common gynecological pathology, it occurs in about 25% of women of reproductive age, 3% of them are detected during a routine examination. This tumor occurs in elderly and young nulliparous women, after childbirth, gynecological operations, and even during pregnancy and menopause.

Causes of uterine fibroids

The following reasons lead to uterine fibroids:

• Hormonal disorders - a sharp decrease or increase in the level of progesterone or estrogens, which are clinically manifested by various menstrual disorders.
• Irregular sexual life, especially after 25 years. As a result of sexual dissatisfaction, the blood flow in the small pelvis changes, and stagnation prevails.
• Inflammatory processes of the genital organs of a chronic nature.
• Mechanical factors: traumatic childbirth, induced abortion, the consequences of gynecological operations, diagnostic curettage.
• Genetic predisposition - the risk of this pathology increases in women whose grandmothers and mothers had uterine myoma.
• late birth.
• Sedentary lifestyle.
• Concomitant pathology - endocrine diseases (obesity, pathological processes of the thyroid gland, metabolic disorders, diabetes mellitus), arterial hypertension.

There are such variants of the course of uterine fibroids:

• by localization - submucosal, intermuscular, subperitoneal and intermediate options;
• by location - the body, fundus, cervix and isthmus of the uterus;
• by size - nodes are large, medium and small;
• by the nature of growth - true and false;
• according to morphological and histochemical features (proliferating and simple).

Symptoms of uterine fibroids

In the early stages, uterine fibroids are most often asymptomatic. Further, the disease is manifested by such symptoms:

1. Menoria is an increase in menstrual flow. Heavy bleeding is dangerous because after some time anemia may occur as a result of this. More abundant bleeding indicates that the muscles of the uterus are contracting worse, in this case, medical assistance is required. In addition, a woman may experience metrorrhagia - acyclic uterine bleeding. In this case, it is not the tumor that bleeds, but the mucous membrane of the uterus, irritated by the tumor.
2. Pain syndrome can be of a different nature. As a rule, pain is localized in the lower back or lower abdomen. Pain can also be sudden if blood circulation is disturbed in the myomatous node. A fibroid of a large size, but slowly increasing, is manifested by pulling pain during menstrual bleeding. The cramping nature of the pain indicates that the growth of the tumor occurs in the uterine mucosa. Pain with uterine fibroids in the early stages of the disease rarely occurs, in most cases, pain indicates that a certain time has passed from the onset of the disease.
3. Violation of the work of nearby organs, primarily the rectum and bladder. They may feel tight if the tumor grows in their direction. Therefore, chronic constipation and urination disorders may occur. If such signs occur, it is necessary to contact not only a gastroenterologist and a urologist, but also a gynecologist so that he can exclude uterine fibroids.
4. As a result of heavy bleeding, anemia can occur - a decrease in red blood cells and hemoglobin in the blood. Anemia is accompanied by dizziness, headache, weakness and pallor of the skin.
5. Pain in the heart area - if the tumor increases, myocardial tone decreases. In severe cases, venous pressure may increase. In this case, it is necessary to visit a cardiologist.
6. Infertility - in the case of a submucosal location of the fibroids, a violation of the patency of the fallopian tube occurs and this prevents the passage of spermatozoa.

Every third woman with multiple fibroids has complications during childbirth. There is evidence that fibroids with the onset of menopause may decrease, as a result of which its symptoms disappear.

Depending on the localization of the myomatous node, its size, certain symptoms of the disease predominate.

Uterine fibroids with the location of the node under the mucous membrane (submucosal location) is manifested by various menstrual irregularities, heavy and prolonged menstruation, uterine bleeding, which often results in anemia. The pain syndrome for such fibroids is not typical, but if the myomatous node from the submucosal layer falls into the uterine cavity, cramping, very intense pain occurs. Very often, submucosal fibroids can cause miscarriage or infertility.

Subserous location of fibroids for a long time can be asymptomatic. But with an increase in the node, discomfort occurs in the lower abdomen and constant, unexpressed, pulling pains. In the event that the nutrition of a large subserous node is disturbed, an “acute abdomen” clinic may occur and it can be erroneously assumed that there are diseases of the abdominal organs, such patients are erroneously hospitalized in a surgical hospital. With such nodes, bleeding does not occur.

