If you have no complaints, you are not planning a pregnancy, the fibroids are not growing, then you do not need to take medications. Treatment of any disease is carried out according to indications. Duphaston is prescribed for severe symptoms of adenomyosis: heavy and painful menstruation, intermenstrual bleeding, to prepare for pregnancy. These same symptoms are also symptoms of uterine fibroids, and here duphaston also has a beneficial effect. But if there are no complaints, admission is not necessary.

Video about symptoms and diagnosis of fibroids

Video about treating fibroids and planning pregnancy

Uterine fibroids(synonyms: fibromyoma, fibroma) is a benign tumor that develops from the muscle tissue of the uterus, consisting mainly of connective tissue elements. The incidence of fibroids by the age of 35 is 35-45% among the entire female population. The peak incidence occurs in the age group of 35-50 years, but recently uterine fibroids have become “younger” and are quite often diagnosed in women of young reproductive age.

Depending on their location in the structure of the uterus, the following types of fibroids are distinguished:

- interstitial (or intramural) - the tumor is located in the thickness of the uterine wall;

- submucous - a significant part of the tumor protrudes into the uterine cavity, which leads to deformation of the cavity;

- subserous - the tumor grows subperitoneally.

Causes of uterine fibroids

Possible causes leading to the development of uterine fibroids include:

- hormonal disorders, clinically manifested by disruptions of the menstrual cycle: late onset of menstruation, too heavy periods, which leads to sharp fluctuations in sex hormones - an increase or, conversely, a decrease in the level of estrogen and progesterone;

- irregular sex life, especially from the age of 25; disharmony in sexual life - an interesting fact is that women who have problems achieving orgasm are more likely to develop uterine fibroids;

— mechanical factors: abortions, diagnostic curettages, traumatic births;

— genetic predisposition;

- sedentary lifestyle.

Symptoms of uterine fibroids

Often, uterine fibroids do not give any symptoms and are found during a routine examination by a gynecologist. Or it happens that the symptoms are quite smoothed out and are often perceived as a variant of the norm. The most striking symptoms are observed with the submucous location of the tumor and with large sizes of fibroids of any type.

Photo Node of large uterine fibroids

Possible symptoms of uterine fibroids that may alert you:

- heavy and prolonged menstruation (menorrhagia). Sometimes the bleeding is so heavy that the woman does not have time to change pads. Often there are acyclic bleedings not associated with menstruation - “metrorrhagia”. Menorrhagia and metrorrhagia lead to iron deficiency anemia - the hemoglobin level gradually decreases. Weakness and pallor of the skin appear, which is not always noticeable and is perceived as a common malaise;

- pain in the lower abdomen and lower back. If blood circulation in the myomatous node is impaired, the pain is acute. However, more often the tumor grows gradually and the pain is rather aching in nature, even if the fibroid is large;

- dysfunction of neighboring organs - the urinary and gastrointestinal tract, in particular, this applies to the bladder and rectum - the tumor compresses these organs. As a result, difficulty urinating and chronic constipation may occur.

For this reason, patients with uterine fibroids often turn to urologists and proctologists.

If the above symptoms are present, a consultation with a gynecologist is necessary.

Diagnosis of uterine fibroids

Diagnosing fibroids is not difficult. During a gynecological examination, the size of the uterus is increased. To confirm the diagnosis, additional research methods are used:

— Ultrasound of the pelvic organs using a vaginal sensor. For better visualization, the study is performed with a full bladder. The method is highly informative and allows you to identify the size of the tumor and its shape;

- hysteroscopy - the method is informative for recognizing submucosal and interstitial myomas with centripetal (cavity-deforming) growth. During hysteroscopy, the gynecologist takes a biopsy (a piece of tissue) from the uterine cavity for further histological examination;

- laparoscopy - used only when myoma cannot be distinguished from an ovarian tumor;

- CT and MRI are rarely used due to the high cost of research.

The scope of diagnostic tests is determined by the gynecologist in each specific case. Most often, a chair examination and ultrasound of the pelvic organs are sufficient to make a diagnosis.

Video about the causes, symptoms and diagnosis of uterine fibroids

Treatment of uterine fibroids

Treatment of uterine fibroids can be conservative, surgical, or combined (both).

Conservative treatment of uterine fibroids

The goal of conservative treatment of uterine fibroids is to stop the growth of the tumor, reduce its size and prevent complications. Conservative treatment is carried out for all women who:

- size of fibroids less than 12 weeks of pregnancy;

— fibroids with subserous and interstitial nodes;

- there is no pronounced clinical picture with menopause and metrorrhagia and if there is no pain syndrome;

- if there are contraindications to surgical treatment (extragenital diseases).

The basis of conservative treatment is the use of hormonal drugs.

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

1) Androgen derivatives: Danazol, Gestrinone. The action of this group is based on the fact that androgens suppress the synthesis of ovarian steroid hormones. As a result, the size of the tumor decreases. Use for up to 8 months continuously.

2) Gestagens. Duphaston, Utrozhestan, Norkolut normalize endometrial growth in the presence of hyperplastic processes (endometrial growth), which often develop against the background of fibroids. In relation to the fibroids themselves, the effectiveness is not high enough. Ideally, gestagens are prescribed for small fibroids and concomitant endometrial hyperplasia. Prescribed courses for up to 8 months.

Noteworthy is the appearance on the Russian market over the past 10 years of the hormonal device Mirena, which contains a gestagen - levonorgestrel. Due to the daily release of the hormone into the uterus, Mirena blocks tumor growth. The spiral is installed for 5 years. Another advantage of the spiral is that, in addition to the therapeutic effect, Mirena protects against unwanted pregnancy.

3) Combined oral contraceptives KOK-Zhanin, Regulon, Yarina. The growth of the tumor is stopped if the size of the nodes is no more than 2 cm. Prescribed for at least 3 months.

4) Analogues of gonadotropin releasing hormone aGnRH (Buserelin, Zoladex). With continuous use, these drugs cause hypoestrogenism. Prescribed for 3-6 months, but no more, otherwise these drugs can cause menopause.

Unfortunately, conservative treatment of fibroids is not always effective. Indications for surgical treatment of uterine fibroids are as follows:

- size of fibroids more than 12 weeks of pregnancy;

— submucous location of nodes, interstitial myoma with centripetal growth;

- rapid tumor growth;

- combination of fibroids with ovarian tumors;

- menopause and metrorrhagia, which lead to anemia;

- for miscarriage and infertility.

Depending on the age of the patient and the location of the myomatous nodes, a choice is made in favor of one or another surgical intervention.

Surgical treatment options for uterine fibroids:

1) Uterine artery embolization (UAE) is a minimally invasive operation that has been introduced into the practice of surgeons over the past decades. An embolus is inserted into the uterine vessels, which blocks the lumen of the arteries. Without blood supply, necrosis (death) of myomatous nodes occurs. Method of choice for young women interested in pregnancy.

2) Conservative myomectomy - myomatous nodes are removed, leaving only healthy tissue. Operative access - laparoscopic or abdominal. The latter is more preferable. It is carried out for women of reproductive age who are interested in pregnancy.

3) Hysteroresectoscopy - during hysteroscopy, myomatous nodes are removed from the inner surface of the uterus. It is performed for women with submucosal nodes.

