Quite an actual problem in medicine (and to be more precise - in the field of gynecology) are pathologies of the uterus. They include various inflammatory lesions of the endometrium and myometrium. One of the most common pathological conditions is uterine fibroids. In medicine, this term refers to a benign tumor. For what reasons do uterine fibroids occur in women, and how is the disease treated? The answers to these questions should be known to all the fair sex, because anyone can face a similar problem.
The essence of the disease and the theory of the origin of fibroids
About such a female ailment as uterine fibroids became known back in 1793. British pathologist Matthew Bailey first described the disease. In subsequent years, uterine fibroids were studied by specialists. To date, it is known that the tumor is a hormone-dependent neoplasm of the muscular membrane of the uterus (myometrium). It is detected, as a rule, in women from the age group over 30.
Statisticstestifies that approximately 1/3 of the fair sex who come to gynecological clinics are diagnosed with uterine fibroids. However, the prevalence of the disease is not judged by the number of patients who applied. In 70% of cases, the tumor grows asymptomatically. Women are often not even aware of its presence, and even more so do not know about the causes of uterine fibroids.
Studies by specialists show that the tumor develops from a single abnormal cell. How this progenitor cell comes to be is debated. There are several theories:
- Mesenchymal. This theory says that the causes of the formation of uterine fibroids are negative changes that occur even in the prenatal period. Undifferentiated mesenchymal precursor cells of uterine smooth muscle cells develop for a long time in the fetus. During this time, they are exposed to the adverse effects of various factors. Under such conditions, there is a possibility of a defective cell.
- Infectious. This theory indicates the formation of a fibroid growth zone around endometrioid foci in the myometrium, inflammatory infiltrates.
Risk factors
The study of the disease in question in the past paid attention, but it did not allow to determine the exact causes of uterine fibroids. Experts were only able to identify predisposing factors. These include early menarche. Studies have shown that women with early periods before the age of 10 years are more likely to develop a tumorhigher. With this beginning of the menstrual cycles, the number of cell divisions that the myometrium undergoes during the reproductive period increases. This, in turn, increases the likelihood of mutation in the genes.
The following factors further increase the likelihood of fibroids:
- no history of childbirth;
- obesity;
- age (late reproductive period);
- African American;
- taking Tamoxifen.
Extremely conflicting reports in the literature about the effect of combined oral contraceptives (COCs) on the growth of benign tumors. In early studies, which indicated the causes of uterine fibroids, experts speculated about the possible negative impact of these drugs. However, in the future, scientists conducted studies, proving the exact opposite effect. They noticed a decrease in the likelihood of growth of uterine fibroids with an increase in the duration of taking contraceptives. After 5 years of COC use, the risk was reduced by 17%.
In the future, however, the point of view about the absence of a negative effect of contraceptives was criticized. Myoma was included in the number of contraindications to taking COCs. Why do research results differ? Modern experts explain this inconsistency with the different doses and types of estrogens and progestogens contained in combined oral contraceptives.
Classification of fibroids
Benign uterine tumors are not characterized by any specificsymptoms. Symptoms of the disease are determined by the type of neoplasm. Depending on the localization in relation to the muscular layer of the uterus, fibroids are isolated:
- intermuscular, or interstitial (tumors are located in the thickness of the wall of the internal organ);
- intraligamentary, or interligamentous (nodes grow between the posterior and anterior layers of the broad ligament of the uterus);
- submucosal, or submucosal (neoplasms grow towards the uterine cavity);
- subperitoneal, or subserous (tumors grow towards the abdominal cavity);
- mixed (combination of 2 or 3 shapes).
Additionally, in the medical literature on uterine fibroids, causes, signs, symptoms and treatment of this disease, the concept of "interstitial tumor with centripetal growth" is found. This term refers to a submucosal neoplasm that affects the muscle layer (it is located in it for more than 1/3 of the volume of the node). Among the submucosal benign structures, a giving birth tumor is still isolated. Its peculiarity lies in the growth in the uterine cavity towards the internal pharynx. Often, such a tumor extends beyond the external opening of the internal organ.
