Many women and young girls may encounter in their lives such a disease as uterine fibroids. It is one of the most common ailments in gynecology. There are several types of this disease, the most common being interstitial fibroids. It is more typical for young women of childbearing age, that is, from 20 to 30 years.

Failure to diagnose and treat it in a timely manner can cause problems with conceiving a child.

General information and causes of pathology

Interstitial uterine fibroids are the excessive formation of new muscle cells inside the walls of the uterus, which gradually form into a myomatous node. This type of fibroid is a benign tumor.

It is divided into two main types:

Interstitial fibroids are characterized precisely by their nodular structure of cellular neoplasms. The nodes can reach various sizes and are rather dense accumulations of muscle cells.

Their location can be absolutely anything, namely:

Myomatous nodes can be single or numerous. The course of the disease, accompanied by symptoms of different nature, depends on their total number and location.

Interstitial uterine fibroids develop mainly against the background of a woman’s hormonal imbalance. An increase in female sex hormones leads to the fact that the smooth muscle cells of the uterine walls begin to actively divide and increase in number. Gradually, so-called interstitial nodes are formed, which are characteristic specifically for this type of fibroid.

Disruptions at the hormonal level can be caused by a number of reasons, including:

Very often, the cause of the development of the disease is a genetic predisposition transmitted from generation to generation through the female line.

Symptoms and signs of the disease

Depending on where the myomatous node or nodes formed, the symptoms of the disease will manifest themselves differently.

Their total number includes:

Signs of an interstitial node on the anterior and posterior wall

If a myomatous node has formed on the back wall of the uterus, at first it will hardly make itself known. If it grows or additional similar nodes form, constant nagging pain appears in the lower back, radiating to the sacrum area. They usually get worse during menstruation.

Interstitial uterine fibroids on the anterior wall are characterized by the rapid appearance of a belly, which is typical for pregnant women, regardless of the direction of growth of the node: external or internal, into the uterine cavity. In this case, the woman will feel more sharp and cramping pain, especially before defecation. Pain may also be felt when feeling the abdomen.

Symptoms of subserous-interstitial type of fibroids

This species is characterized by the location of the myomatous node, both the main and additional ones, on the outside of the uterus. Their small size does not cause any particular inconvenience, and practically does not show any signs.

If they increase in size, then pressure occurs on the organs of the peritoneum, primarily on the intestines, bladder and ureters. As a result, the functioning of these organs occurs. There is constant pain and discomfort in the entire abdominal area.

Problems with stool begin, constipation appears, and gases are difficult to pass. The tumor can completely block the ureters, and therefore urine flow may stop. With constant pressure on the bladder, the woman will experience a constant urge to go to the toilet.

Signs of submucosal-intrestial type of fibroids

In this case, nodes form and grow inside the uterine cavity, damaging and disrupting the integrity of the delicate and loose walls. The main difference is a sharp increase in size of the organ, in the case of a larger node or a large number of them.

A clear sign will be bleeding and traces of blood, as well as heavy periods. Menstruation is accompanied by severe pain. Pain and pain in the lower abdomen will almost always be present. In case of inflammation of myomatous nodes, the state of health sharply worsens and the body temperature rises.

Diagnosis and treatment

For timely diagnosis of the problem, a mandatory preventive visit to the gynecologist is required at least once a year, and preferably twice. Upon examination, the doctor can almost immediately suspect an illness based on the patient’s complaints, and an ultrasound of the genitals and pelvic organs will show a more accurate picture of the neoplasm.

Any disease can be treated well in the initial stages, and to eliminate the risk of its development, it is recommended to follow certain preventive measures.

If interstitial fibroids are diagnosed, constant monitoring of its development is required. Under no circumstances should you let the disease take its course and leave it to chance. There is a certain risk of a benign tumor developing into a malignant one, which is a threat to the patient’s life.

Depending on what stage of development the nodes are at, as well as their number, size and location, the selection of the most effective treatment depends. Sometimes it takes some time to analyze their changes and growth in dynamics. Various types of chronic diseases in women are also taken into account.

The main methods of treating interstitial nodes are:

Certain appropriate treatment is prescribed strictly by a gynecologist, based on all the necessary examinations and tests. In no case should you resort to self-medication using traditional methods, as well as taking various medications.

Remember that fibroids can have dire and dangerous consequences. Do not neglect your health and life.

Benign tumors can develop in the uterus, as in other organs of the human body. A nodular neoplasm formed from muscle tissue is called a fibroid. It can remain in the thickness of the myometrium (muscular layer), occupy a position closer to the uterine cavity, or shift towards the abdominal cavity. If the fibroid is located under the outer serosa of the uterus, it is considered subserous or subperitoneal.

Causes

Focal proliferation of myometrial tissue is a hormonally dependent process. An imbalance of female sex hormones in some cases triggers excessive proliferation of smooth muscle cells, that is, their increased reproduction. Most often, the cause is age-related changes, so fibroids are found in adulthood and premenopause.