Interstitial-subserous (mixed) myomatous nodes are very difficult to diagnose, for a long time they may not be recognized. Reaching large sizes (10-30 cm in diameter), they can manifest themselves in the initial stages as unexpressed discomfort in the lower abdomen. The pressure increases with the increase in the size of the fibroids and signs of damage to neighboring organs come to the fore. Due to constant pressure on the rectum, defecation processes are disrupted. Compression of the ureter and bladder not only leads to impaired urination, but also to damage to the kidney (pyelonephritis, hydronephrosis) and ureter (hydroureter) on the side of the lesion, to manifestations of the syndrome of compression of the inferior vena cava (when lying down, abdominal pain and shortness of breath occur).

Thus, uterine fibroids have characteristic features:

• is the most common tumor in women of premenopausal (46-55 years) and late childbearing age (35-45 years);
• can grow, regress and even completely disappear during menopause (both artificial and natural);
• able to maintain its size for a long time or increase in size very quickly or slowly (“growth spurt”);
• variety of clinical options (symptomatic and asymptomatic).

How does pregnancy proceed with uterine fibroids?

In most cases, with small myoma nodes in the early stages of pregnancy, problems do not arise. Difficulties are possible if the formation of the placenta occurs close to the fibroids. The tumor produces substances that contribute to the contraction of the uterine muscle fibers, and the pregnancy is terminated.

In the second and third trimesters, there is a risk of preterm birth. This is due to the fact that for the growing fetus due to myomatous nodes in the uterus there is less and less space, and this affects the development and growth of the fetus. Often, as a result of squeezing a large tumor in the fetus, deformity of the bones of the skull or torticollis may develop. In addition, uterine fibroids affect the placental circulation, causing the fetus to suffer from a lack of nutrients and oxygen.

In the event that uterine fibroids and pregnancy have been successfully combined for all nine months, childbirth can be complicated as a result of improper presentation of the fetus. That is why in this case a caesarean section is indicated, in which the tumor can also be removed.

Treatment

With a small size of fibroids, its location in the thickness of the muscles of the uterus or subserous, the absence of its rapid growth, conservative treatment is indicated. The following groups of drugs are prescribed:

• androgen derivatives - interfere with the synthesis of ovarian hormones, preventing tumor growth in the future (gestrinone);
• agonists of gonadotropic hormones - reduce the size of fibroids and its symptoms (zoladex, buserelin); with their prolonged use, menopause may develop;
• gestanes - able to stop the growth of the endometrium without affecting the fibroid itself (norkolut, utrozhestan); their reception is indicated for hyperplasia in the inner uterine layer and small fibroids.

Surgical treatment is indicated for large uterine fibroids (more than 12 weeks), heavy bleeding, severe pain, a tendency to rapid tumor growth, infertility and miscarriage.

In modern gynecology, the following types of surgical treatment are used:

• Laparoscopic myomectomy - it is performed through a small incision in the anterior abdominal wall using a laparoscope.
• Embolization of the uterine arteries - an embolus introduced into the vessels blocks the lumen of the arteries that feed the node. This method of treatment is indicated for those women who are planning to conceive a child.
• Hysteroscopic myomectomy - performed with submucosal localization of the tumor, while removing the internal nodes.
• FUS ablation is one of the newer methods that uses focused ultrasound waves. Using this method, you can reduce the size of myomatous nodes. FUS ablation is not recommended for multiple neoplasms.
• Hystrectomy - the uterus is completely removed. It is carried out with tumors in the ovaries, large fibroids, the unwillingness of a woman to have children in the future.

The gynecologist chooses the method of treatment, taking into account the age of the woman, the location and size of the fibroids, the rate of its growth, the woman's desire to have children in the future.

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Article last updated 07.12.2019

Myoma is a benign neoplasm that is located directly in the uterus itself or on the neck of the organ. Despite the prevalence of this disease, scientists have not yet established the exact causes of uterine fibroids.

The size of the neoplasm can vary, the fibroids can be either single (one myomatous node) or multiple (several pathological foci of various sizes).

Most often it appears in women after 35-45 years. However, cases of the onset of the disease in young patients are not uncommon. The tumor can develop both in women of childbearing age and in those who are in the menopause. Therefore, the question is quite relevant: "What causes uterine fibroids?".

The causes of uterine fibroids in young women are often associated with increased hormone production.

Sometimes, myomatous formations resolve on their own in menopausal and premenopausal periods.

