Uterine fibroids: what is it and is it life-threatening? Symptoms and treatment of uterine fibroids Signs of uterine fibroids.

Uterine fibroids are a formation consisting of muscle and connective tissue. Under certain conditions, it can be cured with conservative methods: medications, ultrasound exposure, arterial embolization. An important condition for therapy without surgery is the small size of the tumor. The complexity of this pathology is that it is rarely diagnosed in the initial stages due to the absence of severe symptoms.

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Description and classification

Fibromyoma is a formation that is localized primarily inside the body of the uterus (in 95% of cases, less often in the cervix) and is formed from the connective and muscle tissue.The size of the tumor is expressed in two main quantities:

in centimeters (directly the size of the node);
in weeks.

For example, the term “fibroids 10 weeks” suggests that, due to the tumor, the uterus is enlarged in the same way as at the 10th week of pregnancy.

Fibroids are classified by location:

There are pedunculated tumors with the same location as the above forms. Sometimes a diffuse type of pathology is formed, in which the node is absent, but the myometrium grows over its entire area. All types of fibroids can be formed by two types of tissue:

muscular;
connecting.

The basic composition of the tumor determines whether it belongs to a specific type:

Sometimes the type of fibroid is omitted from the name, implying its varieties.

Features during pregnancy

Fibroids can reduce the likelihood of successful fertilization due to ovulation disorders or displacement of the genital organs, which leads to difficulty in passing the egg and sperm through the fallopian tubes.

Fibroids less than 12 weeks old generally do not affect fertility. Large formations deform the uterine area and reduce a woman’s ability to bear children.

Serious complications can occur in the first trimester if the tumor comes into contact with the placenta. This condition increases the risk of miscarriage. Some types of fibroids may increase the likelihood of preterm birth in the second and third trimester. This is due to the fact that as the child grows, the space for the tumor decreases and the contractile activity of the uterus increases.

In some cases, if a node is present, children are born with cranial deformation or torticollis. Myoma often leads to the birth of a low-weight baby. Half of pregnant women with fibroids experience prolonged labor, which entails the need for a cesarean section. Often the nodes are combined with presentation or abnormal position of the fetus, which also requires surgery. The risk of placental abruption increases. During the postpartum period, fibroids increase the likelihood of bleeding and placenta accreta. Incomplete contraction of the uterus and infectious diseases occur.

The process of bearing a child, in turn, also affects the tumor. During this period, the amount of hormones increases, the muscular lining of the uterus stretches, and blood flow increases. These factors can trigger the growth of fibroids depending on its location. Another phenomenon is noted - destruction of the tumor. This process is accompanied by necrosis, cysts, swelling, bleeding and can develop at any time, even after childbirth.

Reasons for development

The causes of fibromatous nodules are unknown. There are 2 main theories, but neither of them has strong evidence:

Embryonic. Based on the hypothesis of intrauterine disorders. The cells of the uterus of the embryo are formed until the 38th week of pregnancy, and before that they are in an unstable state, due to which the risk of various defects increases.
Traumatic. According to it, defects in cells arise due to repeated menstrual cycles, inflammatory processes, curettage, abortion, violations of childbirth (manual techniques), and a small number of pregnancies.

Previously, all types of fibroids were considered as hormone-dependent benign tumors. It was believed that the main reason for their development is an imbalance of female sex hormones - estrogen and progesterone. This point of view has now been partially revised, but hormonal imbalance is still considered one of significant factors development of the disease.

Since the causes of tumor formation are not fully known, effective methods there is no prevention. There are several factors contributing to the development of pathology:

heredity;
hormonal disorders;
endometriosis, adenomyosis;
irregular sex life or lack of orgasms (lead to stagnation in the pelvis);
diseases of the endocrine system (diabetes, arterial hypertension, especially at a young age);
chronic pathologies of the pelvic organs;
damage to the uterus due to the use of intrauterine contraceptives or termination of pregnancies;
passive lifestyle;
nutritional disorders and obesity (predominance of trans fats and refined foods, low amount of fiber).

Miscarriages and abortions increase the risk of developing a tumor. Pregnancies that end in childbirth, especially those followed by lactation for a long time, are reduced.

Additional reasons include:

taking oral contraceptives;
adhesive disease in the pelvis due to injury, surgery or inflammatory diseases;
high doses of ultraviolet radiation;
apple-shaped figure.

Symptoms and stages

Symptoms depend on the patient’s age, the size and location of the tumor, growth rate, and the presence of other chronic diseases. Sometimes fibroids are almost asymptomatic and are detected only during a routine examination.

The first signs are usually observed with the formation of a node measuring 2-6 cm:

the appearance of pain similar to menstrual pain in the lower abdomen (not associated with menstrual periods);
increased bleeding during menstruation;
the appearance of discharge mixed with blood in the middle of the cycle, its lengthening or shortening;
painful menstruation that was not there before.

The most characteristic symptoms:

Pain between periods. They can vary in duration, occur in the lower abdomen or radiate to the lower back, legs or upper sections. As the tumor grows, discomfort and nagging pain are felt, which intensifies after exercise.
Problems in the reproductive sphere. Infertility often develops against the background of a tumor. If conception occurs, but the embryo attaches close to the fibroids, this can cause spontaneous abortion.

When the pedicle of the fibromyomatous node is torsed, necrosis of the body of the formation develops. The following clinical picture is observed:

sharp pain in the lower abdomen;
tachycardia;
fainting state.

The patient requires emergency surgical care.

When nearby organs are compressed, constipation and pain during bowel movements occur. Bladder. Other symptoms may result from pathologies of indirectly affected organs and include:

dizziness;
pain in the chest area;
headache;
numbness;
neuroses and neurosis-like conditions.