The development of a tumor is also promoted by diseases of the ovaries with a violation of their hormone-producing function, stress, and chronic infectious diseases of various localizations. The production of sex hormones may be disrupted secondary to endocrine pathology with damage to the adrenal glands, thyroid gland or pituitary gland.

Although many women experience hormonal imbalances, not all women develop fibroids. Women who have never been pregnant by the age of 30 and who have a hereditary burden are especially predisposed to their appearance. Risk factors also include artificial termination of pregnancy and repeated diagnostic curettage, chronic inflammation in the organs of the reproductive system, and prolonged stress conditions.

What does subserous fibroid look like?

Subserous uterine fibroids are a node adjacent to the outer serosa of the uterus. It may have a wide base or a fairly thin stem, protruding beyond the boundaries of the organ. The muscle tissue that forms the tumor body remains differentiated and does not have the ability to germinate. Therefore, fibroids are classified as benign mature neoplasms.

Histological examination usually reveals multidirectional, randomly growing deformed smooth muscle cells and unchanged connective tissue. The ratio of these components may be different.

Types of subserous fibroids:

1. leiomyoma, consisting of identical smooth muscle cells;
2. fibromyoma (or fibroid) is a tumor containing a lot of connective tissue;
3. a bizarre leiomyoma, in which, along with round muscle cells, giant cells with several large nuclei are found, unlike a malignant tumor, it does not have uncontrolled growth;
4. epithelioid cell leiomyoma (leiomyoblastoma) with insufficiently clear boundaries, its round cells have light eosinophilic cytoplasm forming stripes;
5. leiomyolipoma, in which mature fat cells appear due to degeneration.

Tumor-forming tissues often undergo changes due to malnutrition. In this case, areas of hyalinosis, necrosis, myxomatous or mucoid degeneration, calcifications and hemorrhages of varying duration and size will appear.

Clinical picture

The presence of uterine fibroids impairs the contractility of the myometrium, which predisposes to heavy and painful menstrual bleeding (menorrhagia). Often, as a result, a woman develops chronic iron deficiency anemia.

Pain can occur not only during menstruation. Unpleasant sensations appear after physical activity, exercises to strengthen the abs, long walking, with a sudden change in body position and jumping. Sexual intercourse is also accompanied by discomfort. The pain in the lower abdomen is usually aching, sometimes radiating to the lower back.

If myomatous nodes protrude towards the rectum, there is discomfort during bowel movements and a tendency to constipation. A large subserous node located above the cervix can compress the adjacent bladder. In this case, dysuria (impaired urination) occurs with frequent painful urges, incomplete emptying of the bladder and difficulty urinating.

In young women, large broad-based subserous fibroids or serous-interstitial uterine fibroids may be the cause. This happens because the tumor leads to deformation of the organ and causes dyshormonal irregular bleeding. Myoma located in the corners of the uterus can also lead to a narrowing of the fallopian tube, impairing its patency. This will make it difficult for the egg to migrate into the uterine cavity after ovulation.

Acute complications of subserous fibroids

Acute intense pain is a sign of the development of complications. This may be central necrosis of the myomatous node or extensive hemorrhage into its tissue. And the subserous node on the leg may twist, which will require urgent surgical intervention.

When the fibroid stalk is torsed, the clinical picture of an acute abdomen develops. Tension of the anterior abdominal wall, pain on palpation in the lower abdomen, and hyperthermia are determined. Severe cramping pain can lead to the development of painful shock with changes in the functioning of vital organs, a drop in blood pressure, and sometimes loss of consciousness.

Acute ischemia and necrosis of the myomatous node lead to the appearance of aching pain, which tends to increase. With hematogenous introduction of bacteria into the ischemic focus, the woman’s condition worsens, body temperature rises, and intoxication occurs.

Diagnostics

The presence of subserous fibroids can be suspected during a gynecological examination. During palpation, the doctor determines the heterogeneity of the uterus, the unevenness of its contours, and the presence of a tumor-like formation in the lower part of the abdominal cavity. The abdomen may be enlarged in the absence of overall weight gain. Myoma does not limit the mobility of the uterus. In women of asthenic physique, it is sometimes possible to palpate to determine that the tumor is smooth and not fused with surrounding organs.

Helps identify the presence of fibroids, its size, position and structure, and the condition of adjacent organs. In this case, vaginal and transabdominal sensors can be used. Ultrasound diagnostics is the main method for dynamic observation, during which the rate of tumor growth and signs of its malignancy (malignization) are assessed. In acute complications, blurred contours of the uterus and adjacent tissues are determined, which indicates the presence of edema in this area.

To determine the degree of deformation of the uterine cavity, metrography is sometimes used. This is the name for an X-ray examination against the background of intrauterine administration of a contrast agent. Subserous fibroids rarely lead to narrowing of the uterine lumen, with the exception of very large subserous-interstitial and multiple nodes.

An MRI or CT scan of the pelvic organs helps clarify the nature of the tumor and the presence of invasion into surrounding tissues. This helps differentiate fibroids from malignant neoplasms. If necessary, laparoscopy is performed, during which the doctor can take a biopsy from the myomatous node for further histological examination.