This is due to a decrease in the production of estrogen by the female reproductive organs. Myoma tumors are formed in almost 70% of all women. Where does innovation come from?

Among the main factors and causes of the formation of uterine fibroids, the following should be highlighted:

• genetic predisposition;
• Imbalance in the level of sex hormones;
• Gynecological pathologies;
• Pathological introduction of the endometrium into the muscular layer of the uterus - adenomyosis;
• The use of COCs (combined oral contraceptives);
• Installation of intrauterine devices;
• History of abortions and miscarriages;

• Irregularity of sexual life;
• Diabetes;
• Pathological processes that indirectly affect the functionality of the thyroid gland, ovaries, adrenal glands;
• chronic diseases;
• Physical inactivity.

Details about the causes of the formation of pathology

To understand why fibroids appear in a given situation, it is necessary to consider in more detail the provoking etiological factors.

Hormonal disorders

The main cause of uterine fibroids is insufficient production of progesterone and excess estrogen. Due to the fact that myoma is a hormone-dependent neoplasm, it cannot be found in girls before puberty. Most often, this pathology affects women of reproductive age and menopause. Neoplasms can appear with improper hormonal contraception.

A special role in the formation and growth of the myomatous node is played by an excessive level of estrogen produced by the body and a reduced level of progesterone. In addition, the body of a woman produces estrogen-like substances - xenoestrogens, the effect of which is similar to the effect of the estrogens themselves. That is, they increase the hormonal effect on the uterus. It is believed that the risk of developing a tumor in nulliparous women is much higher.

Mechanical factors

An important cause of fibroids is the presence of a woman's pregnancies that ended in childbirth.

The risk of developing uterine fibroids in a woman with a full-term pregnancy in history is reduced several times.

Those women who have had medical and spontaneous abortions are at risk for the development of benign formations.

Patients with a history of trauma-complicated delivery, postpartum diagnostic curettage, and other interventions on the pelvic organs are also at risk. The main reason why uterine fibroids arise is interference in its cavity.

genetic predisposition

Heredity also has an important influence on the possibility of developing fibroids in women.

If someone had a similar disease on the maternal side, then the risk of developing this pathology increases by 30%.

In the case of aggravated heredity, a woman must undergo a mandatory examination by a gynecologist every six months, as well as control her hormonal level. These measures will help diagnose the disease at the earliest stages of its development and take the necessary measures to eliminate it.

Quality of intimate life

The development of neoplasms is influenced by the degree of satisfaction of a woman from sexual intercourse. If she does not experience an orgasm for a long time, which ensures the outflow of blood from the pelvic organs after its active inflow, the appearance and progression of hormonal imbalance is possible.

If a girl does not have sexual contacts before the age of 25, then the likelihood of developing fibroids increases.

Why fibroids occur in virgins has not yet been clarified.

In addition, women who lead a promiscuous lifestyle and have a large number of sexual partners are extremely susceptible to the appearance of neoplasms.

Often this is due to the fact that such ladies repeatedly encounter infectious diseases that are purely sexually transmitted.

Such diseases are inflammatory in nature and often lead not only to hormonal imbalance, but also to the formation of adhesions, scars, strictures in the pelvic organs, and also contribute to the development of favorable conditions for the growth of various tumors.

Proper nutrition

An unbalanced diet is also a risk factor for the development of fibroids. The most susceptible to this disease are not only those women who are overweight, but also those who neglect plant foods rich in fiber and abuse fried, fatty, refined foods.

Excess fat mass affects the increase in the amount of estrogens by synthesizing them from androgens, thereby disrupting the normal functionality of the endometrium. One of the main causes of uterine fibroids is obesity. It is worth remembering that extra pounds increase the likelihood of developing fibroids in women of reproductive age by 20%.

Diabetes

Chorionic pathologies are common causes of fibroids. Any metabolic disorder leads to an imbalance of hormones in the body, including sex hormones. Diabetes is no exception.

With a long-term process, the risk of endometrial dysfunction with the subsequent development of fibroids increases. This is especially true for women with a aggravated course of the disease or its advanced form.

Arterial hypertension

Hypertension at a young age is a very common provoking factor in the development of uterine formations. Often, hypertensive patients are overweight, which further exacerbates the situation. Hypotension is also sometimes the cause of pathology. Fibroids can occur after severe stress.