The formation of pathology occurs in several stages:

1. At the first stage from a single cell, others begin to form through division.
2. At the second stage the vascular network feeding the formation grows. The growth of the tumor accelerates, and its structure stabilizes.
3. Third stage occurs subject to therapy. Fibromyoma involution occurs (its reverse development).

Diagnostics

It is not always possible to distinguish between fibroids and myomas, especially in cases where the latter has clearly defined connective tissue. For this purpose, a biopsy or histology of the removed tumor is performed.

Myoma on ultrasound

Types of diagnostics are described in the table:

Type of study	Description
Ultrasound of the pelvic organs	Often the examination is carried out using a transvaginal probe. It makes it possible to clearly see the nodes, their location and size
Hydrosonography	Allows you to identify a submucosal node in 100% of cases, accurately determine its location, and check whether there are other endometrial pathologies
Biopsy	The material is collected using a tool designed for this purpose in the form of forceps, which is placed into the uterus through the cervical canal. Unambiguously determines the origin of the tumor
Hysteroscopy	The uterine cavity is examined from the inside using a video camera; endometrial curettage may be performed.
Hysterosalpingography	A radiopaque liquid is injected into the fallopian tubes, which makes it possible to see the internal contours
Doppler ultrasound	Often performed before vascular embolization to assess the intensity of blood flow in the tumor and nodes. This method is also used to test the effectiveness of surgical intervention

Treatment

You can get rid of fibroids without surgery by changing your lifestyle and diet. This is necessary in order to restore the balance of hormones in the body and improve the functioning of immune system. At the same time, herbal medicines are taken.

Basic treatments include:

therapy of sexually transmitted diseases;
restoration of the microflora of the vagina and genitals;
correction of emotional state;
normalization of the menstrual cycle;
following a diet to lose weight and improve metabolism.

Drug therapy

Applies if the following requirements are met:

the size of the uterus with a tumor corresponds to 12 weeks of pregnancy or less;
there is no rapid growth of the node;
no obvious symptoms;
the woman is premenopausal.

The following medications are used for treatment:

Group of medicines	Effect	Titles
Combined oral contraceptives (COCs)	Reduce the diameter of the node to 15 mm, reduce the manifestation of symptoms	Norgestrel with ethinyl estradiol (Rigevidon, Ovidon), desogestrel with ethinyl estradiol (Novinet, Marvelon)
Gonadotropin-releasing hormone antagonists	They reduce the node by 50%, but have an increased risk of recurrence. Do not use for a long time due to the possible development of estrogen deficiency. The maximum duration of therapy is six months. Used for surgical treatment to reduce possible blood loss	Diferelin, Decapeptyl, Buserelin, Leuprorelin and others
Antigonadotropins	Rarely used because they have a large number of side effects. Reduce symptoms of fibroids	Danazol, Gestrinone
Gestagens	Opinions regarding the effectiveness of this group of funds are divided. There is no clinical evidence of the effectiveness of their use in fibromatosis. However, they help when fibroids are combined with endometrial hypoplasia, since in this case the cause may be an imbalance of hormones	Linestrenol, norethisterone, medroxyprogesterone acetate

Surgery and non-invasive procedures

Indications for surgery are:

node necrosis;
rapid growth rate of education;
extensive uterine bleeding;
fibroid size more than 12 weeks;
multiple or submucosal nodes;
twisting of the leg;
submucosal location.

The method of surgery is selected depending on the location, type of tumor and individual characteristics patients. The main types are described in the table:

Uterine artery embolization

During this procedure, a probe is inserted into the uterine cavity to help identify the largest vessel feeding the tumor. Special drugs are injected into it, causing an embolism (blockage). Under their influence, the nutrition of the tumor stops and it resolves.

The procedure is relatively new; all possible consequences and risks of resuming the process have not been studied. The ability to preserve fertility varies from person to person.

Fuse ablation

One of the most progressive techniques today. Focused ultrasound beams are used to coagulate nodes in the uterus. Magnetic resonance imaging is used to monitor the procedure in real time.

This is a much safer and less traumatic method than radical surgery, but it has some limitations, so the choice of treatment method is made by a doctor.

The fuse ablation method has the following advantages:

Accompanied by minimal side effects.
Helps prevent recurrence of the disease.
Has high efficiency.
Allows you to fully preserve the functions of the organ.
It is not accompanied by blood loss, is performed in the conscious mind of the patient, and does not require the use of serious painkillers.

Magnetotherapy

The area of the body is exposed to low-frequency magnetic pulses, which leads to normalization of the amount of hormones. The procedure lasts 10-25 minutes.

Main advantages:

immunity improves;
swelling is eliminated;
pain and soreness during menstruation are reduced;
the menstrual cycle is normalized.

Iodine-bromine and radon baths

Radon restores biological processes, reduces hormone production and enhances the immune response.

Iodine-bromine baths regulate the metabolism of carbohydrates and lipids, stabilize hormone levels. The procedure is carried out only under the supervision of the attending physician and in the absence of contraindications.

Traditional methods

Folk remedies are used by women who are afraid of taking hormonal medicines or surgery. They help reduce symptoms but do not cure the tumor.

The most effective recipes:

Nettle decoction. 2 tbsp. l. dry plant, pour 0.5 liters of boiling water and boil for 10 minutes. Use for douching once a day for a month.
Infusion of oak bark. Helps eliminate uterine bleeding. 1.5 tbsp. l. The product is brewed with 300 ml of water. Used for douching or as impregnation of tampons.
Camomile tea. Take 1 tbsp. l. herbs in a glass of boiling water, infuse in a thermos for an hour. Used for douching. This remedy helps relieve inflammation and neutralize infectious agents.