Additionally, a general blood test is performed, which is necessary to identify the degree of concomitant iron deficiency posthemorrhagic anemia and assess the inflammatory response.

Treatment of subserous uterine fibroids

When prescribing treatment, the nature of the existing disorders and the growth rate of the tumor are taken into account. The development of acute complications is a direct indication for emergency surgery. The extent of surgical intervention is finally determined after direct examination of the uterus. The doctor may limit himself to removing the fibroid protruding above the surface of the organ or decide to remove the entire uterus (hysterectomy).

If the woman’s condition is stable and the subserous node is growing slowly, treatment is prescribed, the basis of which is the use of hormonal drugs and symptomatic therapy. COCs, gonadotropin releasing hormone agonists and antigonadotropins are used. If necessary, nonsteroidal anti-inflammatory and antianemic drugs are prescribed. Hormonal therapy helps control tumor growth and in some cases leads to a gradual reduction in the size of fibroids. This tactic is indicated for the treatment of women of childbearing age planning pregnancy.

Indications for surgical treatment of subserous uterine fibroids:

1. rapid tumor growth rate;
2. the appearance of signs of malignancy;
3. enlargement of the uterus exceeding the size of the organ at 12 weeks of pregnancy;
4. heavy frequent uterine bleeding;
5. persistent pain syndrome.

Depending on the size and position of the tumor, myomectomy (removal of the node while preserving the surrounding tissue) is performed laparoscopically or laparotomically, or hysterectomy (removal of the entire uterus). It is also possible to perform uterine artery embolization (UAE), which will lead to the death of the tumor due to lack of nutrition. After such an intervention, the myomatous node is replaced by dense connective tissue.

If a woman does not plan a pregnancy in the future, but wants to preserve the uterus, she can undergo FUS ablation of fibroids. In this case, under MRI control, local remote exposure to focused ultrasonic waves of a certain frequency is carried out. Myomatous tissues heat up and become necrotic. Complications of FUS ablation are associated with the impact of waves on the uterus itself and neighboring organs, with the development of neuralgia of the sciatic nerve and necrosis of the intestine, skin, subcutaneous tissue, and uterine wall.

Although subserous uterine fibroids are benign neoplasms, they require regular follow-up and treatment by a specialist.

When fibroids develop on the posterior wall of the uterus, this means that the myomatous lesion is distinguished by some features of the dynamics of its course. Let us consider the specifics of the development of this form of myomatous pathology in more detail.

Dynamics of development

Myomatous lesion on the posterior wall of the uterus is a type of benign formation characterized by a certain clinical picture of development. In addition, the pathology differs in its causes, symptoms and possible treatment regimen.

Among the possible causes of uterine fibroids on the back wall of the uterus it is worth noting:

• hormonal imbalance in the body;
• presence of somatic diseases;
• pathological heredity;
• irregular sexual intercourse;
• low quality of sexual life, lack of regular orgasms;
• previous abortions and complex surgical interventions in the vital functions of the genital organs;
• being overweight.

The spread of uterine fibroids along the posterior wall occurs at a fairly intensive pace. Most often, this form of myomatous lesion has multiple manifestations. The number of nodes can range from 2 to 8 or more, and the total diameter of myomatous growth can be about 30 centimeters. However, in the case of such an intensive rate of development, the patient must immediately contact her consulting gynecologist, since these manifestations are pathological.

Possible symptoms

Unlike fibroids that develop on the anterior wall of the uterus, this form of myomatous lesion is characterized by a specific pattern of clinical development. Myomatous formation developing on the posterior uterine wall is characterized by certain manifestations:

• changes in the regularity and intensity of menstrual bleeding;
• more abundant periods;
• painful sensations localized in the lower back and lower abdomen;
• anovulatory spotting;
• difficulties with conceiving and bearing a child.

When periods become too heavy, there is a risk of developing anemia due to large blood loss. In addition, the patient may feel constant weakness, dizziness, and apathy.

It is worth remembering that small myomatous lesions that develop in the uterine cavity tend to be asymptomatic. They can only be identified through a special gynecological examination. Therefore, it is very important to attend gynecological consultations in a timely manner and pay attention to the prevention of diseases of the reproductive system.

Myomatous lesions are divided into several categories, depending on the specific location of the pathology:

• intramural (the lesion is located in the muscular layer of the uterine surface);
• subserous (pathology is located under the muscular layer of the uterine wall and develops inside the uterine cavity);
• submucous (fibroids are located under the connective tissue of the uterine wall).

In addition, an interstitial location is distinguished - that is, fibroids

When the pathology develops interstitially, it is characterized by a specific location and some clinical manifestations.

Fibroids that form interstitially have increased dynamics of development and are quite dangerous if diagnosis and treatment are not carried out in a timely manner.