Manifestation of uterine fibroids

Myoma is a tumor that forms in the smooth muscle tissue of the uterus. mainly manifests itself at later stages of the development of the pathological process. This pathology at an early stage is asymptomatic and in many cases is detected by chance during a preventive examination by a gynecologist.

Manifestations of fibroids directly depends on the location in the uterus of a benign tumor. To understand where fibroids come from, you can consider its main varieties.

Doctors distinguish three main types of fibroids based on their location: interstitial, subserous, and submucosal.

Interstitial or intermuscular fibroids - can form in the thickness of the uterine wall, and progress for a long time without clinical symptoms. Women rarely pay attention to irregularly occurring symptoms.

Subserous neoplasms - when a fibroid is formed directly under the peritoneum and grows outward, sometimes it has a so-called leg, which connects the myomatous node itself with the organ.

Symptoms of the disease appear only when the trophism of the node is disturbed due to compression or torsion of the tumor stem. The main signs of subserous fibroids are acute pain in the lower abdomen and fever. Pain syndrome of a pulling nature in the lower abdomen with irradiation to the lateral regions of the abdomen and back is observed when the tumor compresses adjacent organs (intestines, bladder).

Submucosal tumors - grow through the mucosa of the organ and, as it were, protrude into the uterine cavity, deforming it. This form of the disease has the most pronounced clinical symptoms:

• heavy menstrual bleeding longer than usual;
• bleeding between normal periods;
• progressive weakness, malaise, increased fatigue;
• anemia due to heavy bleeding.

Diagnosis of the disease

First of all, the necessary tests are taken from the woman. The basis of diagnostic research methods are:

• Gynecological examination - enlarged uterus is found;
• Ultrasound examination of the pelvic organs. With the help of ultrasound, it is possible to assess the structure and size of the uterus, the number, location and size of the nodes;

• Hysteroscopy - helps to diagnose fibroids of the submucosal location. A biopsy of the uterus allows you to get more accurate data, using this research method, you can take a biopsy of the tissues of the node and evaluate the cytological and histological composition;
• Diagnostic laparoscopy - allows not only to make a diagnosis with accuracy, but also to assess the degree of damage and neglect of the disease, as well as to remove myomatous nodes at the same time, if necessary.

Therapeutic treatment of fibroids

The treatment strategy for myoma is determined by many factors: the size of the tumor, the number and location of the nodes, resistance to conservative therapy, the growth rate of the node and the possibility of its malignancy. Treatment of the disease can be therapeutic and surgical. To learn everything about uterine fibroids, a thorough diagnosis is carried out.

Conservative treatment is aimed at reducing the growth rate of the neoplasm, as well as correcting the hormonal balance, normalizing all metabolic processes, and eliminating the clinical symptoms of the disease.

The basis of conservative treatment is the use of specialized groups of drugs: hormonal drugs; immunomodulatory agents; homeopathic medicines.

Of no small importance is the physiotherapeutic effect (electrophoresis, magnetotherapy, therapeutic baths), herbal medicine and the treatment of concomitant pathologies, if any. But it is worth remembering that you cannot treat this pathology on your own, otherwise you can aggravate the disease. If the fibroid appeared during pregnancy, then the woman in labor is given a caesarean section.

Surgical treatment of uterine fibroids

Surgical intervention is performed if a large tumor is found and there is no positive dynamics from the ongoing conservative therapy. Doctors try to perform organ-sparing myomectomy, especially for women of childbearing age who are planning a pregnancy in the future. But in severe cases, radical methods are used - amputation of the uterus with or without appendages.

Medicine does not stand still and now there are many methods of surgical treatment of fibroids. But there are four main ways of surgical intervention:

• Laparoscopy - the operation is performed through small openings in the abdomen;
• Hysteroscopy - removal of the tumor with a special instrument through the vagina;
• Abdominal surgery is an outdated method, but in some cases it is very effective;
• Hysterectomy - amputation of the uterus, performed with the rapid growth of a benign tumor.

A benign tumor can appear at any age. Only a qualified doctor can make a correct diagnosis and prescribe the most appropriate treatment in each specific case.

Despite the fact that fibroids are considered benign neoplasms, there is a 1% chance of their transformation into a malignant tumor (cancer).

Therefore, every woman should visit a gynecologist at least once a year for preventive purposes. The sooner the disease is detected, the easier it is to deal with it.