4) Hysterectomy – removal of an organ. In this case, the principle “No organ - no problems” applies. Surgical access - abdominal, laparoscopic or vaginal. The latter is used for small fibroids. Abdominal access is most often used. In this case, either supravaginal amputation of the uterus or hysterectomy is performed. After extirpation, urinary incontinence often develops, so surgeons prefer supravaginal amputation of the uterus, provided that the patient has a healthy cervix and there are no large nodes between the uterus and cervix.

No less pressing is the question that must be decided before or during surgery - whether to keep the ovaries or not. Surgical tactics are determined individually, taking into account the patient’s age and the presence or absence of formations on the ovaries.

Hysterectomy is suitable for all women with uterine fibroids whose tumor size is more than 13 weeks of pregnancy, if conservative methods are ineffective, if the tumor is growing rapidly, if there are ovarian tumors, or if there is acute blood loss.

Combined method is the “gold standard” for the treatment of uterine fibroids. Quite often, after surgery, COCs and GnRH agonists are prescribed for a short course to avoid relapses. This does not apply to hysterectomy, where the problem is solved radically - by removing the organ.

Folk remedies for treating uterine fibroids

If you have been diagnosed with uterine fibroids, this is a signal to change your lifestyle. Firstly, this concerns nutrition - you need to give up fatty foods and consume more plant-based foods. Eat foods rich in fiber. Fish dishes are recommended. Secondly, thermal procedures are strictly contraindicated for fibroids: sauna, hot bath, solarium, holidays in hot countries, baths, tanning.

If you follow a certain lifestyle, you will be able to avoid surgical treatment or reduce the likelihood of relapses in the postoperative period.

Folk remedies can also be used for fibroids, but I must say right away that everything is very individual. In some cases (for example, with rapid tumor growth), excessive reliance on traditional medicine can lead to even greater complications. Herbal medicine is indicated for women with small tumors. You can use tinctures of nettle, celandine, mint and hawthorn. Drink twice a day - morning and evening.

If we talk about alternative medicine in general, the use of “Love Moon” anion pads, which contain negatively charged atoms, deserves attention. The effectiveness of pads, according to manufacturers, is due to the influence of anions on metabolism in the muscle cells of the uterus. Thus, when using pads, tumor growth slows down.

Video about planning pregnancy with fibroids and treatment of fibroids in women

Complications of uterine fibroids:

— miscarriage, hypoxia and fetal malnutrition;

- infertility;

Prevention of uterine fibroids:

Questions and answers from an obstetrician-gynecologist on the topic of uterine fibroids.

1. I have uterine fibroids, I’m 50 years old, I don’t have periods. Will myoma grow?

No. Myoma is a hormone-dependent tumor; if there is no menstruation, there will be no growth.

2. I am 36 years old, I have interstitial fibroids, I have not given birth, I have had abortions.

It was difficult to get pregnant. Will I be able to carry a child?

You need to go to a gynecologist to assess the condition of the fibroids and the tone of the uterus, so that the doctor can prescribe adequate therapy.

3. I have a fibroid for about 6-7 weeks, with a submucous node that is growing posteriorly. The doctor prescribed dietary supplements. Will they help me?

4. How does pregnancy affect the growth of fibroids?

Pregnancy stops the growth of fibroids, but in the first and second trimester a slight growth of the tumor is possible.

5. I have fibroids; an ultrasound scan revealed a subserous node measuring 81 x 62 x 76 mm on the anterior wall. Is it possible to save the uterus, or should it be removed?

6. I have had fibroids for 7-8 weeks. Is it possible to do physical exercise and pump up the abs?

If there is no heavy bleeding or pain, then it is possible.

7. I have a small subserous node (2 cm) - do I need treatment?

Each method has its own side effects and possible complications, but this does not mean that they will affect you specifically.

Questions and answers on the topic of uterine fibroids (archive of questions 10.12-10.12)

Hello Philip Alexandrovich. I had the operation Laporoscopic, myomectomy, salpingostomy, bilateral stomatoplasty, chromohydrotrubation, posterior colpotomy. An interstitial-submucous node up to 8 cm located in the bottom of the uterine cavity was opened. I was 33 years old and had one childbirth. Doctor, is it possible for me to become pregnant after such an operation? If so, how long after? Thank you very much in advance for your answer.

Hello, the hospital advised me to do laparoscopic surgery, because we don’t do this, can you tell me if I can do it? What tests are needed, how much will it cost and how can I make an appointment? Thanks in advance!

Hello! Your answer: after removal of the node on the leg, you can plan a pregnancy 4 months after the operation. A pedunculated fibroid node could well be the cause of a non-developing pregnancy. At the MEDICA clinic where the operation took place, the doctor said that pedunculated fibroids cannot be the cause of a non-developing pregnancy (twins are 4-5 weeks old). They told us to take all possible tests for infections, my husband and I tested negative. My husband passed the tests spermograms, cultural examination of the sexual partner for STIs. All tests were good. They told me to take hemostasis tests (detailed hemostasiogram, homocysteine, hereditary thrombophilia, AT to FL). I had an unclear situation before conception. The sperm came out of the vagina with blood, I asked the doctors, they said they didn’t know what could have affected it. Could this be slight bleeding due to subserous fibroids? I also lean more toward your answer. The question is: is it necessary to undergo hemostasis tests before a planned pregnancy? Thank you!

Love (arch region, 10/19/12)

Hello. I am 30 years old. I have one child, 8 years old. In 2009 I had an abortion at 12 weeks because the bleeding did not stop. No treatment was carried out. I did not become pregnant again. On October 5, 2012, I had an ultrasound. The ultrasound result: The uterus is deviated towards the sacrum, not enlarged, 62*44*59 mm, volume 90.8 cm3, homogeneous with clear, even contours. The structure of the myometrium is not changed. The uterine cavity is not expanded. M-echo is not deformed. Endometrium 5.8 mm. Cervix length 36 mm, anteroposterior 20 mm, width 24 mm. The right ovary is 36*28 mm, with a fluid formation of 3.0 cm with smooth contours and homogeneous contents. The left ovary is 36*24 mm unchanged, of heterogeneous size and structure. There is no fluid in the posterior fornix. Conclusion: the uterus is in Retroslexio. The fluid formation of the right ovary is probably a follicular cyst .I have questions:

Is my cyst dangerous during pregnancy? I’m planning a pregnancy but it’s not working out. Could a cyst be the cause? How to avoid the situation in 2009? What tests need to be taken? What should I drink?

Hello! I haven’t given birth for 22 years! In 2011, I became pregnant with twins. Unfortunately, I couldn’t carry them to term. At 5 months my waters broke and the pregnancy was terminated. Doctors say that the culprit was uterine fibroids; they formed during pregnancy! Now I’m afraid of getting pregnant, tell me please, can I get pregnant with a fibroid with a diameter of 27 mm? Our doctors say that we need to do a strip operation, but I don’t want to, since I already have a stitch for the second time, I don’t want to, or rather, I’m afraid! Please answer my question!

Modern methods of treating uterine fibroids

In modern gynecology there are several methods for treating uterine fibroids. They are divided into three types:

Drug treatment of uterine fibroids

Currently, only one pharmaceutical drug, Esmya, is used for the drug treatment of uterine fibroids. This is a non-hormonal agent that blocks progesterone receptors, the main hormone that promotes the growth of fibroids. Under the influence of this drug, myomatous nodes are reduced. Unfortunately, this does not always happen.