When a myomatous lesion develops as a subserous node, that is, located under the inner muscular layers of the uterine cavity, diagnosis of the lesion can be complicated. In such cases, pathology is usually detected using ultrasound. The use of ultrasound diagnostics makes it possible to identify even the smallest myomatous nodes with a diameter of up to 5 mm, which significantly increases the dynamics and effectiveness of curing the pathology.

The subserosal location of myomatous pathology has certain specificities that determine its diagnosis and treatment.

Specifics of treatment

Treatment of a myomatous node located on the posterior uterine wall involves the use of conservative therapy methods aimed at stabilizing hormonal levels in the body, as well as inhibiting the growth and development of myomatous lesions.

When the myomatous lesion is small in size, clinical observation and certain preventive measures are recommended.

In particular, the patient should pay attention to her own diet and minimize the consumption of fatty and spicy foods. The emphasis should be on plant components, vegetables, fruits. It is possible to consume synthetic vitamin complexes.

Conservative treatment of pathology is aimed at inhibiting the growth and development of the tumor, as well as stabilizing the hormonal balance and normalizing the menstrual cycle. For this purpose, the use of norcolut, orgametril, nemestran, gestrinone, norethisterone is prescribed.

When these drugs are not effective enough in the fight against myomatous pathology, a surgical method of eliminating the pathology is used.

Surgical intervention is prescribed for:

• accelerated rates of development of myomatous growth;
• significant size of myomatous lesion;
• submucosal location of the pathology;
• formation of a subserous node on a pedicle;
• development of fibroids in the cervix;
• infertility and chronic miscarriage.

Surgical intervention to eliminate myomatous pathology is mainly carried out using laparoscopy or hysteroscopy. The operation is performed under general anesthesia and is practically painless.

It is carried out in accordance with the latest standards of surgical medicine and demonstrates a fairly high dynamics of cure rate at an accelerated pace of rehabilitation.

Most women are frightened by the “terrible” diagnosis – subserous uterine fibroids. Surgery to remove the uterus seems inevitable to them, and therefore infertility is inevitable. Is this really so and is it worth panicking? In order to understand this issue, it is necessary to have an understanding of what fibroids are, why they occur, and what treatment methods currently exist.

Please note that this text was prepared without the support of our website.

General information about uterine fibroids

The development of uterine fibroids is caused by impaired regulation of myometrial cell growth. The formation of myomatous nodes is most often associated with hormonal imbalances in a woman’s body and damage to uterine tissue.

Hormonal disorders that provoke the development of a tumor can affect both the reproductive system and the endocrine sphere. Thus, decreased thyroid function (hypothyroidism) and obesity lead to an increase in estrogen levels, which, in turn, is a predisposing factor in the occurrence of fibroids.

The regulation of cell growth can be disrupted due to damage to smooth muscle cells, which often happens during curettage of the uterine cavity, abortion, inflammatory processes in the uterus and long-term use of intrauterine contraceptives. In addition, the development of a tumor may be due to hereditary predisposition, unfavorable environmental situation, frequent stress and decreased immunity, which increases the body's susceptibility to damaging agents.

Myoma nodes can be single or multiple, their sizes can be several millimeters and tens of centimeters. Myomatous formations are localized mainly in the body of the uterus; in some cases, the disease affects the cervix of the organ and its ligamentous apparatus.

Prevalence of the disease

Uterine fibroids are the most common benign tumor of the female genital area. Most often, the disease is diagnosed in women aged 30 to 48 years.

There are also cases where myomatous nodes were found in younger women, under the age of 20 years.

Localization of uterine fibroids

Fibroids can affect different parts of the uterus. The following localizations are considered the most common:

• subserous - begins development from the outer part of the uterus and continues to grow outward into the pelvic cavity. This type of pathology, as a rule, does not lead to disruption of the menstrual cycle, but can cause some discomfort associated with its size and compression of surrounding tissues by the knot.
• intramural - grows in the middle muscular layer of the uterus and leads to a significant increase in its size, the appearance of pain and a feeling of pressure in the pelvis, and also disrupts the menstrual cycle. This type of tumor is the most common;
• submucous (submucosal) uterine fibroids - occurs deep in the uterus, under the thin layer of endometrium lining its cavity. This type of disease manifests itself with severe symptoms and is less common than others.

Symptoms of uterine fibroids

More than a third of cases of uterine fibroids occur without characteristic symptoms and the disease is detected only during a routine visit to the gynecologist. This is especially true for small intramural and subserous nodes.

The intensity of fibroid manifestations depends on factors such as the size and number of nodes, their location and morphological features.

Women may complain of the following symptoms:

• heavy, prolonged menstruation with severe pain;
• intermenstrual spotting and bleeding;
• clots in menstrual flow;
• pain in the abdomen, lower back and above the pubis;
• sensations of pressure and heaviness in the lower abdomen.

The most pronounced manifestations are observed in women with multiple or large uterine fibroids.

In addition, with fibroids, the functions of nearby organs are disrupted, problems arise with carrying a pregnancy, and infertility develops.

The pain syndrome accompanying the pathology has a different origin.

Interstitial uterine fibroids of small size are manifested by long, heavy and painful menstruation.