Traditional methods should be in addition to the main treatment and used only with the knowledge of the attending physician.

Features of therapy for menopause

Uterine neoplasms are a contraindication for the use of hormone replacement therapy that contains estrogens. Women who are diagnosed with fibroids during menopause are prescribed to visit a gynecologist twice a year to monitor the rate of its development.

Medicines are prescribed to relieve symptoms, vitamin and mineral complexes, sedatives, and herbal remedies.

The diet for fibroids corresponds to that for menopause: it is necessary to avoid heavy foods, increase the amount of vegetables, fruits and dairy products, and avoid caffeine-containing and alcoholic beverages.

Prognosis and possible complications

The prognosis of the disease is favorable if fibroids are detected in the early stages and treated successfully. The main danger of a tumor is the likelihood of complications. With constant monitoring by a gynecologist, their risk can be significantly reduced.

Pathology can provoke the following conditions:

Complication	Description
Massive uterine bleeding	Are dangerous in themselves, pose a threat to life and cause anemia
Torsion of the leg of the knot	Causes the development of the clinic " acute abdomen"requires urgent surgical care
Necrosis	Tissue necrosis appears when the uterus shrinks in the postpartum period (up to the 40th day). Requires urgent surgery
Fertility disorders	Ectopic embryo insertion, childbirth ahead of schedule, miscarriage, complications during labor
Development of inflammatory processes in surrounding tissues with the formation of pus	Without medical intervention can lead to serious complications
Malignancy of tumor cells	Degeneration into a malignant formation occurs in 1.3% of cases. It is one of the most serious complications. Ultrasonic monitoring of changes in the size of the formation is carried out. The rapid growth of fibroids is a sign of its transition to uterine cancer

Tumor diseases in the gynecological field are a widespread problem, regardless of their clinical and morphological nature. Among benign tumors of the female reproductive system, uterine fibroids are highly prevalent, affecting, according to some estimates, up to 70% of the female population of the planet.

What is uterine fibroid

Uterine fibroids are a benign hormone-dependent tumor formation formed from muscle and connective tissue fibers. The development of this hormone-dependent tumor begins in the reproductive period - 35-55 years and can involute during menopause. In 95% of patients, fibroids are located in the body of the uterus, and only 5% have a cervical localization of the formation. Its main difference from fibroids is its morphological structure: fibroids consist of altered muscle cells, and fibroids also include connective tissue.

Causes of uterine fibroids

The cause of the development of fibroids is the influence of predisposing factors:

reproductive failure – absence of pregnancy, childbirth and lactation in women over 30 years of age;
abortions;
stress;
frequent tanning or prolonged ultraviolet exposure;
inflammatory diseases reproductive organs;
cystic process in the ovaries;
long-term use of hormonal contraceptives;
diabetes and obesity;
hereditary predisposition.

Symptoms and signs

Uterine fibroids have an asymptomatic or low-symptomatic course. Symptoms that may indicate its presence:

painful menstruation;
bloody issues from the genital tract outside of menstruation;
heaviness, abdominal cramps;
pain during sexual intercourse;
frequent urge to urinate;
pain radiating to the lumbar or dorsal region;
frequent bloating, flatulence;
increase in abdominal size;
problems with conception for no apparent reason.

Types of uterine fibroids

Depending on the approach, there are several classifications of fibroids. From the point of view of its localization and type of growth, they distinguish:

submucous form - formed under the mucous membrane of the uterine body;
interligamentous - develops in the space between the ligaments holding the uterus;
diffuse – a tumor occupying more than 50% of the area of the uterine body;
subserous uterine fibroids - a tumor that develops under the outer layer of the uterine wall and progresses into the pelvic cavity;
nodular form, in which several myomatous nodes are formed;
interstitial (intrawall, intermuscular) – location of tumor nodes inside the uterine wall.

From the point of view of clinical and morphological nature, fibroids are divided into the following forms:

simple – slowly developing inactive form;
proliferating – rapidly developing, active, multinodular;
presarcoma is the most unfavorable form, contains a large number of atypical cells and can degenerate into a malignant tumor;

Complications

Fibroids can cause various complications, the lack of timely treatment of which can even lead to death. Common ones include:

Diagnosis of fibroids includes standard diagnostic measures to determine its nature, size, localization, morphological structure, presence of complications or associated pathological conditions. The list of mandatory examinations includes:

examination and gynecological examination;
Ultrasound of the pelvic organs;
metrography;
hysteroscopy;
diagnostic curettage of the uterus;
histological and cytological examination of tissues of the uterus and myomatous node.

Treatment of uterine fibroids

Depending on the degree of development of the process, the size of the tumor, the patient’s age and other factors, two main directions are considered for the treatment of uterine fibroids:

conservative drug therapy;
surgical intervention.