The effectiveness of the drug depends on how many progesterone receptors are contained directly in the myomatous node. Depending on this, the results of treatment can be different - from almost complete absence of effect to a pronounced effect.

Drug treatment of this disease is recommended in cases where embolization of the uterine arteries would be an unnecessary method - for example, at a young age with small myomatous nodes. If a 20-year-old patient has nodes that do not exceed 1.5–3 cm and the disease is asymptomatic, then initial drug treatment with Esmya, which allows reducing these nodes to a minimum at an early stage of the disease, will be quite sufficient. Over time, drug treatment can be repeated if necessary.

Sometimes other medications are also used to treat this disease, but in modern gynecological practice they are considered less effective than any other treatment methods.

Surgical treatment of uterine fibroids

Surgical removal of myomatous nodes is performed using myomectomy or hysteroresectoscopy.

But in this case, it is necessary to assess how traumatic this treatment method can be for the uterus - in each case this is decided individually.

These surgical treatment methods are applicable if:

Hysterectomy (surgical removal of the uterus) is prescribed only in exceptional cases:

Uterine artery embolization

UAE allows you to finally solve the problem of myomatous nodes, since this method does not have relapses that occur during surgical treatment, and with this method there are practically no complications.

If the disease occurs with severe symptoms (excessive bleeding, pain, etc.), then embolization of the uterine arteries can completely solve this problem.

• for symptomatic fibroids in a patient who is not planning a pregnancy in the near future, but intends to have children in the future
• for symptomatic fibroids in a patient who has already completed her reproductive period
• if a woman is planning a pregnancy in the near future, and the fibroids are multiple or the myomatous nodes are located in different locations, therefore the surgical treatment method can cause a pronounced defect in the uterus in the form of deep multiple scars

During embolization, myomatous nodes are not removed. Emboli block the vessels feeding the nodes, and the fibroid dries out, just as grapes become raisins.

Other treatments for uterine fibroids

Although doctors sometimes offer women some other treatments for this disease, they are currently considered ineffective. These methods include Mirena and FUS ablation.

It has been proven that the Mirena hormonal device does not have any effect on myomatous nodes and is not a method of treating uterine fibroids.

A method such as FUS ablation initially promised good results, but it has serious drawbacks. Firstly, there are many conditions for the implementation of this method (i.e. its use is possible only in certain cases), and secondly, with this method of treatment relapses very often occur.

Dietary supplements (indinol, epigalate) and traditional medicine are not methods of treating uterine fibroids, since they do not have any proven therapeutic effect on this disease.

Small uterine fibroids - often not clinically manifested

Small fibroids are fibroids up to 15–25 mm in size. Most often, such fibroids do not manifest themselves in any way and are an accidental finding during an ultrasound examination of the pelvic organs. The goal of treating such fibroids is to completely stop its growth.

Small fibroids - how they appear

The appearance of a tumor usually begins at the age of about 30 years, when a woman develops various gynecological diseases. It takes about five years for the tumor to reach a size that can be detected by ultrasound.

Small fibroids can grow very quickly or exist unchanged for a long time. During menopause, when the level of female sex hormones estrogen in the body decreases, fibroids can spontaneously shrink to the size of a stable nucleus.

Various external and internal factors can stimulate the growth of fibroids. This usually occurs after the age of 35–40 years. These are induced abortions, difficult childbirth, high physical and neuropsychic stress, various neuroendocrine diseases (for example, obesity) and so on. All these factors have a stimulating effect on the growth of fibroids.

Detection of small fibroids

Small fibroids (15–25 mm in diameter) are usually detected during ultrasound examination. Modern equipment makes it possible to detect myomatous nodes with a diameter of up to 5 mm.

As a rule, small fibroids do not manifest themselves in any way for a number of years and only then, after the age of 35, do the characteristic symptoms of this disease appear.

Symptoms of small fibroids can only appear when the fibroids are located directly under the uterine mucosa. Such fibroids are called submucous and its first manifestations are cyclic bleeding.

Cyclic bleeding is heavy, prolonged bleeding. Blood loss increases with tumor growth. At the same time, a woman may be bothered by aching pain in the lower abdomen and lower back.

If fibroids grow for a long time, a woman does not always notice these changes, considering them to be the norm. But regular significant blood loss can already at this stage of the disease lead to the slow and imperceptible development of iron deficiency anemia. In this case, the woman experiences slight weakness, malaise, and decreased performance due to the fact that the amount of hemoglobin in the blood decreases, and then red blood cells.

If small fibroids are located inside the muscular layer of the uterus (interstitially) or under its outer, serous membrane, then at this stage it usually does not manifest itself in any way.

Is it necessary to treat small fibroids?

After identifying small fibroids, it is imperative to achieve its stabilization, that is, reduction to the size of a stable nucleus and persistent suppression of growth. Such fibroids can exist for a long time in an unchanged state.

Stabilization of small fibroids can be achieved through lifestyle changes and conservative hormonal therapy Hormone therapy - is it possible to deceive nature? .

A woman is recommended to follow nutritional recommendations - fatty meat (a source of cholesterol, which goes into the formation of estrogens that stimulate the growth of fibroids) is excluded from the diet; instead, it is recommended to eat more vegetables, fruits, and cereals. Easily digestible carbohydrates (sweets, baked goods), which can lead to obesity and increased fibroid growth, are also excluded.

A woman should lead a moderately active lifestyle, excluding high physical and neuropsychic stress.

To suppress the growth of fibroids and reduce its size to the size of a stable nucleus, various hormonal drugs are used. Hormonal drugs are not only contraceptives. These are mainly low-dose hormonal contraceptives, which include third-generation gestagens. Such drugs are prescribed orally or administered intrauterinely in the form of hormonal intrauterine devices. This helps restore a woman’s normal hormonal background. A woman’s hormonal background - how does it affect the body as a whole? and stabilization of fibroids.

Galina Romanenko

Uterine fibroids

• What is uterine fibroid
• What causes uterine fibroids?
• Symptoms of Uterine Fibroids
• Diagnosis of uterine fibroids
• Treatment of Uterine Fibroids
• Prevention of uterine fibroids
• Which doctors should you contact if you have uterine fibroids?

What is uterine fibroid

Uterine fibroids are a benign hormone-dependent tumor in women of reproductive age (mostly 30-45 years). Uterine fibroids account for up to 30% of gynecological diseases.

What causes uterine fibroids?

The modern understanding of the development of uterine fibroids is based on the hormonal theory. Disturbances in the excretion and metabolic transformation of estrogens, as well as the ratio of estrogen fractions (the predominance of estrone and estradiol in the follicular phase, and estriol in the luteal phase) lead to morphological changes in the myometrium. Myometrial mass can increase as a result of both hyperplasia of smooth muscle cells, which is initiated by estrogens, and hypertrophy of these cells. Along with estrogens, the growth of fibroids is stimulated by progesterone. Hypertrophy of smooth muscle cells in uterine fibroids is similar to their hypertrophy during pregnancy and can only occur with the combined effect of relatively high concentrations of estradiol and progesterone. During the luteal phase, progesterone increases the mitotic activity of fibroids, in addition, progesterone affects the growth of fibroids by inducing growth factors. There are more estradiol and progesterone receptors in myoma tissue than in the unchanged myometrium. Disruption of sex steroid metabolism in myomatous nodes causes autocrine stimulation of cells with the participation of so-called growth factors. Mediators of the action of estrogens in uterine fibroid tissue are insulin-like growth factors I and II.