With the active growth of nodes, a woman experiences constant aching pain. Necrosis of the node is accompanied by severe pain, increased body temperature, and symptoms of intoxication of the body. A similar emergency situation occurs with subserous uterine fibroids with pedunculated nodes. If the leg is thin, torsion of the node may occur, as a result of which its nutrition is disrupted. In such situations, an acute condition occurs - severe pain syndrome. In some cases, a woman may develop peritonitis, requiring urgent surgical treatment.

With large fibroids, the function of nearby organs is impaired, which leads to constipation and increased urination. Sometimes the myomatous node compresses the ureter, as a result of which the outflow of urine from the kidney is disrupted.

Submucosal fibroids with submucosal localization of the node are manifested by heavy menstruation. With large sizes of the submucosal node, which occupies a large area of ​​the uterine cavity, there is a disturbance in the cyclicity of menstrual flow, and sometimes its complete cessation.

The clinical manifestation of subserous (subperitoneal) fibroids is pain. Pain is felt in the lower abdomen or lower back. They arise due to the tension of the ligamentous apparatus of the uterus and the pressure of the growing myomatous node on the nerve plexuses of the pelvis. If blood circulation in the tumor is impaired, the pain increases and becomes acute.

Uterine fibroids can cause infertility and miscarriage, which is explained by a change in the size of the uterine cavity by a growing node, mechanical compression of the tubal angle and deterioration of local blood flow in the endometrium.

Thus, uterine fibroids can have a varied clinical picture, but most often it manifests itself as a triad: bleeding, pain and dysfunction of adjacent organs.

What is subserous uterine fibroid

Subserous uterine fibroids are a benign tumor that affects the outer side of the uterus, its growth is directed into the pelvic cavity.

Subserous fibroids usually look like a node with a wide base or a thin stalk through which the tumor is fed. Nodes can be single or multiple. A single node in subserous uterine fibroids is covered by a capsule that separates it from the surrounding tissues. Myomatous node can be small or large, but usually no more than 10 cm.

Due to its localization on the outside of the uterus and growth into the abdominal cavity, subserous uterine fibroids are considered one of the most harmless tumors. In women with this type of fibroid, the size of the uterus does not increase and menstrual function is not impaired. There are no problems with pregnancy. Difficulties with conception can arise only in cases where the subserous node is located near one of the fallopian tubes and compresses it. However, the presence of this tumor can cause miscarriage.

Types of subserous uterine fibroids

In modern gynecology, there is the following classification of subserous fibroids:

• zero type - a subserous node on a stalk that does not contain an intramural component;
• first type – the size of the intramural component is less than 50% of the volume of the myomatous formation, most of it is subserous;
• the second type is a myomatous node with an intramural component of more than 50%, with a mild subserous component.

Causes of development of subserous uterine fibroids

The development of this benign formation may be due to the following predisposing factors:

• endocrine disorders: according to statistics, subserous fibroids most often develop in women before or during menopause, when the usual ratio of female hormones - progesterone and estrogen - is disrupted;
• hereditary predisposition: if close relatives of the woman suffered from this disease;
• trauma to the muscular layer of the uterine wall during childbirth, pregnancy or heavy uterine bleeding.

Symptoms of subserous uterine fibroids

Patients with subserous nodes usually complain of pain. Most often, the pain has a pulling, aching character, is localized above the pubis and can radiate to the lumbar region.

The pain syndrome intensifies in case of hypothermia, overwork, being in an uncomfortable position for a long time and after intense physical activity.

Diagnosis of subserous fibroids

After collecting an anamnesis: clarifying the patient’s complaints, genetic predisposition, life history and illness, the gynecologist prescribes a series of laboratory and instrumental studies:

• blood test (at least three times): general - to exclude inflammatory processes, biochemical and hormonal;
• gynecological examination;
• Ultrasound: considered the main diagnostic method;
• computed and magnetic resonance imaging: to determine the size and location of the tumor in the uterine cavity and in relation to adjacent organs.

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Treatment of subserous uterine fibroids

Treatment tactics for subserous fibroids are selected according to the size of the tumor. For example, the most effective method of treating large fibroids is surgery to remove the nodes. For small myomatous nodes, it may be sufficient to use conservative therapy, embolization of the uterine arteries, or regular monitoring of tumor growth using ultrasound (at least four times a year). Thus, surgery is not the only method of treating this pathology.

Conservative therapy.

Conservative treatment of subserous uterine fibroids involves taking medications such as:

• combined oral contraceptives (progesterone-containing and estrogen-containing);
• gestagens;
• antiestrogens (not used for the treatment of fibroids in patients under 45 years of age);
• antigonadotropins and gonadoliberins.

The duration of conservative therapy is three months. During this period, a woman must follow a special diet. After finishing taking the medications, the woman must remain under regular supervision of a specialist to monitor the condition of the myomatous node.

Unfortunately, hormonal therapy rarely leads to lasting results; relapses often occur: growth and enlargement of nodes. In this situation, surgical intervention is necessary.