Drug therapy

The basis drug treatment fibroids is treated with hormonal therapy for at least six months to slow and reverse tumor growth. In addition to it, sedatives are used, vitamin preparations, immunomodulators and other drugs, depending on the individual characteristics of the course of the disease in each patient. Drug therapy includes the following groups of drugs:

Group of drugs	Indications for use	Effects of drugs	Examples of drugs
Gestagenic	They are used in patients under 45 years of age in the absence of menstrual irregularities and in the presence of small fibroids with endometrial hyperplasia.	Normalizes endometrial growth and prevents tumor development	Dydrogesterone Norethisterone Utrozhestan Duphaston Progesterone
Estrogen-progestogen	Used in patients under 45 years of age with menstrual irregularities, acyclic uterine bleeding	Normalizes the menstrual cycle, endometrial growth and slows down the development of tumor nodes not exceeding 2.0 cm in diameter	Ulipristal acetate Norkolut Rigevidon
Antitumor hormonal agents and hormone antagonists (antigonadotropic agents and gonadotropin-releasing hormone agonists)	It is used to reduce the size of tumor nodes in preparation for surgical treatment.	They help reduce the size of tumor nodes by reducing the estrogen content in the blood and reducing blood flow to the uterus. Can be used to artificially achieve menopause.	Triptorelin Buserelin Zoladex Decapeptyl Diferelin.
	Used in patients over 45 years of age with a menopause duration of no more than 5 years	Reduce tumor growth, cause temporary amenorrhea	Methyltestosterone Gestrinone Drostanolone Proloteston
Antifibrinolytic drugs	Used to stop uterine bleeding	Reduces blood loss	Tranexamic acid
Analgesics	In the presence of menstrual pain and manifestations of fibroids	Reducing pain	Naproxen Ibuprofen
Sedatives	Decreased nervous excitability	Reduces anxiety, calming effect	Motherwort tincture Sodium bromide
Immunomodulators (vitamins and iron supplements)	Treatment of posthemorrhagic anemia, increasing immunity	Replenishing iron reserves in the body, improving immunity	Folic acid Askorutin Ferretab Ferrous sulfate
Vasodilators and angioprotectors	Prevention of thrombosis and vascular changes in the veins of the lower extremities	Normalization of peripheral blood flow	Troxevasin Anavenol
Hepatoprotectors	Prevention of hepatic complications of drug therapy	Normalization of liver functions	Essentiale Silymarin

Fibroids are a common gynecological disease in which specific nodes consisting of muscle and fibrinous tissue form in the patient’s uterus.

To the question “how to treat uterine fibroids?” Only a gynecologist can answer after a thorough examination.

That is why it is important not to neglect preventive examinations, and also to consult a doctor at the first appearance of unpleasant symptoms. Timely diagnosis and early treatment can prevent complications and achieve successful recovery.

Uterine fibroids are a disease that can be subject to conservative therapy and surgical treatment. In some cases, such as the small size of the formation and its slow growth, you can do without surgery.

In this case, the woman is prescribed conservative therapy, which includes:

GnRH analogues – Buserelin, Zoladex- agents that cause a decrease in the synthesis of estrogen in the body, which leads to a decrease in nodes. These drugs can be used both for treatment and as preoperative preparation for large fibroids.
Gestagens– Norkolut, Duphaston – medications that suppress the release of gonadotropins, which leads to a decrease in the production of estrogen by the ovaries.
Combined oral contraceptives– Novinet, Yarina, Jess, who, in addition to the expressed therapeutic effect for fibroids, have a rebound effect. After their cancellation, the woman’s chances of a long-awaited pregnancy increase.
An intrauterine device (Mirena) is used as hormonal therapy.

The attending physician also prescribes symptomatic therapy to patients. It includes iron supplements to correct anemia, analgesics and antispasmodics to relieve pain, sedatives, as well as vitamin and mineral complexes.

When treating fibroids and uterine leiomyomas, it is important to carefully follow all medical prescriptions, and also adhere to healthy image life: eliminate alcohol and smoking. To speed up the healing process, you need to eat right, eat foods rich in protein, fresh vegetables and fruits.

It is very important to improve blood circulation and eliminate venous congestion in the pelvic area. This requires sports (swimming, dancing), as well as regular sex life.

It has been proven that women with irregular sexual contact, as well as those who do not experience orgasm, are more likely to develop benign neoplasms in the uterus.

Surgical interventions for fibrous nodes in the uterus

Uterine fibroids can be treated surgically if they are large in size (12 or more weeks of pregnancy), have rapid growth dynamics (more than 4 times per month), and also in the presence of complications (necrosis, pedicle torsion, nascent submucosal node).

There are minimally invasive sparing and radical surgeries. The choice of surgical procedure is made by the doctor. This occurs depending on the characteristics of the tumor, the woman’s age and the presence of concomitant diseases of the internal organs. Methods used for uterine fibroids include:

Arterial embolization. In which, with the help of a special drug, blood flow in the vessels supplying the uterus is blocked, as a result of which the node decreases and disappears. The recovery period for this intervention is 1-2 days.
FUS ablation– removal of a pathological neoplasm with a directed ultrasound flow. This method is considered one of the most effective among minimally invasive interventions.
Laparoscopic removal of nodes.

Supravaginal uterine amputation and total hysterectomy– radical operations used in complex cases with multiple nodes, heavy, intractable bleeding, as well as malignancy of neoplasms.

By diagnosing fibroids at an early stage, it is possible to avoid serious surgery and get by with conservative therapy or gentle surgery with a short recovery period.

Home therapy methods

Treatment of fibroids folk remedies cannot replace drug therapy and surgery, but only reduces the unpleasant symptoms of the disease. The most useful and in effective ways, who deserved many positive feedback, recognized:

Healing is guaranteed by the infusion of boron uterus. With regular use, this composition promotes recovery hormonal balance and regulates the menstrual cycle. To prepare it you need 2 tbsp. dry raw materials, pour 1 liter of boiling water and leave for 1 hour. You need to drink the resulting drink one glass 3 times a day. Many patients drinking this decoction noted an improvement in their condition and a decrease in pain 2 weeks after the start of treatment.