Along with the hormonal aspects of the pathogenesis of uterine fibroids, changes in the body’s immune reactivity play an important role, especially in chronic foci of infection; pronounced changes in pelvic hemodynamics, as well as hereditary predisposition. Myoma growth zones form around inflammatory infiltrates and endometriotic foci in the myometrium. In the growth of fibroids, a significant role is played by the phenotypic transformation of smooth muscle cells and degenerative changes in conditions of impaired microcirculation. The rudiments of myomatous nodes can form at the embryonic stage. The growth of progenitor cells continues for many years against the background of pronounced ovarian activity under the influence of estrogens and progesterone.

Myomas are heterogeneous in structure. Based on their tissue composition, nodes are divided into myomas, fibromas, angiomyomas and adenomyomas.

Based on morphogenetic characteristics, there are 3 main forms:

• simple fibroids developing as benign muscular hyperplasia;
• proliferating fibroids with morphogenetic criteria of a true benign tumor. Every 4th patient has proliferating uterine fibroids with rapid growth of myomatous nodes. Pathological mitoses in proliferating fibroids do not exceed 25%;
• presarcomas are a stage on the path to true malignancy.

Presarcoma includes multiple foci of proliferation of myogenic elements with symptoms of atypia, heterogeneity of cell nuclei; the number of pathological mitoses reaches 75%. However, true malignancy of fibroids occurs in less than 1% of clinical cases.

Depending on the location and growth of myomatous nodes, submucosal (submucosal) myomatous nodes are distinguished, growing into the uterine cavity and deforming it (see section “Intrauterine pathology”), and subserous (subperitoneal) nodes. Myomatous nodes grow towards the abdominal cavity. If, as the myomatous node grows, it separates the leaves of the broad uterine ligament. It is called an intraligamentary myomatous node. Interstitial (intermuscular) myomatous nodes grow from the middle layer of the myometrium and are located in the thickness of the myometrium.

Symptoms of Uterine Fibroids

The clinical picture of subserous myomatous nodes largely depends on their topographic location and size. There is a classification of subserous nodes based on the ratio of interstitial and subserous components:

• Type 0 - subserous myomatous node on a thin base;
• Type 1 - less than 50% of the volume of the myomatous node is located interstitially;
• Type 2 - more than 50% of the volume of the myomatous node is located interstitially;
• Type 3 - intraligamentary subserous myomatous nodes.

Individual subserous myomatous nodes (type 0) of small sizes may not manifest themselves clinically for a long time, but as their size increases, signs of malnutrition of the tumor appear, and the likelihood of torsion of the pedicle of the myomatous node increases. Patients may complain of discomfort in the lower abdomen, periodic nagging or sharp pain. Pain can radiate to the lumbar region, leg, perineum. When the legs of the myomatous node are torsioned or a large area of ​​necrosis occurs, the pain becomes intense, symptoms of peritoneal irritation and general clinical signs of peritonitis appear.

Interstitial-subserous myomatous nodes of types 1 and 2 are less susceptible to destructive processes due to malnutrition, do not manifest themselves clinically for a long time and can reach a diameter of 10-25 cm or more. Patients are concerned about a feeling of heaviness and discomfort in the lower abdomen, and an enlarged abdomen. Pain syndrome is associated with stretching of the visceral peritoneum of the uterus, pressure of myomatous nodes on the nerve plexuses of the pelvis. If blood circulation is impaired in large myomatous nodes, the pain is acute. Depending on the location of the subserous nodes, dysfunction of neighboring organs may occur. Anterior growth of the myomatous node contributes to the development of dysuric phenomena: patients complain of frequent urination, incomplete emptying of the bladder, imperative urge to urinate, and acute urinary retention. The isthmus location of the myomatous node on the posterior wall of the uterus leads to pressure on the rectum and disrupts bowel movements. Subserous nodes, located on the lateral wall of the uterus in the lower and middle third, when they reach large sizes, change the topography of the ureter and can lead to disruption of the passage of urine on the affected side, the appearance of a hydroureter and the formation of hydronephrosis. Subserous myomatous nodes rarely cause menstrual dysfunction. However, with multiple subserous myomatous nodes of types 1-2, disruption of the contractility of the myometrium with menometrorrhagia is possible.

Interstitial myomatous nodes lead to uterine enlargement and can markedly affect the contractility of the myometrium. Patients complain of heavy, prolonged menstruation, less often of intermenstrual bleeding from the genital tract. However, there is no direct relationship between the size of the uterus and the occurrence of uterine bleeding. Anemia in patients with uterine fibroids may be a consequence of chronic blood loss and acute uterine bleeding. Without menstrual irregularities, anemia can be caused by the deposition of blood in the uterus enlarged by myomatous nodes. Patients with large uterine fibroids (more than 20 weeks of pregnancy) may have inferior vena cava syndrome - palpitations and shortness of breath when lying down. Patients may complain of pain, abdominal enlargement, acute urinary retention, and hydronephrosis.

With a combination of interstitial, submucosal and subserous nodes, the clinical picture is more diverse than with isolated myomatous nodes.

Diagnosis of uterine fibroids

During a gynecological examination, individual subserous myomatous nodes (type 0) are palpated separately from the uterus as round, dense, mobile formations. Subserous nodes of types 1-2 lead to an enlargement of the uterus and a change in its shape. The uterus can reach significant sizes, its surface becomes lumpy, myomatous nodes are dense, and if blood circulation is impaired, palpation is painful. Subserous nodes of the 3rd type (intraligamentary) are determined on the side of the uterus by performing the parametrium. The lower pole of the node is reachable by palpation through the lateral vaginal fornix, the node has a dense consistency, and has limited mobility when trying to displace it. In patients with interstitial myoma, an enlarged uterus of dense consistency with a smooth or tuberous surface is palpated, usually painless.

With ultrasound, subserous myomatous nodes are visualized as round or oval formations extending beyond the outer contour of the uterus. Myomatous nodes often have a layered structure and a so-called pseudocapsule, which is formed as a result of compaction and hypertrophy of the myometrium adjacent to the myomatous node. Echogenicity and sound conductivity depend on the histological structure of the myomatous node. In homogeneous hyperechoic myomatous nodes, fibrous tissue predominates. The appearance of intranodular hypoechoic inclusions indicates necrosis or cystic cavities. Hyperechoic inclusions with an acoustic absorption effect occur with calcified degenerative changes. Ultrasound scanning can detect interstitial myomatous nodes with a diameter of no more than 8-10 mm. According to ultrasound data, depending on the direction of growth of interstitial myomatous nodes, the appearance of submucosal and subserous myomatous nodes can be predicted. The centripetal location of fibroids indicates the growth of an interstitial myomatous node into the uterine cavity; when such a node increases by more than 10 mm, a clear deformation of the uterine cavity appears. Centrifugal growth of nodes occurs towards the abdominal cavity. Central growth occurs with true intermuscular localization of myomatous nodes and leads to diffuse enlargement of the uterus. Ultrasound scanning is complemented by the study of peri- and intranodular blood flow to clarify the tumor morphotype. The growth of myomatous nodes depends on the increase in blood flow in the uterine vasculature. The density of the vessels is associated with the morphological structure and localization of the myomatous node. A large number of arteries are located on the periphery of the myomatous node. Ultrasound, supplemented by Doppler ultrasound, allows you to assess the characteristics of blood circulation in myomatous nodes. With simple fibroids, a single peripheral blood flow is recorded, with proliferating fibroids - intense central and peripheral intratumoral blood flow.