Subserous uterine fibroids: dimensions for surgery

Surgery for subserous uterine fibroids can be a treatment method for large node sizes and in cases where the node grows on a thin stalk. The operation can also be performed in case of infertility and the presence of severe pain, uterine bleeding that cannot be treated with conservative methods.

Abdominal surgery. One type of surgical treatment is abdominal surgery aimed at removing the myomatous node. Indications for its implementation are the large size of the node, as well as malignancy of the process - the degeneration of a benign form into a malignant one. The incision is made in the area above the pubis. Then all layers (skin, subcutaneous fat, peritoneum, etc.) are dissected layer by layer, after which the fibroid is excised.

Hysterectomy. If the fibroids are very large, compressing adjacent organs and it is impossible for one reason or another to remove the myomatous node, the woman is prescribed a hysterectomy. During such operations, the uterus is removed along with the node. Hysterectomy is a radical treatment for fibroids. This operation is used only in cases where the disease threatens the woman’s life.

Laparoscopy. Currently, removal of uterine fibroids is most often performed using the laparoscopic method. A laparoscope is inserted through an incision on the anterior abdominal wall, after which the fibroid is excised and removed. This is a minimally invasive method, after which there are no cosmetic defects - postoperative scars.

Uterine artery embolization (UAE). An effective and safe organ-preserving alternative to surgery is the innovative method of uterine artery embolization. This technology is based on stopping the nutrition of the myomatous node by introducing special balls - emboli, which block the blood flow in the uterine arteries. With the help of UAE, a lasting lifelong effect is achieved, relapses of the disease are excluded. This is the most preferred method of treating fibroids and avoids surgery.

FUS ablation. A method involving exposure of uterine fibroids to ultrasonic waves. The effectiveness of the procedure is high only when treating fibroids with small single nodes.

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Diet for subserous uterine fibroids

During treatment, a woman must follow the following nutritional rules:

• give preference to plant foods high in fiber, which help normalize metabolism;
• reduce the amount of meat consumed;
• give up fatty, fried and spicy foods;
• eat vegetables and fruits daily;
• introduce soy products and bran into the diet, which cleanse the body of toxins;
• to normalize hormone levels, regularly consume nuts and dairy products;
• eat dishes made from fatty varieties of sea fish, which have an antitumor effect.

Improper nutrition can cause serious disruptions in the functioning of the endocrine system and the active growth of myomatous formations.

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Traditional medicine

Traditional medicine has a large number of recipes for herbal infusions and decoctions, with the help of which you can significantly reduce the severity of the symptoms of subserous fibroids, as well as stop the growth of myomatous nodes. However, these drugs should be taken only as an additional method in complex therapy and only after consultation with the attending physician.

Flax seeds. Due to the content of antiestrogens, flax seeds have a positive effect in the treatment of this hormone-dependent tumor. Preparations from flax seeds help restore hormonal balance, help suppress inflammatory processes and counteract carcinogens that provoke the development of tumors.

Potato juice. This remedy has wound-healing, anti-inflammatory, antispasmodic, analgesic, diuretic, restorative, immunostimulating effects, and also normalizes metabolism and the body’s water-salt balance. In addition, a decoction of potato flowers also has similar healing properties. However, taking potato juice is contraindicated for patients suffering from diabetes, intestinal dysfunction, and gastritis with low acidity.

Borovaya uterus. This plant is rightly called “female herb”. With the help of boron uterus infusion, many gynecological problems are solved, including uterine fibroids.

Poisonous plants. Due to their antitumor properties, tinctures of hemlock, aconite, hellebore and celandine are successfully used in the treatment of subserous uterine fibroids. It is important to understand that these plants should only be purchased in pharmaceutical packages that contain instructions for use, because Preparations from poisonous herbs must be taken strictly in the indicated doses.

Hemostatic herbs. If uterine fibroids are complicated by heavy uterine bleeding, you can take infusions and decoctions from plants that have a hemostatic effect. The following help reduce the volume of blood secreted: barberry, nettle, shepherd's purse, yarrow, burnet, burdock, cloves.

Leeches. The saliva of leeches contains enzymes and other biologically active substances that help restore the level of hormones in the female body, due to which treatment with leeches has a positive effect on such a hormone-dependent tumor as uterine fibroids. In addition, hirudotherapy helps thin the blood, eliminate congestion in the blood vessels of the pelvis, strengthen the immune system, and reduce inflammatory processes.

There is no need to be afraid to get treatment, you need to be afraid to get sick! In order to prevent fibroids, a woman needs to adhere to a healthy lifestyle, avoid heavy physical activity, abortions, treat her body with care, and if any warning symptoms are detected, do not hesitate to consult a doctor. Any disease can be treated more easily and effectively in the early stages, and uterine fibroids are no exception.

We will help you select the best specialists who use organ-preserving methods of treating fibroids in their practice, incl. and embolization of the uterine arteries, as the most preferable way to get rid of fibroids without surgery. Our partners are leading clinics in Moscow and other Russian cities. Contact us to any doctor at the clinic with which we cooperate. . We will provide ongoing support. To all your questions.