In order to remove excess estrogen from the body and reduce the size of the nodes, you need to drink milk thistle, thistle, a decoction of dandelion leaves and yellow sorrel.
In case of heavy, prolonged bleeding, it is necessary to drink tea from strawberry leaves, which has hemostatic properties.
Many people are interested in the question “is it possible to get rid of fibroids using celandine?” in such ways - this remedy has a very strong effect, therefore, when prescribing, strict adherence to an individually selected dosage is required. To prepare an infusion from this plant, you need to fill a 3-liter jar, 1/2 filled with raw materials, with boiling water and leave for 5 hours in a place protected from light. The resulting liquid should be filtered and taken 1 tsp. 3 times a day.
Bee products such as bee bread and propolis are popular among many patients. In order to eliminate the inflammatory process and to reduce the size of the tumor, it is necessary to place propolis balls into the vagina.

Calamus root should be grated on a fine grater. Use the resulting pulp 1 tsp. 1 hour before meals 3 times a day.

Before you start treating uterine fibroids with folk remedies, you should definitely consult with a specialist to identify possible contraindications, as well as for the selection of drug therapy.

What will help relieve the condition?

In the occurrence of hormone-dependent diseases of the uterus, an unhealthy lifestyle plays an important role - moral exhaustion, physical fatigue or physical inactivity, bad habits.

To speed up recovery, it is important not only to exercise, give up alcohol and smoking, but also, if possible, avoid stressful situations. For this purpose, many patients visit a psychologist, practice dancing, music and art therapy.

IN Lately The method of working with the healing energies of Reiki has gained particular popularity. The essence of the method is psychological work over themselves, during which patients understand the subconscious causes of their problem and find ways to solve them.

This method “morally healed” and improved the psycho-emotional state of many patients, which contributed to a speedy recovery compared to those who continued to be exposed to stress factors.

You should not rely on treatment with folk remedies and various energy practices in the treatment of fibroids.

Only properly selected hormonal therapy and surgical interventions to remove pathological nodes are effective.

It is important to know the symptoms and treatment of fibroids, so that at the first appearance of unpleasant manifestations you do not put off visiting a doctor and start therapy as early as possible. Timely treatment will help avoid many unpleasant and dangerous complications, speed up recovery and the onset of the desired pregnancy.

Uterine fibroids are a benign, hormone-dependent neoplasm that develops in the body (up to 95%) or cervix (about 5%) of the uterus. This pathology occurs in women from 35 to 55 years of age, but can be diagnosed up to 30 years of age. When talking about uterine fibroids, it is meant that the tumor consists of muscle and connective tissue fibers, with the latter predominating (2-3 times). unlike fibroids, it contains more muscle fibers than connective tissue, approximately 4 to 5 times.

This tumor can grow, in some cases reaching significant sizes, which requires surgical intervention. But in most women, the tumor regresses and in some cases disappears on its own in the postmenopausal period.

Causes of fibroids

There are 3 theories that explain the cause and mechanism of uterine fibroids. Researchers have not come to a consensus which of them is correct; rather, they complement each other:

Hormonal theory. This theory is based on a hormone imbalance, in which FSH and LH are noted monthly, and anovulation occurs. Against the background of hormonal imbalance, the receptor apparatus of the muscles of the uterus and its circulatory system coupled with the ovaries, which leads to a malfunction of the ovaries; accordingly, there is a disruption in the maturation of follicles and metabolism in fibroid tissues and normal uterine tissues.
Extramedium theory. Explains the stimulation of epidermal, insulin-like, vascular and heparin-binding growth factors against the background of hormonal imbalance, which triggers the formation and growth of tumor nodes.
Theory of myogenic hyperplasia. Proponents of this theory believe that fibroids are not tumors, but myometrial hyperplasia, which forms when the menstrual cycle is not disrupted. The process is triggered by hypoxia of the muscle fibers of the uterus, which causes their proliferation and the formation of muscle hyperplasia.

Factors predisposing to fibroids:

disruptions in the production of hormones by the ovaries;
irregular sex life (blood flow in the pelvis is disrupted);
inflammatory diseases of the female genital organs;
lack of sex life;
metabolic disorders (;
immunodeficiency states;
long-term anovulation and;
underdevelopment of the genital organs;
heredity (oncological diseases abdominal cavity and pelvis in the family);
concomitant extragenital pathology;
refusal to give birth before 30 years of age and lactation;
surgical interventions on the uterus (abortion, diagnostic curettage, metrosalpingography, hysteroscopy, removal and wearing of an IUD);
long-term and constant insolation;
chronic;
hidden sexually transmitted infections;
(against the background of painful menstruation, constant hypoxia of the myometrium occurs, which leads to its ischemia).

note

The presence of one or more predisposing factors does not mean that uterine fibroids will necessarily develop.

Classification

Benign uterine neoplasms are systematized according to the following principle:

According to the predominance of connective tissue and muscle components of the tumor:

fibroids.

According to the severity of proliferation processes:

simple fibroids/myoma – grows slowly, there are no cell proliferation processes;
proliferating fibromyoma/myoma – grows quickly, myometrial cell activity is increased, atypical cells are absent;
presarcoma – characterized by multiple elements with signs of atypia.

According to the location of tumor nodes:

interstitial or intramural myoma/fibromyoma - nodes are located in the thickness of the myometrium;
subserous myoma/fibromyoma – the neoplasm grows under the serous (outer) lining of the uterus, that is, into the pelvic cavity;
submucosal or submucosal myoma/fibromyoma – the tumor grows under the endometrium, into the uterine cavity, which leads to its deformation;
intraligamentary or interligamentous myoma/fibromyoma - the neoplasm is located in the leaves of the broad ligament of the uterus and grows in the parametrium.

By growth pattern:

diffuse growth - uniform germination of the muscular layer of the uterus;
nodular growth - individual nodes form in the thickness of the myometrium.