To clarify the topographic location of subserous myomatous nodes, ultrasound tomographs that provide a three-dimensional ultrasound image can be used.

For differential diagnosis of subserous nodes and tumors of the retroperitoneal space, enlarged lymph nodes, tumors of the pelvis and abdominal cavity, along with ultrasound, computed tomography and magnetic resonance imaging are used.

Diagnostic laparoscopy is indicated when it is impossible to differentiate between subserous uterine fibroids and tumors of the abdominal cavity and retroperitoneal space using non-invasive methods.

Hysteroscopy is indicated for the occurrence of menstrual irregularities in patients with a uterus that is enlarged by no more than 12-13 weeks of pregnancy. With greater enlargement of the uterus, the information content of hysteroscopy decreases. To exclude pathology of the endometrium and the mucous membrane of the cervical canal in patients with metrorrhagia and contact bleeding, regardless of the size of the uterine fibroids, separate diagnostic curettage of the uterine mucosa is performed.

Treatment of Uterine Fibroids

The question of the advisability of treatment for small uterine fibroids without clinical manifestations has not been completely resolved. Nevertheless, such patients are advised to undergo dynamic monitoring by a gynecologist with mandatory ultrasound monitoring once a year. Patients are given recommendations aimed at preventing further growth of fibroids and regulating the hypothalamic-pituitary-ovarian relationship. Excess carbohydrates and fats are excluded from the diet, spicy and salty foods are limited. Patients are advised to avoid thermal procedures; they should not sunbathe in the sun or in an artificial solarium. Myoma can increase due to massage and physiotherapy for somatic diseases. In order to regulate menstrual function, vitamin therapy is recommended according to the phases of the menstrual cycle (folic acid and B vitamins in the first phase and vitamins C, E and A in the second phase) or the use of hormonal contraceptives. Monophasic estrogen-gestagen drugs and low-dose gestagens are preferred.

Conservative treatment of uterine fibroids carried out to inhibit the growth or reverse development of a tumor, treat menometrorrhagia and anemia. For this purpose, derivatives of 19-norsteroids are prescribed (norcolut, primolut-nor, norethisterone, organametril, gestrinone, nemestran). Under the influence of these drugs, fibroids and, accordingly, the uterus are reduced on average by 1 - 2 weeks of pregnancy; blood loss during menstruation is reduced and hemoglobin levels are normalized. In reproductive age, gestagens are prescribed cyclically from the 16th to 25th day of the menstrual cycle or from the 5th to 25th day for 6-24 months. As a rule, a clinical effect can be obtained with fibroids not exceeding 8 weeks of pregnancy. In perimenopausal patients, it is advisable to use gestagens continuously for 6 months, thereby promoting drug-induced endometrial atrophy and the onset of menopause.

Antigonadotropins with a steroid structure (danazol, gestrinone) and gonadoliberin agonists (zoladex, diferelin, buserelin, etc.) affect the growth of myomatous nodes. Under the influence of GnLH agonists, it is possible to reduce the volume of myomatous nodes by up to 55%. However, after stopping the drug and restoring menstrual function, 67% of patients begin to experience expansive growth of fibroids with signs of malnutrition. The use of GnLH agonists is advisable in perimenopausal patients, since it causes a persistent reduction in steroidogenesis and the onset of menopause. Antigonadotropins (nemistran, gestrinone) are also used to create medicinal menopause.

GnLH agonists are used for preoperative preparation for conservative myomectomy. Under the influence of GnLH agonists, the structure of the myomatous node becomes denser, and intranodular and perinodular blood flow decreases. A decrease in intratumoral blood flow, as well as a decrease in fibroids and myometrial density around myomatous nodes are most pronounced after 2-3 injections of the drug. With a longer course of hormonal preparation, due to the progressive reduction of arterial blood flow, destructive and necrobiotic processes in myomatous nodes are possible, complicating conservative myomectomy.

GnLH agonists can change the topography of interstitial-submucosal nodes towards the uterine cavity, and interstitial-subserous nodes - towards the abdominal cavity.

The use of GnLH agonists makes it possible to facilitate laparoscopic conservative myomectomy and hysterectomy in 76% of patients due to reduction of the uterus and myomatous nodes. With all conservative myomectomies, after hormonal preparation, blood loss is reduced by 35-40%.

In order to prevent menometrorrhagia and fibroid growth, the Mirena intrauterine hormonal system containing a capsule with levonorgestrel (gestagen) is used. Mirena is administered for a period of 5 years; it ensures regular delivery of levonorgestrel into the uterine cavity and local action on the endometrium and myometrium with minimal systemic effects. Menstruation becomes scanty, and in some cases drug-induced amenorrhea occurs. Contraindications for the use of Mirena: submucous myomatous nodes, a large uterine cavity, as well as absolute indications for surgical treatment.

Surgical treatment of uterine fibroids remains leading, despite fairly effective conservative methods. The frequency of radical operations is 80%. Surgical interventions for uterine fibroids account for 45% of abdominal interventions in gynecology.

Indications for surgical treatment of patients with uterine fibroids:

• large fibroids (13-14 weeks of pregnancy);
• rapid growth of fibroids (more than 4 weeks per year);
• submucosal location of the node;
• subserous node type 0;
• malnutrition, necrosis of myomatous node;
• cervical fibroids;
• uterine fibroids and menometrorrhagia, anemizing the patient;
• growth of fibroids in postmenopause;
• dysfunction of neighboring organs;
• infertility and recurrent miscarriage.

Surgical treatment of uterine fibroids can be radical or functional (organ-preserving). Currently, there is a tendency to reduce the number of radical surgical interventions for uterine fibroids and expand the indications for organ-preserving operations. Functional surgery of the uterus, in addition to preserving menstrual and reproductive functions, helps prevent disruption of the pelvic organs and helps prevent their prolapse.

The extent of surgical intervention depends on various factors. Surgical treatment of uterine fibroids is considered radical when performing a hysterectomy and includes hysterectomy or supravaginal amputation of the uterus without appendages. The cervix of the uterus plays an important role in the formation of the pelvic floor and blood supply to the genitourinary system, therefore the scope of surgical intervention is expanded to hysterectomy in women of reproductive age with recurrent background processes of the cervix, leukoplakia with dysplasia of stratified squamous epithelium, as well as with the cervical and isthmus location of the myomatous node. In patients with newly diagnosed underlying cervical disease, conservative treatment of this pathology should be carried out at the first stage, and supravaginal amputation of the uterus should be performed at the second stage.

Hysterectomy can be performed through abdominal, laparoscopic and vaginal approaches. The choice of surgical approach depends on the size of the uterus, the size and location of myomatous nodes, as well as on the experience and qualifications of the surgeon.