References

• Sidorova I.S. Uterine fibroids (modern aspects of etiology, pathogenesis, classification and prevention). In the book: Uterine fibroids. Ed. I.S. Sidorova. M: MIA 2003; 5-66.
• Androutopoulos G., Dekavalas G. Recent advances in the treatment of uterine fibroids. Translation from English N. D. Firsova (2018).
• Savitsky G. A., Ivanova R. D., Svechnikova F. A. The role of local hyperhormonemia in the pathogenesis of the growth rate of tumor nodes in uterine fibroids // Obstetrics and Gynecology. – 1983. – T. 4. – P. 13-16.

Uterine fibroids are a benign formation of smooth muscle, chaotically intertwined fibers, accounting for up to 25% of all diseases of the female genital area. The most common type is interstitial fibroid of the muscular layer of the uterus. About 35% of all diagnosed formations are subserous, submucosal is less common, and very rarely - fibroids in the interligamentous space, the cervical region. Smooth muscle formations can develop in single or multiple nodes; multiple nodules are more often diagnosed.

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The disease is getting younger every year - it is found in young women, and there are cases of fibroids being detected in girls. Most often, myomatous nodes are diagnosed in women over 35 years of age, as well as in menopause. The menopausal period is characterized by hormonal changes, during which the balance of hormones is disrupted, which becomes one of the reasons for the growth of smooth muscle nodes of the uterine wall.

Factors that influence the development of the disease include frequent abortions, injuries to the walls of the uterus, surgeries on the reproductive organ, diseases of the genital organs, endocrine system and other factors. The real reason for the development of smooth muscle nodes has not yet been studied. Often the disease has a hereditary predisposition when it occurs in several women of the same family.

To inform women about methods of diagnosing and treating fibroids, an expert council of doctors was created who devoted themselves to studying and developing methods for treating the disease while preserving the reproductive organ. Women with fibroids can turn to expert advice and get advice; doctors will answer all questions during.

Nodes in the body of the uterus

A healthy female reproductive organ is about 9-11 cm in length in women who have given birth, the uterus is 4 to 5 cm wide. The reproductive organ has three layers - peritoneal (serous), muscular (myometrium), mucous (endometrium). The nodes in the body of the uterus consist of muscle and connective tissue. The nodes of the muscular layer of the uterus are named depending on their location:

• Developing in the myometrium are the interstitial nodes of the uterus.
• Formations growing towards the endometrium are submucosal (submucosal) nodes.
• Smooth muscle formations growing towards the abdominal cavity are called subserous fibroids.
• Between the leaves of the broad ligament of the uterus there are intraligamentary nodes.

The most common formations are the muscular wall (body) of the uterus, less often the cervix.

What is fibroid: subserous node

Subserous fibroid is a benign formation that has formed in the muscle layer and grows towards the abdominal cavity. It can be located on a wide base or a thin leg. The development of smooth muscle subserous formation at the initial stage is asymptomatic, with its growth the first signs appear - pain in the lower abdomen, often radiating to the rectum, vagina, and lower back. The most pronounced pain symptom is with a subserous node on a wide base. Single subserous formations are located in a dense capsule, which separates them from the surrounding tissues.

Subserous formation can be of several types:

• Fibroid - consists of muscle fibers and a large amount of connective tissue.
• Leiomyoma is bizarre - histological examination reveals giant cells with several large nuclei.
• Leiomyoma - formation consists of smooth muscle cells.
• Leiomyoblastoma – the boundaries of the formation are unclear, the cells of the nodes have band-forming, light eosinophilic cytoplasm.
• Leiomyolipoma – degeneration processes occur in the nodular formation and mature fat cells appear.

Reasons for development

The reasons for the development of a subserous node are not fully understood; factors that influence its appearance and growth are known. Fibroids are sensitive to hormones - modified smooth muscle fibers have more receptors sensitive to the effects of hormones than healthy myometrium. The effect of steroid hormones on nodular formations leads to their rapid growth. Hormonal disruptions and imbalance of hormones are observed during pregnancy, menopause, and in obese women. Various factors contribute to the appearance and growth of nodes:

• Diagnostic curettage, abortion, difficult childbirth.
• Hereditary predisposition.
• Chronic inflammatory processes in the female genital organs.
• Ovarian diseases.
• Diseases of the endocrine system.
• Infertility.

The stage of development of the disease is determined by the size of the uterine node:

• Small – 20 (mm).
• Average – from 20 to 60 (mm).
• Large – from 60 (mm) and more.

Uterine fibroids are also described in weeks of pregnancy - the size of the uterus corresponds to a specific week of pregnancy.

Subserous node on the anterior and posterior wall of the uterus

A growing subserous node along the anterior wall of the uterus can lead to the development of problems with urination, compression of the ureter, the development of kidney diseases (pyelonephritis), and impaired renal and bladder function. Growing subserous fibroids on the back wall of the uterus compresses the intestines, blood circulation in the intestines is disrupted, and constipation occurs.