Symptoms of uterine fibroids

The symptoms of fibroids are varied and depend on many factors: the age of the patient, how long the tumor has existed, the location of the tumor nodes, the presence/absence of chronic genital and extragenital diseases. The leading signs of fibroids include:

At the beginning of the disease, with a small size of fibroids, the woman is bothered by heavy and prolonged periods. As the size of the tumor increases, acyclic bleeding is added, which leads to anemia in the patient. The severity of cycle disorders is determined by the location of the tumor. In the case of subserous fibroids, menstruation is moderate and acyclic bleeding occurs extremely rarely. With submucosal fibroids, even if they are small in size, menstruation immediately becomes long and heavy, plus painful. The intensity of pain increases as the tumor grows (the node occupies an increasing area of the uterine cavity). Also, with submucous fibroids, acyclic bleeding appears early. With interstitial fibroids, menstruation is prolonged due to impaired contractile function of the uterus and dilation of the uterine veins.
Pain. The nature and origin of the pain syndrome is different for each patient. The pain is localized; as a rule, pain or discomfort in the lumbar region may be disturbing. With subserous or interstitial fibroids, the pain is constant, aching and is caused by stretching of the peritoneum that covers the uterus. If the pain becomes intense, this indicates the growth of the tumor. If microcirculation is disrupted in the fibromyomatous node, first ischemia occurs, then necrosis, and the pain becomes very sharp, even unbearable. Against the background of submucosal fibroids, pain is cramping in nature and occurs during menstruation, which is associated with contraction of the uterus and its attempt to “push” the node out. With intraligamentary fibroids, the pain is pronounced and appears due to compression nerve plexuses which are located in the cervix.
Disruption of the work of related organs. Fibroids, especially large ones, put pressure on nearby organs, that is, the bladder and rectum. The patient develops complaints and frequent urge to urinate (if the tumor is large). When the rectum is compressed, the patient is also bothered by a false urge to defecate.

Why is fibroids dangerous?

Uterine fibroids can cause severe conditions that will require emergency medical intervention:

Birth of a node. This complication is typical for submucous fibroids, when a node from the uterine cavity is pushed into the vagina, and in some cases beyond it. The patient is experiencing severe spastic pain and profuse bleeding from the genital tract. Treatment is only surgical. Either the node, if the length of the leg allows, is unscrewed and the uterus is curetted, or, if it is impossible to unscrew the node, a hysterectomy is performed.
Necrosis of the node. It develops as a result of disruption of the trophism of the fibromyomatous node, which leads to its necrosis. Necrosis can occur either in a certain area of the node (partial necrosis) or in the entire node (complete necrosis). Accompanied by severe pain, tenderness of the abdomen during external palpation and tenderness of the uterus during gynecological examination, symptoms of intoxication and signs of irritation of the peritoneum. Treatment is only surgical - removal of the uterus.
Suppuration of the node. Develops after necrosis of the fibromyomatous node. Accompanied by severe symptoms of intoxication up to the development of septic shock. Requires immediate hysterectomy.
Twist of the leg of the knot. Characteristics for intraligamentary and subserous fibroids. Accompanied by intense pain in the lower abdomen and lumbar region and signs of peritoneal irritation. Due to impaired blood supply, necrosis occurs in the twisted node, which also requires removal of the uterus.

Fibrosarcoma of the uterus degenerates into malignancy(sarcoma) in 5 - 7% of cases.

Diagnostics

Diagnosis of uterine fibroids includes the collection of anamnesis and complaints of the patient, a general and gynecological examination, during which the size of the uterus is determined (compared in weeks with pregnancy), nodular or diffuse enlargement of the uterus, and its growth since the last examination is noted. ABOUT rapid growth says fibroids increase by 4 weeks or more per year. Additional diagnostic methods are used:

Treatment

Treatment of the disease can be carried out conservatively and surgically. Each method has its own indications.

Conservative therapy

Conservative treatment of fibroids is carried out in cases:

absence or low severity of symptoms of the disease;
the patient's desire to give birth;
fibroids no more than 12 weeks;
subserous or interstitial fibroids;
the presence of extragenital diseases with severe course;
preparation for surgery to reduce the size of the tumor.

The complex of conservative measures includes:

therapeutic nutrition - with sufficient protein, vitamins, iron;
– for treatment or prevention;
– correction of vegetative-vascular disorders and instability of mental state;
hemostatic drugs - to stop bleeding;
vascular drugs - normalization of blood flow in the pelvis;
hormones - progestins, COCs, androgens and GnRH agonists (in premenopause), for at least six months.

Surgery

Surgery for uterine fibroids is performed in the following situations:

submucosal localization of fibroids;
significant tumor size (exceeds 14 weeks);
chronic posthemorrhagic anemia due to uterine bleeding;
fast growth;
combined gynecological pathology (available,);
compression of the bladder and rectum, constant bleeding and pain;
complications of fibroids;
cervical localization.

For this disease, 3 types of operations will be performed: how much surgery will be performed is determined by the age of the patient and the indications for surgery.

Types of operations:

radical hysterectomy is divided into supravaginal hysterectomy and hysterectomy;
semi-radical operations: uterine defundation and high supravaginal amputation;
organ-saving operations – conservative myomectomy.

Prevention measures

maintaining a healthy lifestyle (giving up bad habits, fighting obesity, rational nutrition);
timely treatment of gynecological and extragenital diseases;
refusal of abortion;
planning the first birth before age 22, the second by age 25;
refusal of sun exposure, including visits;
maintaining lactation after childbirth;
rational contraception;
maintaining regular sex life;
refusal to visit baths, saunas and hot baths after 30 years;
regular visits to the gynecologist.

Sozinova Anna Vladimirovna, obstetrician-gynecologist.