Functional surgery of fibroids. There are methods of surgical intervention that allow maintaining adequate blood supply to the ovaries by isolating the ascending branches of the uterine arteries and preserving menstrual function with high supravaginal amputation, as well as defundation of the uterus.

Menstrual and reproductive functions with uterine fibroids can be preserved by conservative myomectomy. Myomectomy consists of removing myomatous nodes and preserving the uterine body and can be performed by laparotomy, laparoscopic and hysteroscopic access.

The choice of surgical approach depends on:

Laparotomy access is preferable for multiple interstitial myomatous nodes more than 7-10 cm, with low cervical-isthmus localization of nodes, especially along the posterior and lateral walls of the uterus. Laparotomy access allows adequate comparison of the edges of the bed of the removed large node with the application of double-row vicryl sutures. The course of the planned pregnancy and the management of childbirth depend on the usefulness of the uterine scar.

Laparoscopic access is indicated for subserous myomatous nodes of types 0-3, as well as for interstitial myomatous nodes with a diameter of no more than 4-5 cm.

Individual subserous myomatous nodes (type 0) do not pose any difficulties for endoscopic removal. After fixation with serrated forceps, the node is separated from the uterus, coagulating the pedicle, after which it is crossed with scissors or a coagulator. Modern marcellators make it possible to remove nodes of various sizes and weights from the abdominal cavity; small myomatous nodes can be removed through a mini-laparotomy and colpotomy opening.

Interstitial-subserous myomatous nodes are removed by decapsulation and enucleation with step-by-step coagulation of the bleeding vessels of the bed. If the size of the bed remaining after conservative myomectomy is significant, endoscopic double-row sutures are applied along with electrosurgical coagulation. Suturing the node bed allows for additional hemostasis, helps prevent adhesions in the pelvis and forms a full-fledged scar.

Intraligamentary nodes are removed after dissection in the transverse or oblique direction of the anterior layer of the broad uterine ligament and enucleation.

Removal of small interstitial myomatous nodes is particularly difficult. Located in the thickness of the myometrium, myomatous nodes do not deform the outer contours of the uterus, which complicates visual diagnosis during surgery. The indication for removal of myomatous nodes in these cases is preparation for pregnancy or stimulation of ovarian function in women with infertility. For accurate topical diagnosis, intraoperative ultrasound is performed using vaginal, rectal and transabdominal sensors. This allows for precise localization and removal of interstitial nodes with a diameter of 1 to 3 cm with minimal trauma. After ultrasound localization, a small deep incision is made above the location of the node, and the myomatous node is grabbed with serrated forceps or a corkscrew. The feeding vessels are coagulated after enucleation of the node.

There is no consensus on the number of myomatous nodes to be removed. The doctor’s tactics depend on the goal—preserving reproductive or menstrual function. It is important that after conservative myomectomy it is possible to prolong pregnancy.

Endoscopic myomectomy allows preserving menstrual function in all operated patients and restoring reproductive function in every 3rd patient. Pregnancy can be planned 6 months after surgery. After removal of large interstitial-subserous myomatous nodes, as well as after removal of interstitial nodes, delivery by cesarean section is preferable.

For submucosal myomatous nodes, conservative hysteroscopic myomectomy using mechanical, electrosurgical and laser methods is possible.

Conservative surgical methods for treating uterine fibroids include laparoscopic myolysis (vaporization of the myomatous node using a laser) and uterine artery embolization.

Uterine artery embolization (UAE) is performed under x-ray guidance by catheterizing the femoral artery and placing emboli into the uterine artery. Thus, the blood supply is disrupted and degenerative processes occur in the myomatous nodes. Myomatous nodes are reduced and their further growth is prevented.

Forecast. Uterine fibroids are benign tumors with rare malignancy, so the prognosis for life is favorable. However, fibroid growth may require surgical treatment to exclude menstrual and reproductive functions in young women. Even small myomatous nodes can cause primary and secondary infertility.

Prevention of uterine fibroids

Prevention of uterine fibroids involves timely detection of the disease in the early stages.

Uterine fibroids are a benign neoplasm that is localized in the muscular layer of the organ and consists of muscle fibers. This tumor is quite common; every 4th woman is diagnosed with it.

Cervical fibroid is a fibroid node on the cervix, and as it grows it moves into the vagina. This type of neoplasm is rare.

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Fibromyoma is a benign tumor that is formed from smooth muscle tissue and has a pronounced connective component.

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For example, this is abortion, hysteroscopy, laparoscopy, biopsy, coagulation of the cervix. Sexually transmitted infections are also of great importance in the development of such neoplasms.

Many young people begin to be sexually active quite early and without barrier protection. This often becomes a prerequisite for the development of fibroids.

How big can these formations be?

The size of fibroids is one of the main parameters due to which effective treatment is prescribed. They can be calculated in millimeters (mm), centimeters (cm), and also weeks of pregnancy.

The size of the fibroid is its diameter (cm, mm). But also one of the criteria is the size of the uterus, which is calculated in weeks of pregnancy. That is, the size of the organ corresponds to its size at different stages of pregnancy.

According to these criteria, the doctor can determine the approximate size of the formation during a gynecological examination. This is explained by the fact that as the node grows, the uterus also increases in size. Despite the fact that there are many modern diagnostic methods, doctors today still use this method.

We can say that the tumor enlarges the uterine cavity, just like the embryo growing in it. The gestational age fully corresponds to the size of the organ in centimeters, that is, the height of its bottom.

What size does the uterus reach? At 8-9 weeks the uterus reaches 8-9 cm, 10-13 weeks - 10-11 cm, 14-15 - 12-13 cm, 16-17 - 14-19 cm, etc.

The diameter can only be determined using ultrasound, although this method also does not provide accurate numbers.

More accurate results are determined by MRI and CT.

Such modern methods can diagnose myomatous nodes, the diameter of which is only 5 mm.

Depending on the size, the following types of fibroids are divided:

• small;
• average;
• big.

Small tumor

Small fibromyoma is a tumor that is treated conservatively. The uterus can correspond to the size of up to 6 weeks of pregnancy, but no more. Small fibroids range in size from 15 mm to 25 mm.

The operation is performed only if the fibroid is of the submucous type, if there is torsion of the pedicle in the fibroid of the subserous type, or if there is a high probability of this.

Also, small nodes can be removed if the patient has been diagnosed with infertility or has developed anemia due to heavy bleeding.

Small formations of the interstitial type do not appear in any way.

Such myoma or fibromyoma often decreases significantly or disappears completely upon the onset of menopause.

But there may be situations when an operation during this period is necessary.

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Medium myoma and fibromyoma

An average myomatous node is diagnosed if the uterus is enlarged before 10-12 weeks of pregnancy. The diameter of such fibroids can reach from 40 mm to 60 mm.

In this case, the conservative method is indicated only if there are no symptoms of the disease, and also if there are no signs of active growth. In other cases, surgery is performed.

With medium-sized formations that are localized on the outer side of the uterine wall, the functioning of nearby organs may already be disrupted. Such nodes can provoke infertility, and spontaneous abortions often occur. This happens especially often if there are lesions of the cervix.

Large knots

If there is a large node, then the uterus has already reached a size comparable to 12-15 weeks of pregnancy, while the diameter of the myoma or fibroids can be 60 mm or more. At this stage of development, the myomatous node is removed during surgery. In this case, the location and type of tumor are unimportant.