In 2011, the International Federation of Obstetrics and Gynecology (FIGO) published a classification of fibroids. The identified types of tumors are listed in the table.
| Type of neoplasm | Code in classification | Description of neoplasm |
| Submucosal | 0 | Submucosalleg swelling. Located entirely in the uterus. |
| 1 | Intramural fibroids. More than half protrudes into the uterine cavity. | |
| 2 | Intramural neoplasm. Protrudes into the uterine cavity by less than half. | |
| Other | 3 | Intramural fibroids that are in contact with the endometrium and are completely intraparietal. |
| 4 | Intramural tumor. | |
| 5 | Subserous intramural fibroids protruding less than half into the abdominal cavity. | |
| 6 | Subserous intramural tumor. It is characterized by a protrusion into the peritoneal cavity by more than half. | |
| 7 | Subserous pedunculated fibroids. | |
| 8 | Specific benign neoplasm (e.g. cervical). | |
| Hybrid | In this type, for certain reasons, uterine fibroids are formed in the body of a woman, involving both the endometrium and the serosa in the pathological process. The disease code is composed of two digits, written with a hyphen. The first of them reflects the connection with the endometrium of the uterus, and the second - the connection with the serous membrane. | |
Clinical picture
The disease can be asymptomatic. In such cases, women have no complaints, there are no changes in the menstrual cycle. When a fibroid occurs with symptoms, it makes itself felt by pain, bleeding, dysfunction of nearby organs. Painlocalized in the lower abdomen and lower back. They are varied:
- spicy;
- cramping;
- constant aching.
The first of them occur with uterine fibroids due to malnutrition of the node. Cramping pains are observed during menstruation and indicate submucosal localization of the tumor. Constant aching sensations are characteristic of subperitoneal fibroids and are due to stretching of the peritoneum, compression of the pelvic nerve plexuses.
The most common symptom of a benign tumor in the uterus is bleeding. Submucosal localization of fibroids is characterized by prolonged and heavy menstruation. In medicine, they are also called menorrhagia. Intermuscular and subperitoneal fibroids are characterized by acyclic uterine bleeding (metrorrhagia) occurring in the intermenstrual period.
Violation of the functioning of neighboring internal organs is observed only with some neoplasms. If the fibroid is located in front of the uterus, it puts pressure on the urinary tract and provokes a violation of urination. If the tumor is localized on the opposite side, it makes it difficult to empty the intestines.
Possible Complications
All women are advised to periodically visit a gynecologist to prevent the negative consequences of uterine fibroids. There are several reasons. First, with the growth of the tumor, signs appear that reduce the quality of life and cause discomfort. Only at the initial stage, the disease does not bother. Second, some women due to fibroidslose their uterus.
If the disease is not treated, complications will arise in the future. The most common of these is tumor necrosis. It begins due to torsion of the leg, impaired blood supply and is manifested by symptoms of an acute inflammatory process.
Women with fibroids worry about whether this benign tumor will turn into a malignant one. This is possible, but the probability of starting such a process is quite low. In 0.25–0.75% of cases, cancer is diagnosed in women of reproductive age. During the postmenopausal period, these numbers increase to 2.6–3.7%.
Infertility, complicated pregnancy and childbirth
In medical articles on the causes, signs and treatment of uterine fibroids, infertility is still listed among the negative consequences. It is diagnosed in approximately 24% of women with a benign tumor. In 33-69% of cases, infertility is eliminated after removal of the node. Those women who still manage to conceive a child in the presence of fibroids sometimes face a complicated pregnancy:
- threatened miscarriage;
- late preeclampsia;
- fetal growth retardation;
- premature placental abruption;
- polyhydramnios;
- Chronic intrauterine fetal hypoxia.
Complications during delivery occur such as premature rupture of amniotic fluid, primary weakness of labor, prolonged labor. Approximately 65% of women doctors perform a caesarean section. At the same time, in 42% of pregnant women, the scope of the operation expands to myomectomy in order totreatment of uterine fibroids and because of the need to remove a benign neoplasm. The remaining 35% of women give birth on their own.
Treatment prescription
Uterine fibroids are always treated on an individual basis. It is impossible to know the causes of the tumor, so doctors only consider the following factors:
- presence of uterine bleeding and pain;
- having trouble urinating or defecation;
- patient age and expected period before menopause, woman's desire to maintain fertility;
- size of neoplasms, their number, location, change in volume during the observation period.
