Uterine fibroids - what is this disease and how to treat it? In ICD-10, this pathology is classified as leiomyoma under the code D25. In almost all cases, it is a benign tumor. However, even such neoplasms can lead to the development of serious complications requiring complex treatment.
Modern gynecologists can easily diagnose even microscopic tumors up to a centimeter, which are often detected quite by accident. Some women can even live with fibroids all their lives and not face a single complication, while others are forced to undergo surgery to remove tumors due to all sorts of consequences.
Uterine fibroids - what is this disease
The symptoms of this pathology depend primarily on the size of the tumor and the general he alth of the woman. Myoma is a neoplasm consisting of muscle tissue, which is characterized by slow growth and benign nature. Impressive tumors certainly do not develop in a few years. If the neoplasm growsrapidly, its malignant nature cannot be ruled out.
Uterine fibroids is a female disease, the exact mechanism of which is still not fully understood. In recent decades, the incidence has increased significantly among girls under 30 years of age. This phenomenon is explained not only by harmful environmental conditions, but also by improved diagnostic methods.
Features
There are several important statements regarding uterine fibroids.
- It occurs exclusively in women of reproductive age, and gradually disappears during menopause, since certain sex hormones are required for its development. If a neoplasm is diagnosed in a woman at the menopause stage, one can suspect its malignant nature.
- Approximately 80% of women with fibroids have hormonal abnormalities - menstrual irregularities, symptoms of polycystic disease, uterine polyps, malfunctioning of the thyroid gland.
- Often pathology is combined with mastopathy. The breast and uterus are interconnected functionally. Abnormal changes in one organ often lead to deviations in the work of another. That is why most women with fibroids often have mastopathy at different stages. Such a condition should be treated in a complex, and not separately.
- All the information that doctors have today does not make it possible to determine the real causes of the defect. All modern medicines can only temporarily stop the development of neoplasms and the corresponding consequences.
- In medicine, fibroids are called by various terms. This is explained very simply. The uterus itself is made up of connective and muscular tissue. It is impossible to determine exactly what tissue the tumor consists of before its removal and histological analysis, even with the help of CT, ultrasound and MRI. Although this nuance does not affect the tactics of treating women with fibroids.
Histological analysis can determine the nature of the tumor:
- leiomyoma - consists solely of smooth muscle structures;
- rhabdomyoma - from other muscle fibers;
- fibromyoma - from muscle and connective tissue;
- fibroma - a large area consists of connective cells.
Classification
Uterine fibroids - what is this disease? In the photo you can see what this pathology is. Although it is, of course, impossible to visually determine it, you should rely on other symptoms and your own observations. If you suspect that you have such a tumor, be sure to go to the gynecologist. Remember that it is much easier to cure this defect in the early stages than in a neglected state.
Uterine fibroids - what is this disease? This is one of the most common pathologies in women of reproductive age. This disease occurs in about 25-30% of modern women. The prevalence of the defect increases with age. The real peak of the disease falls on 40-45 years.
Medics divide fibroids into several types.
- Small - one or more knots up to 5 cm.
- Big -the presence of at least one mass larger than 5 cm or uterine parameters corresponding to 12 weeks of pregnancy (approximately 11-12 cm).
- Multiple - a history of uterine fibroids implies more than three nodules.
- Solitary - the presence of only one tumor.
- Submucosal - the history of uterine fibroids suggests the localization of the neoplasm with a protrusion into the uterine cavity, which contributes to its deformation.
- Subserous - the tumor is located above the surface of the uterus, protruding into the abdominal cavity.
- Interstitial - the node is located directly in the muscle wall.
- Mixed - often fibroids grow in different directions, then doctors talk about a mixed type.
- Symptomatic - a tumor that appears against the background of some abnormal conditions, for example, due to bleeding during anemia.
- Cervical - the node is localized in the area of the cervix, the frequency is approximately 6-7% of all diagnosed uterine fibroids.
What is this disease and how to detect it? Of course, the doctor will tell you about all this at the reception. However, the general symptoms of pathology, by which it can be suspected, should be known to every woman.
Causes of occurrence
Until now, doctors can not determine the exact prerequisite for the development of uterine fibroids. What kind of disease it is and why it occurs is a secret for many scientists. It is generally accepted that, due to heredity, a tissue area is formed in the uterus with an excessively high number of receptors that perceive the influence of hormones. Such endings are more sensitive to gestagens.and estrogen, compared to neighboring tissues. That is why over time this area begins to develop more actively, unlike the others. The body gradually loses control over this process, a tumor appears, the size of which can reach more than 20 cm.
Risk group
In fact, uterine fibroids can appear without obvious causes and predisposing conditions. But most often this defect is diagnosed in women who:
- have a family history of similar illnesses;
- prone to hormonal abnormalities;
- are overweight;
- prone to regular stress, chronic fatigue and lack of sleep;
- did not give birth;
- suffer from metabolic disorders and diabetes;
- had undergone multiple IVF or ovulation induction treatments.
Some scientists believe that uterine fibroids are an environmental disease that occurs due to harmful environmental conditions. However, this statement is due only to the increased incidence of women in recent years. But it has not been confirmed by clinical trials.
Among other things, the factors of increased risk of fibroids include chronic lack of ovulation, inflammatory pathologies, curettage and abortion, as well as genetic predisposition. By the way, contrary to popular belief, the use of oral contraceptives does not increase the likelihood of developing a defect. On the contrary, there is scientific evidence thatthe use of birth control pills reduces the risk and slows the growth of fibroids.
Clinical picture
Usually, signs of pathology become noticeable only after the tumor reaches an impressive size - more than 2-3 cm subcumous neoplasm and about 5 cm subserous and interstitial nodes. Until this time, the history of the disease with uterine fibroids may be characterized by a complete absence of pathological manifestations.