Treatment of a large node may involve the use of complex drug treatment, and then surgery is prescribed. Medicines are needed to stop the rapid growth of the tumor.

When performing an operation to remove a large node, there is a risk of bleeding, and as a result, the doctor will be forced to remove the entire organ.

Since removal surgery is quite stressful for the reproductive organs, after it is carried out, medications are necessarily prescribed to normalize the condition and structure of the uterus, as well as to prevent relapse.

To do this, you need to normalize hormonal levels.

How fast can a tumor grow?

In diagnosis and treatment, it is very important how fast the node grows. Rapid growth is noted if the uterus has increased by 5 weeks of pregnancy or more over the course of a year. Such a rapid increase in tumor entails hyperplastic processes in the endometrium and anemia.

Uterine fibroids can grow to very large sizes. Sometimes it reaches 3-5 kg, and the diameter can be up to 40 cm. That is, it can grow to the size of a full-term pregnancy.

The reason for the rapid growth of myomatous nodes is a hormonal imbalance in the body. But it should also be noted that fibroids and fibroids grow rapidly if the following factors occur:

If a woman does not undergo proper treatment, then the node may begin to die, which is very dangerous, since all the symptoms of an “acute abdomen” appear, and the woman must be hospitalized and immediately operated on.

Does this affect pregnancy?

Pregnancy with small and medium fibroids usually proceeds normally. But when the fibroids are large, from 60 mm, then the woman cannot bear a fetus. And also often, even the process of fertilization does not occur, since the node blocks the fallopian tube.

If a pregnant woman is diagnosed with a large node, then during childbirth such serious consequences as bleeding, labor disturbances and the danger of infectious and inflammatory processes may occur.

Especially dangerous are myomatous nodes of the cervix, which grow in the vagina. Such formations can cause a woman to become infertile, and in most cases miscarriages occur. If pregnancy occurs due to cervical fibroids, the patient most of the time is under the supervision of doctors in the hospital to prevent miscarriage.

Pregnancy with cervical fibroids may be accompanied by complications such as intrauterine fetal death and uterine bleeding.

If the formation on the cervix rapidly increases and poses a threat to the life of the pregnant woman, then the pregnancy is terminated.

According to statistics, during pregnancy in 50% of women the myomatous node does not grow, in 10-20% it decreases, and in 20-30% the tumor begins to actively grow.

Indications for surgery

Doctors prescribe surgery for the patient in the following cases:

Women who have reached menopause also often undergo surgery. If the patient has pain, sometimes at this age a woman is recommended to have the entire organ removed.

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One of the most common operations in gynecology is hysterectomy. Complete or partial removal of the uterus is a serious surgical procedure, so it is necessary to take into account the indications for surgical treatment. A doctor will never offer a surgical treatment option if there are uterine fibroids or the nodes do not interfere with the woman’s normal life. In what cases the operation is performed, the specialist knows exactly, so there is no need to refuse treatment: if the size of the tumor has reached large sizes or uterine bleeding occurs, then the only type of therapy is complete removal of the uterus.

Reviews from doctors and patients indicate that if surgery is not performed on time, there may be complications that significantly reduce a woman’s quality of life.

When to operate

All readings can be divided into absolute and relative. The first include the following types of pathology:

• heavy and prolonged bleeding associated with menstruation or occurring regardless of menstruation;
• large tumor sizes, changing the anatomical situation in the woman’s pelvis;
• the size of a benign tumor formation, similar to 12 weeks of pregnancy;
• rapid growth of leiomyoma, when the tumor increases in a short period of time;
• large pedunculated subserous tumor with a risk of torsion and acute symptoms;
• necrosis of fibroids with signs of inflammation and pain;
• submucosal node larger than 50 mm;
• suspicion of uterine cancer.

Relative indications for surgery:

• cervical-isthmus location of leiomyoma;
• intraligamentary leiomyoma;
• combination of uterine fibroids with frequently recurring endometrial hyperplasia and ovarian tumors.

At the stage of examination, treatment and monitoring of myomatous nodes, the doctor will evaluate pathological changes from the point of view of the need to perform surgery. A woman’s desire to give birth to a child is of great importance. In this case, everything possible must be done to save the uterus.

What tumor sizes are important for surgery?

If surgery is necessary, the doctor will always assess the size of the benign tumor, which is performed during a gynecological examination and using an ultrasound scan. During the initial examination, the doctor may find:

• uterus up to 12-13 weeks of pregnancy;
• giant uterine tumor more than 15 weeks old;
• large subserous nodes (more than 60 mm);
• newborn submucous tumor larger than 50 mm.

If uterine fibroids of similar size and location are detected, then surgery is needed to remove the organ. Usually, no other treatment methods are able to change the situation with muscle tumor in a positive direction.

If, upon repeated examination by a doctor, a rapid growth of the nodular neoplasm is detected (in 6 months the size has increased by 5 weeks), then surgery to remove the fibroids cannot be avoided. That is why, with any type of tumor formation, regular monitoring by a specialist is necessary: ​​otherwise, a rapid increase will not be noticed.

With ultrasound scanning, the doctor can estimate the size of the nodes in millimeters, which significantly improves the choice of treatment tactics. An ultrasound will detect the following options:

Small fibroids

If an ultrasound reveals a single node or several small fibroids, the size of which does not exceed 15 mm, then there is no need for surgery. At this stage, drug therapy can and should be used.

Multiple small fibroids

The total volume of the tumor lasts for 6-7 weeks, and each node does not exceed 20 mm.

In this situation, the woman will complain of heavy menstruation and lack of pregnancy. A specialist may start with medicinal treatments, especially if the woman has reproductive plans for the coming years. Surgery to remove fibroids will be required if the nodes grow rapidly.

Medium sized fibroids

The volume is similar to pregnancy at 8 weeks, and a single node does not exceed 40 mm. As a rule, in this case it is necessary to use surgery to remove the node (conservative myomectomy). Especially if a woman wants to give birth to a baby.

Multiple fibroids with a dominant node of medium diameter

If there are many small nodules and one interstitial nodule measuring up to 40-60 mm, then the doctor will suggest an organ-preserving therapy option. The method of uterine artery embolization can provide an excellent effect.

Large fibroids

If there are one or more nodes larger than 60 mm, then surgery to remove the tumor is indispensable. In some cases, the doctor may initially suggest drug treatment to shrink the tumor to make it easier for the surgeon to perform the operation.

Submucosal fibroid

The presence of a node in the uterine cavity, up to 50 mm in size, is an indication for endoscopic surgery - hysteroresectoscopy. The doctor can easily remove the tumor-like formation on the leg, preserving the woman’s chances of childbearing. However, if the node is more than 50 mm, then other treatment methods will need to be used.

Subserous fibroid on a pedicle

Regardless of the size, the doctor will perform endoscopic surgery (laparoscopy) to remove the node. This treatment option is optimal: reviews from women after laparoscopic interventions indicate an excellent effect, rapid recovery and the ability to conceive a baby in the near future.

After any organ-conserving surgery, it is necessary to continue drug therapy, because in the absence of observation and treatment, recurrence of uterine fibroids is possible.