Treatment can be medical, surgical and combined. The first method is also called conservative therapy for uterine fibroids in women. The reasons for the treatment are the need to stop the growth of the tumor, to achieve its reverse development. Surgical treatment is prescribed to remove the neoplasm from the body. In this case, the volume of surgical intervention can be different - conservative myomectomy (removal of the tumor), subtotal (removal of the uterus without a neck) and total (removal of the uterus with a neck) hysterectomy. Combined treatment involves an operation followed by and / or preliminary administration of hormonal drugs.
Conservative Therapy
Medical treatment has certain indications:
- the patient wishes to preserve her reproductivefunction;
- tumor size does not exceed 12 weeks of pregnancy;
- the disease is characterized by a clinically asymptomatic course;
- for a node (on a wide base) is characterized by an interstitial or subserous location, there is an intermuscular or subperitoneal fibroid;
- development of a benign tumor is accompanied by extragenital pathologies with high surgical and anesthetic risks.
When conducting conservative therapy, the doctor prescribes non-hormonal drugs - hemostatics for uterine bleeding, non-steroidal anti-inflammatory drugs and antispasmodics for pain. In addition, diseases that promote tumor growth are treated.
Hormone therapy is carried out in several stages:
- First, nodal regression inducers, GnRH agonists, are used to treat uterine fibroids. The reasons for their use are that these drugs help reduce tumors to a clinically insignificant size, stop uterine bleeding. Such medications are prescribed, as a rule, for 6 months (no more).
- The next stage is considered stabilizing. The doctor prescribes modern microdosed oral contraceptives or an intrauterine hormonal releasing system. The treatment is carried out for a long time and helps to stabilize the size of myomatous nodes and inhibit the development of new benign tumors.
Surgery
Surgery to remove a tumor or uterus is done only for certain reasons:
- uterine fibroids do not correspond to small sizes - it exceeds 12 weeks of pregnancy;
- neoplasm grows rapidly;
- patient is worried about meno- and metrorrhagia causing anemia;
- a woman has a submucosal tumor, an intermuscular neoplasm with centripetal growth, or a pedunculated subperitoneal node;
- myoma necrosis detected;
- there is a combination of fibroids with ovarian tumors, disruption of the functioning of neighboring organs;
- has a history of infertility or miscarriages.
One of the possible surgical interventions is a conservative myomectomy. This is an organ-preserving operation. During it, myomatous nodes are removed, and the uterus is preserved. With such an operation, the possibility of a future pregnancy remains. Removal of fibroids is performed under anesthesia and requires a hospital stay of 3-7 days. The recovery postoperative period takes 3-4 weeks.
Removing the uterus is another treatment option. It is considered a last resort. In about 5-10% of cases, this operation is inevitable for uterine fibroids. The reasons for its implementation are neglected disease, large tumors, suspicion of malignant neoplasms. The operation is also performed under anesthesia. In the hospital, women after it are from 3 to 7 days. The recovery postoperative period for an uncomplicated course takes 3-6 weeks.
Combination treatment
Combination therapyconsists in carrying out a conservative myomectomy against the background of taking the necessary medications in the pre- and postoperative period. Treatment is carried out according to indications:
- a woman plans to have a child in the future, which means that she wants to preserve her uterus and reproductive function;
- patient has a fibroid with many nodes;
- myoma with a node larger than 5 cm was detected.
The first stage of combined treatment may consist of 2 injections - an analogue of GnRH with an interval of 28 days. After medical treatment, a conservative myomectomy is performed. This is the second stage of therapy. After the operation, another injection of the GnRH analogue is performed. This is the third stage of therapy, at which the combined treatment ends.
Uterine fibroids are a rather serious disease, despite the fact that at first it may be asymptomatic. It is sometimes possible to prevent its occurrence. The specialized medical literature on the causes, signs, and symptoms of uterine fibroids outlines primary preventive measures. They consist in the timely correction of hormonal disorders in the body, the correct treatment of inflammatory diseases of the female genital organs, the passage of preventive examinations by a gynecologist once every 6 months, and the rejection of abortions.