Benign tumors of the uterus can cause considerable harm to a woman’s health, as complications include problems with pregnancy and deterioration in general well-being. Signs of the formation of such tumors appear as the nodes grow and their mechanical impact on neighboring organs. In order to avoid the consequences of the formation of uterine fibroids, it is necessary to carry out a course of treatment. It is advisable to do this while the tumor is small. Otherwise, surgery will be required to remove it.

Content:

What is the disease

Fibroids are called benign tumor, which is formed in the uterus and consists of muscle and connective tissue fibers. It is classified as hormone-dependent, since its development is facilitated by an increased, compared to the norm, content of female sex hormones in the blood. The appearance of this neoplasm is mainly observed in women 20-40 years of age.

Types of uterine tumors

Benign tumors form in the thickness of the uterus and then grow towards its outer or inner lining. The wall of the organ consists of muscle tissue (myometrium) and connective tissue (fibrous). Depending on the structure of neoplasms, the following types are distinguished:

Fibroids - consists of approximately 2/3 connective tissue and 1/3 muscle.
Myoma – it is dominated by muscle tissue (about 4-5 times more than connective tissue).
Fibroma - consists of connective tissue.
Leiomyoma and rhabdomyoma are tumors consisting of muscle fibers of various types.

Uterine fibroids can appear in the form of a single node (nodular) or several located in different parts of the organ (diffuse type). Diffuse tumor nodes differ in size and shape.

Types depending on location

The tumor node can be located deep in the wall, protrude from it into the abdominal cavity, or be located inside it.

Interstitial node- the one that is located inside the wall.

Submucosal (submucosal) the node grows towards the uterine cavity. Due to the growth of such a tumor, its volume is reduced.

Subserous (subperitoneal) the node grows towards the outer serous membrane of the uterus and is located on the side of the abdominal cavity.

Intraligamentary (interligamentous) node - located in the ligaments that hold the organ in the abdominal cavity.

The tumor, located on the outside of the uterus, is connected to the body by a thin stalk. Neoplasms up to 6 cm in size are considered small. The diameter of large tumors reaches 20 cm or more.

Stages of development

The development of uterine fibroids occurs gradually.

At the first stage growth initiation occurs, that is, from a single cell in the process of division, the following begin to form.

At the second stage the vascular network that feeds it grows. The tumor growth progresses and its structure stabilizes.

Third stage– this is a recovery in which, as a result of the treatment, involution of the neoplasm occurs (reverse development).

Complications

Uterine fibroids can develop in different ways, presenting a greater or lesser threat to health.

Simple. It grows slowly and responds well to treatment.

Proliferating. It grows quickly, but cell division occurs without abnormalities.

Presarcoma– the most dangerous type of tumor. It contains many cells of atypical structure that degenerate into cancer. Such nodes must be removed as early as possible.

When nodes enlarge, the following health-hazardous situations arise:

Enlargement of nodes leads to growth of the abdomen.

Video: What is fibroids in the “Live Healthy” program

Causes of fibroids formation

There are various theories explaining how uterine fibroids and other similar neoplasms form. According to one of them, a genetically determined mutation of cells occurs in a woman’s body, from which a tumor subsequently develops.

Addition: It has been observed that the disease most often occurs in several women who are blood relatives. If one of the female identical twins develops fibroids, the disease also appears in the second.

The disease occurs more often in women of the Negroid race.

According to the second theory, the main cause of the disease is hormonal imbalance, an imbalance in the ratio of estrogen and progesterone. Moreover, a tumor can occur both with a pathological increase in the content of estrogen in the blood (hyperestrogenism), and with a simultaneous increase in the content of both hormones in the blood. By using special medications, the condition can be controlled hormonal levels and achieve tumor involution.

Hormonal disorders

The mechanism of hormonal disorders that contribute to the development of uterine fibroids may be different.

Immunity to progesterone. The following situation arises: despite the fact that hormone production is normal, the influence of estrogen predominates. This occurs due to a weakening of the sensitivity of uterine receptors that respond to the effects of progesterone (the so-called “uterine variant” of tumor development).

Ovarian dysfunction. Due to inflammatory diseases or the formation of cysts, the production of hormones in the ovaries is disrupted (“ovarian variant”).

Disruption of the central nervous system. Hormonal imbalance occurs due to improper production of hormones by the pituitary gland and hypothalamus. The cause may be neurological diseases, stress, head injuries (“central variant”).

Other factors

Factors contributing to the formation of uterine fibroids are:

possible damage to the organ wall during childbirth, abortion and gynecological operations;
formation of scars in tissues as a result of inflammatory processes;
Unfavorable course of menstruation (frequent occurrence with shortened cycles, too long periods). In this case, the blood supply and the formation of muscle tissue cells do not have time to recover.

The risk of the disease is increased in women of reproductive age who abstain from sexual activity for a long time. Fibroids are more often observed in obese patients. Metabolic disorders, underdevelopment of the reproductive organs, weakened immunity as a result of chronic infectious and inflammatory diseases also provoke the development of uterine fibroids.

Symptoms of the disease

Manifestations of the disease depend on the stage of development and size of the tumor, their location, as well as on the age of the patient, the presence of other diseases of the genital organs, liver, heart, and blood vessels. The neuropsychic state matters.

Small tumors have no manifestations. When they increase to 6 or more centimeters, the woman develops a feeling of heaviness in the pubic area and nagging pain, intensifying before the arrival of menstruation. Irritation of the nerve endings located in the peritoneum leads to constant aching pain in a stomach. You can notice its asymmetrical increase.

In the presence of submucosal nodes, menstrual irregularities, bleeding after sexual intercourse, and physical stress are observed.