- Sickness. This is the most common symptom of the disease. Uterine fibroids provoke the appearance of pain at the stage of active development and involvement of other organs in the pathological process. Unpleasant sensations are localized in the lumbar region and lower abdomen. Pain can increase many times during intimacy, exercise, and before menstruation. As the nodes progress, the pain becomes constant. It is characterized by pulling sensations, reminiscent of the presence of a stone in the lower abdomen.
- Bleeding. Too abundant menstruation is also a frequent companion of fibroids. They appear for a number of reasons. For example, if the tumor is submucosal, it interferes with the full rejection of the endometrium. If the knot is too large, it deforms the uterine cavity, increases the area that bleeds, and prevents the normal contraction of the myometrium. Systematic blood loss entails the appearance of anemia with a pronounced clinical picture, which is characterized by apathy, lethargy, shortness of breath, pallor, dizziness.
- Infertility. The history of uterine fibroids may also be characterized by such a symptom. Small nodules have almost no effect on the course of pregnancy. But actively developing and too large tumors in the uterine cavity prevent the full formation of the embryo. Fibroids, unlike normal myometrium, do not stretch well, due to which, with an intensive increase in the uterus, the risk of miscarriages and premature births increases.
- Constipation. If the tumor is too large or grows in the rectal area, it can be compressed, against which this symptom appears.
- Problems with urination. Such symptoms occur when a tumor grows on the anterior wall of the uterus. In this case, the woman may experience incontinence or too frequent urge to empty the bladder.
Diagnosis
The most accessible and reliable way to detect pathology is considered to be ultrasound of the pelvic organs. However, even during a routine gynecological examination, a specialist may suspect the presence of nodes if an enlarged uterus or its tuberous structure is noticeable.
To detect a neoplasm using ultrasound, several rules should be followed:
- do at the beginning of the cycle - during this period, you can objectively assess the condition of the endometrium and the parameters of the nodes, 5-6 days is the optimal time;
- transvaginal procedure - makes it possible to detect even miniature neoplasms up to a centimeter;
- regularly monitor the dynamics - to control the development of the tumor, you need to do an ultrasound scan every six months.
If submucosal neoplasms are suspected, a woman is prescribed a hysteroscopy, which makes it possible to immediately remove small nodes.
Some patients are recommended CT or MRI to diagnose the disease in gynecology. Uterine fibroids with their help is determined more easily. In addition, these techniques make it possible to estimate the location of nodes and their sizes as accurately as possible.
Even less often, hysteroscopy and laparoscopy are used to diagnose fibroids. True, such events are most often prescribed already as medical procedures.
Uterine fibroids treatment
What is this disease and how to get rid of it? This question comes first for most women who have been diagnosed with a tumor. Like any other growth, fibroids do not disappear on their own. However, its development can stop and even regress when:
- breastfeeding and pregnancy;
- menopause.
This phenomenon is explained by cardinal changes in the hormonal background at these stages of a woman's life. In all other cases, specific therapy is required.
How to treat the disease? Uterine fibroids are actually poorly amenable to conservative therapies. Usually, drug treatment is only temporary, and simply stops the development of the tumor. Although even after removing all neoplasms, new nodules may appear after some time.
Conservative treatment
To slow down the development of a neoplasm or reduce its area before surgeryInterventions may include drugs in the following categories:
- analogues of the hormone gonadotropin-releasing ("Diferelin", "Decapeptil", "Buserelin", "Zoladex") - suppress the hormonal regulation of the menstrual cycle at all levels, causing a specific state of temporary menopause, as a result, the fibroids and the uterus itself decrease by about 30-50%, but after the withdrawal of the remedy, the symptoms return;
- antigestagens ("Ginepristone", "Mifepristone") - inhibit the effect of progesterone;
- "Esmiya" - has an action similar to antigestagens;
- antigonadotropic drugs ("Gestrinon", "Danazol", "Lukrin Depot") - suppress the production of gonadotropic hormones, that is, FSH and LH, which depresses the activity of the ovaries;
- combined contraceptive pills ("Yarina", "Regulon", "Jess") - lower the production of LH and FSH, suppress ovarian function;
- gestagens ("Utrozhestan", "Dufaston", "Visanne") - used to regulate the menstrual cycle, ineffective in the treatment of fibroids.
With the development of all sorts of complications, such as tumor necrosis or inflammation, antibiotics, antispasmodics, and analgesics in the form of suppositories, injections or tablets are used.
Surgery
Indications for surgery for uterine fibroids:
- Tumor larger than 5 cm;
- symptomatic type of education;
- preparation for IVF;
- growth necrosis or pedicle torsion;
- active development of nodes for six months;
- presence of legs;
- associated malformations of the endometrium and cysts on the ovaries.
The method of surgical intervention is selected taking into account the age of the woman and the presence of concomitant diseases.
Laparoscopy. It is most often used to remove subserous and interstitial tumors. This technique is deservedly considered one of the safest interventions. In addition, modern technologies make it possible, with appropriate indications, to completely remove the uterus
- Laparotomy. The traditional way to remove leiomyoma nodes. The operation may involve the excision of some nodules, partial removal of the uterus or the entire organ.
- Uterine vessel embolization. The technique is aimed at blocking the arteries of the neoplasm, due to which it significantly decreases in size, and sometimes disappears completely. To achieve this result, angiosurgical intervention is performed - bringing a special solution to the arteries of the uterus.
- FUZ-ablation of the tumor. By means of MRI, the location of the growths and their sizes are specified, after which a strong ultrasonic pulse is applied to this area. Gradually, the neoplasm heats up and burns out. True, the technique has a number of contraindications. For example, FUS-ablation is forbidden to be performed with a large myoma and its localization nearpelvic bones.