Subserous node on a pedicle in the uterus

Subserous formation is often located not on a wide base, but on a thin stalk. The pedicle can be long and thin; the subserous node on the pedicle is located in the abdominal cavity. This arrangement is very dangerous - torsion of the leg or its injury can cause tissue necrosis of the myomatous formation and the development of complications. The patient develops a high temperature, severe abdominal pain, weakness, and as her condition worsens, the patient loses consciousness. The situation becomes dangerous for the health and life of the woman.

Diagnostics

If symptoms of fibroids appear, you should immediately undergo a diagnosis of the disease by a gynecologist. Subserous fibroids often cause pain while walking, pain and discomfort during sexual intercourse, the ability of the myometrium to contract is impaired, and menstruation becomes heavy and painful. Early diagnosis will preserve reproductive function and reduce the risk of complications. Small fibroids respond better to treatment than large fibroids.

Diagnosis of the disease begins with an examination by a gynecologist. During the examination, the doctor determines the condition of the uterus, the presence of deformation of the organ, and its size. Changes in contours, size, and pain during examination become the reason for prescribing diagnostic studies. To diagnose the disease, they are referred for ultrasound, MRI or CT, and various tests. Additionally, laparoscopy or hysteroscopy may be prescribed to examine the tissues of the formation.

Histological examination will determine the type of fibroid. Due to malnutrition, the subserous node has areas of necrosis, mucoid and myxomatous degeneration, hyalinosis, hemorrhages, and calcification. An ultrasound will help determine the location of the fibroid, its size, tissue structure, the condition of the organs and tissues located next to the fibroid. Magnetic resonance imaging serves to clarify the nature of the formation and helps determine the benign or malignant nature of the formation.

Subserous myomatous node of the uterus: complications

The growth of subserous formation can lead to various complications. One of the complications is torsion of the pedicle of the subserous node, causing tissue necrosis and the development of an inflammatory process. A growing subserous node can put pressure on neighboring organs and disrupt the blood circulation of tissues - this leads to the development of congestion in the bladder and intestines. A large formation can deform the uterus, cause the organ to bend, and the position of the uterus will prevent conception. The fusion of myomatous formation with the peritoneum causes severe pain during movement and physical activity. When the capsule of the subserous node ruptures, the contents enter the abdominal cavity and peritonitis develops, which can be fatal if assistance is not provided in a timely manner.

Subserous node in the uterus: to operate or not

There are certain indications for surgical treatment - large size of fibroids, torsion of the node, peritonitis, various complications requiring immediate surgical intervention. Whether to operate or not to operate on fibroids can only be answered by a doctor who will be guided by the individual characteristics of the patient’s body, her state of health, and the size of the fibroids.

Subserous node of the uterus and pregnancy

This type of formation rarely affects conception and pregnancy; the course of pregnancy depends on the size and location of the node. If there is a large node, it is recommended to remove it before planning a pregnancy.

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Uterine fibroids, subserous node: treatment

When prescribing treatment, the doctor is guided by the patient’s age, the size of the formation, its location, the general condition of the patient, and the presence of concomitant diseases. The woman is undergoing tests for endometriosis, tumors of the uterine appendages, and cancer of the mucous layer of the uterus - the endometrium. Drug therapy is not prescribed: in the presence of large nodules, prolonged and heavy bleeding, or rapid growth of the nodule. Young women with small nodules are prescribed oral contraceptives, the Mirena spiral with hormonal content is recommended, and hormonal therapy is carried out.

Treatment of fibroids is carried out using organ-preserving methods and radical surgery (removal of the reproductive organ), when the uterus is significantly deformed, the fibroid nodes are huge, and the course of the disease is complicated.

Organ-preserving techniques include uterine artery embolization (UAE). Embolization of the uterine arteries allows the treatment of all myomatous nodes during one procedure, does not require the use of general anesthesia, and the procedure is bloodless and painless. The doctor performs UAE through a puncture of the femoral artery, observing the passage of special microbeads - emboli - into the vessels of the fibroids. Together with emboli, a contrast agent is used, which helps to observe the entire process of movement of polymer particles through the vessels, blocking of the vessels of the nodular formation. Complete destruction of the nodes occurs within several months. After the procedure performed by an experienced specialist, a woman can plan a pregnancy.

Treatment of fibroids should be carried out in modern, specializing in the treatment of the disease, using a variety of treatment methods, including the most modern techniques.

References

• Lipsky A. A.,. Gynecology // Encyclopedic Dictionary of Brockhaus and Efron: in 86 volumes (82 volumes and 4 additional). - St. Petersburg. 1890-1907.
• Bodyazhina, V.I. Textbook of gynecology / V.I. Bodyazhina, K.N. Zhmakin. - M.: State Publishing House of Medical Literature, 2010. - 368 p.
• Braude, I. L. Operative gynecology / I. L. Braude. - M.: State Publishing House of Medical Literature, 2008. - 728 p.