If there are complications, such as twisting of the leg or rupture of the tumor, severe pain, weakness, nausea, and vomiting occur. Signs of anemia include dizziness, headache, mild rapid heartbeat, and a drop in blood pressure.

If you have symptoms of complications, you should consult a doctor immediately. A life-threatening condition may occur.

Video: Symptoms of benign tumors

Diagnostics

Symptoms of uterine fibroids are similar to the manifestations of pathologies such as ectopic pregnancy, ovarian cysts and tumors, endometritis, endometriosis, adenomyosis, and cancer. Instrumental laboratory research, allowing to distinguish this pathology from other diseases, to determine the size, number and location of nodes.

It is important to notice how quickly the tumor grows. To do this, its dimensions are measured once a year at the same time in the cycle. They are usually calculated not only in cm, but also in the number of weeks of pregnancy (the diameter of fibroids in centimeters corresponds to the size of the abdomen at a certain period). An increase in tumor size by more than 4 obstetric weeks per year is considered rapid.

To detect a submucosal tumor, colposcopy and hysteroscopy, transvaginal ultrasound are performed. During hysteroscopy, a biopsy of the tumor contents may be performed.

Submucosal nodes are detected by performing a transabdominal ultrasound of the abdominal cavity. At the same time, ultrasound signs are determined, by which the density and internal structure of the neoplasm are judged, and its type is determined.

Using diagnostic laparoscopy, a sample of the material that makes up the tumor is taken. A pregnancy test is required, and a cervical smear is taken for microflora.

If there is doubt about the nature of the submucous tumor, diagnostic curettage and histological examination of mucosal particles are performed. Various blood tests are done (to check hormone levels, biochemical and microbiological composition).

Video: Causes of fibroids, symptoms

Treatment

If uterine fibroids are detected, medication or surgery. Sometimes you have to combine these methods, supplementing them with physiotherapy. When choosing treatment, the doctor focuses primarily on the degree of danger it poses, its size, growth rate, as well as the woman’s age and her desire to preserve reproductive ability.

Drug therapy

It is carried out if the size of uterine fibroids is less than 12 weeks, the tumor has a wide base, the symptoms are minor, the woman has chronic infectious and inflammatory processes in organs other than reproductive system. In such diseases, carrying out surgical operation associated with the risk of blood poisoning, so it is not performed.

Prevention of tumor growth. Sedatives (tincture of motherwort, sodium bromide), B vitamins, iron supplements, immunomodulators, agents that improve blood flow (trental) and improve the condition of veins (troxevasin, anavenol) are prescribed.

Drugs are also prescribed to restore liver function (Essentiale, Carsil, Silymarin).

Diet therapy is carried out. During treatment, the diet includes protein foods, as well as foods containing iron, which are beneficial for the liver.

Hormonal treatment. Progesterone preparations (utrogestan, duphaston) and its analogues (norkolut, pregnin) are used. These drugs are prescribed to women under 45 years of age with normal menstrual cycle. In case of an irregular cycle or the presence of unrelated bleeding, drugs containing both estrogens and progesterone (Zhanine, Yarina, Rigevidon) are prescribed.

Drugs are prescribed to suppress the production of gonadotropins - LH and FSH hormones of the pituitary gland, which regulate the production of estrogen and progesterone in the ovaries (danazol). Drugs containing androgens and progesterone are used to reduce the concentration of estrogen (methyltestosterone).

Physiotherapy

Physiotherapy methods can stop the growth of small tumors and speed up their reverse development. Therapeutic baths (radon, iodine-bromine), electrophoresis and magnetophoresis, laser irradiation of blood and other methods are prescribed.

Surgery

It is carried out if the size of uterine fibroids is 13 weeks or more, there is pain, bleeding, possible “birth” of a node and the appearance of other dangerous complications. The tumor grows faster than 4 weeks per year, and the woman begins to develop endometriosis.

Methods are used to remove only the tumor or amputate the uterus (partial or complete). One of the gentle methods of tumor removal without incisions of the peritoneum and uterine wall is the method of uterine artery embolization (UAE). Introduction of a special substance into blood vessels The uterus allows you to stop the blood supply to fibroid nodes, which leads to their involution.

The FUS ablation method (tumor destruction with ultrasound) is also used. The disadvantage of this method is the possibility of recurrence of uterine fibroids.

If the tumor is large and there are multiple nodes, either supravaginal amputation of the uterus (preserving the vagina and part of the cervix) or removal of the uterine fundus along with the tubes is performed. Sometimes the uterus is completely removed (if presarcoma is observed).

The nature of the operation depends on the location and size of the nodes. To prevent relapses, subsequent hormonal therapy is carried out.

Fibroids and pregnancy

Fibroids during pregnancy lead to serious consequences. Occupying an increasing volume, it interferes with the development and growth of the fetus and its normal blood supply. Even in the presence of a small tumor, there is a threat of miscarriage due to the fact that the fertilized egg cannot be retained in the endometrium, and normal formation of the placenta becomes impossible.

Complications occur during childbirth due to weak contractility of the uterus.

Warning: If a woman is just planning to have children and is diagnosed with fibroids, then it is recommended to undergo preliminary treatment to avoid dangerous consequences.

If uterine fibroids are small (its diameter is no more than 2-3 cm), does not increase, and there is no threat of complications, then during pregnancy only systematic monitoring of its condition is carried out. The larger tumor is removed. At the same time, they try to perform the operation in such a way as to minimize the risk of wall rupture in the suture area, bleeding and fetal death. As a rule, childbirth is carried out by caesarean section. In this case, sometimes small internal nodes are removed at the same time.