If a hysterectomy is performed, no further observation is required. Reviews from young women who underwent conservative tumor removal allow us to remain optimistic - the majority were able to become pregnant and successfully carry a child to term, giving birth to a baby on time. If a hysterectomy was done, then reviews indicate positive changes for everyday comfort - no uterine bleeding, and no severe pain. At the same time, the woman does not have any problems with her personal life and external changes caused by hormonal imbalances.

In some cases, the surgeon will perform a partial hysterectomy, where the uterus is removed but the cervix is ​​left in place. Supravaginal amputation is technically easier to perform, there are fewer complications after surgery, and at the same time the woman has the appearance of maintaining normal anatomy, which sometimes has implications for her personal life.

Uterine fibroids are a benign neoplasm in the area of ​​the uterine body or cervix, which occurs quite often in women of all ages. Such tumors are usually not dangerous to life and health, but sometimes they grow to large sizes, put pressure on surrounding organs, and there is a possibility of their degeneration into a malignant tumor. They prefer to operate on fibroids in most cases; it is worth learning more about the size of uterine fibroids in millimeters for surgery, what types of surgical intervention are there.

Myoma is one of the most common gynecological pathologies, along with various types of cysts. The neoplasm is benign, it is usually dense, consists of fibrous tissue and muscle fibers, the symptoms of this disease are usually quite mild. Often the disease is detected exclusively during a preventive examination by a gynecologist. According to the latest data, fibroids are detected in 80% of women. However, the tumor manifests itself clinically in only 35% of women.

Previously, it was believed that this disease occurs exclusively in older women, but recently doctors often diagnose the pathology in young women. Most likely, this is due to the fact that the diagnostic capabilities of medicine are improving over time, now the disease is detected much earlier, it is possible to track the slightest changes and differences from the normal state in the organs of the reproductive system.

Fibroids can increase or decrease in size under the influence of various factors; this process can proceed rather slowly. In medical practice, there have been cases where the tumor reached 18–20 centimeters in diameter and compressed the pelvic and abdominal organs.

At the very beginning of the development of pathology, a neoplasm can usually be gotten rid of with the help of medications; they are required if the tumor is small and just beginning to develop. Larger fibroids must be removed surgically, using different methods depending on the size and location of the tumor.

Multiple fibroids are also quite common; the tissues that form the tumor are distributed unevenly and form several separate tumors. Before starting treatment and operations, it is important to find out the exact number of tumors and their location. If you leave any fibroid, it may continue to grow, and you will not be able to completely get rid of the disease.

Also, in the early stages, removal and any intervention may not always be required. The approach to treating this tumor is usually individual; it is impossible to come up with a general treatment plan that would suit every patient with this disease. Depending on the indication, it may only be necessary to observe the nature of tumor development without intervention until certain stages.

In general, fibroids are not a dangerous diagnosis. However, without observation and the necessary surgical intervention, proper treatment, it develops uncontrollably, and you may miss the moment when complications begin to develop.

Important! To identify fibroids at an early stage, all women of reproductive age are advised to visit a gynecologist once a year with an ultrasound examination in order to notice changes in time.

In general, fibroids are considered a fairly “safe” tumor; they extremely rarely lead to cancer and provoke other disorders in the organs of the reproductive system. However, it is worth noting that it is still worth monitoring the dynamics of changes in this disease and applying appropriate treatment, if necessary.

First of all, fibroids, especially large ones, cause many unpleasant symptoms: pain in the lower abdomen, complicated menstruation, bleeding can be more heavy and prolonged. There is also always the possibility of compression of neighboring organs, for example, the kidneys, urinary tract with formations of hydronephrosis (enlarged kidney) and hydroureter (enlarged ureter). The larger the tumor, the higher the likelihood of such complications.

Uterine fibroids are especially dangerous during pregnancy. During pregnancy, small tumors tend to shrink, but a large tumor can begin to grow faster under the influence of changes in a woman’s hormonal levels; large tumors greatly increase the likelihood of miscarriage and other complications during pregnancy. Therefore, before carrying a child, it is always advised to undergo an examination by a gynecologist and make sure that there are no pathologies that could affect the health of the expectant mother and child.

Important! Also, the very fact of the appearance of a tumor can indicate various disorders in the functioning of the body, for example, problems with a woman’s hormonal levels.

Can fibroids resolve?

This neoplasm should not be confused with a functional cyst, which can easily disappear on its own. Fibroids do not resolve on their own, however, small tumors can go away under the influence of drug treatment; usually drug therapy is suitable for small uterine fibroids of no more than eight millimeters in diameter.

For treatment without surgery, various drugs are used; depending on the disorders that accompany the development of the tumor, hormonal drugs and hemostatic drugs may be required. You may also need to take various vitamins and eat a healthy diet.

First of all, it is worth noting that there are many types of surgical intervention; its choice depends on the size of the fibroids; usually specialists determine it in weeks, comparing it with the size of the uterus during pregnancy. In general, all neoplasms can be divided into several groups, the classification by size is as follows:

1. Small. Size - up to 2 centimeters (20 millimeters), usually about four weeks.
2. Average. Size – from 2 to 6 centimeters (up to 60 millimeters), period – 10 – 11 weeks.
3. Big. Size from 6 centimeters (from 60 millimeters), period - from 11 weeks and above.

Dangerous sizes are considered large, in which the tumor can be six centimeters or more, especially from 15 weeks. At this stage, in most cases, removal is indicated, especially if the likelihood of complications is high.

Types of operations

Depending on the size of the fibroid in weeks or millimeters, it is best to select the type of intervention. There are several types of operations; it is also worth paying attention to other characteristics of fibroids: whether multiple nodes are present, its location, the presence of complications, for example, torsion of the tumor stalk. Depending on all factors and size, the following types of interventions are usually used:

1. Organ-preserving operations. With such interventions, only myomatous nodes are removed. The operation can be performed laparoscopically - the most gentle method. With this operation, only a few punctures are made, the recovery period does not take much time, and in one operation several nodes can be removed in case of multiple fibroids. The second method is transcervical (access through the cervix).
2. The radical method of removing fibroids is hysterectomy, the complete removal of the uterus along with the tumor. This technique is indicated in the later stages of the disease, for large tumors, if there are concomitant pathologies, for example, endometriosis. Before resorting to this method, it is first worth considering other types of interventions. This method is most suitable for treating women during menopause; the uterus is removed if several nodes are present for more than fifteen weeks.

There are practically no contraindications to various types of surgical intervention; modern techniques allow the operation to be performed as safely and without complications. After removal of fibroids, you need to be observed by a gynecologist for some time, since there is a possibility of new nodes developing.

Sizes for surgery during pregnancy

It happens that fibroids have to be removed during pregnancy. This is done in extreme cases; removal of such a tumor depends not on size, but on the danger to the fetus. If the tumor greatly interferes with normal pregnancy, the likelihood of miscarriage in the expectant mother increases, the fibroid must be removed.

In addition, pregnant women with such tumors are usually delivered by cesarean section, since fibroids also affect the course of labor - untimely discharge of water, abnormalities of contractile activity, etc. During a caesarean section, after removing the baby, it is sometimes necessary to remove fibroid nodes, and even the entire uterus.

In general, during pregnancy, large tumors begin to grow faster due to the influence of hormones; pregnancy in this case should proceed under the constant supervision of the attending physician. The presence of large fibroids and malnutrition of the child are indications for myomectomy.