Multiple uterine fibroids. Multiple nodes of uterine fibroids Multiple fibroids of the uterus during the period

Today they are not uncommon and are found in various forms in half of patients of reproductive age.

These are benign formations localized on the internal or external surface of the uterine body or forming inside its muscular layer.

Myomatous formations can be single, when only one node is formed, or multiple, when the tumor process manifests itself in several nodular formations.

Multiple fibroids are found somewhat more often and may have different prognoses, depending on the size, location, rate of growth and development, etc.

More about the disease

So, multiple uterine myoma is a benign formation that grows from the muscle tissue of an organ and has several nodular formations.

The pathology can develop latently, and the patient will not even suspect anything until the formation reaches a decent size and provokes the appearance of a characteristic symptomatic picture.

Carefully! Photo of multiple uterine fibroids (click to open)

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Nodes on multiple myomatous formations have different numbers, parameters and shapes.

According to statistical information, multiple myomatous formations are found in 85% of cases of all uterine fibroids. Such tumor processes require mandatory treatment.

But today the situation is such that most women turn to a gynecologist when the situation reaches an advanced stage. Therefore, pathologies are often detected at later stages, when only surgical intervention can save the situation.

Reasons

The exact factors that cause the formation of multiple uterine myomatous nodes are quite difficult to determine. Most experts are inclined to believe that the multiple myomatous process begins to develop from a previous cell, the mechanism of which is controversial.

The vast majority believes that under the influence of certain factors, damage to mature cells occurs, which subsequently leads to their abnormal growth.

Hormonal instability, manifested in the form of increased levels of estrogen hormones, also plays a significant role.

In addition, increased progesterone content stimulates accelerated development. Under the influence of these factors, uterine cells begin to divide uncontrollably, which subsequently leads to the appearance of myomatous nodes.

Experts name the following as provoking factors:

A history of a large number of abortions, curettages and other interventions in the uterine cavity;
Traumatic injuries of the pelvic organs;
Hard work in terms of physical activity;
Psycho-emotional overload, stress;
Inflammations “female-style”, infectious pathologies of the genitourinary and reproductive systems;
Hereditary predisposition;
Obesity, etc.

Experts also include the late onset of regular menstruation, abuse of oral hormonal contraception, metabolic and metabolic disorders, long-term wearing of an intrauterine device, endocrine disruptions, etc. as provoking factors.

Signs

Among the main symptoms of multiple uterine fibroids are:

Pain syndrome of a cramping nature that occurs during menstruation, but with the development of the tumor process, pain begins to bother between menstruation;
If the localization of the node is characterized by muscle tissue, then the tumor compresses neighboring tissues and disrupts the blood supply;
Menstrual flow becomes more abundant, intermenstrual flow appears;
Increase in abdominal volume;
Frequent urge to urinate;
Problems with bowel movements;
Feeling of heaviness and discomfort.

Sometimes large nodes lead to compression of the inferior vena cava, which contributes to the occurrence of tachycardic signs, shortness of breath, etc. But in general, the symptoms are individual, depending on the size and number of nodes, concomitant pathologies, etc.

Species

Multiple fibroids happen, with. In addition, such tumors are divided into small, medium and large.

Large multiple fibroids are a cluster of uterine tumors measuring 6 cm. Such tumors are considered severe and are characterized by the critical condition of the patient. Medium multiple fibroids are a cluster of 2-3 formations measuring 6-2 cm. Small fibroids are multiple formations less than 2 cm in size.

Multiple fibroids develop over a long period of time and unevenly. Therefore, multiple myomatous processes are characterized by the simultaneous detection in the uterus of nodes with different stages of development. In this case, the symptoms are formed from the totality of signs of each individual node.

Submucosal node

Submucosal multiple myomatous tumors of the uterus are distinguished by their submucosal location. For this form of fibroids, the most typical is the rapid enlargement of nodes and the pronounced severity of symptoms.

This picture makes it possible to detect a tumor in the early stages of formation, which has a beneficial effect on treatment prognosis.

Interstitial and interstitial-subserous

With multiple interstitial uterine fibroids, the nodes are localized mainly within the muscle tissue. Tumors of this nature vary in nature, and prognoses depend on the specific location, size of the nodes and other factors.

Multiple uterine fibroids and pregnancy

Multiple fibroids in the uterine cavity can make pregnancy difficult because they block passage through the fallopian tubes.

If the nodes are small, they cannot affect conception and the course of pregnancy.

If pregnancy occurs in the presence of multiple myomatous formations, then complications may arise if at least one node is located close to the placenta.

Small nodes cannot harm the fetus, but if they begin to grow, the risk of premature birth, complications in fetal development and delivery increases.

In addition, according to statistics, myomatous formations often provoke placental abruption.

Complications

Myomatous tumors can develop in the uterine body asymptomatically for a relatively long time, and after the menopausal period they can resolve on their own. But in the presence of multiple submucosal formations, if there is no treatment, then there is a high probability of developing severe consequences and removal of the uterus.

Constant bleeding leads to persistent anemia with critically low hemoglobin levels. Against this background, the woman constantly feels weak and dizzy, may often lose consciousness and be in an exhausted state, and experience symptoms of chronic fatigue.

If the disease is advanced, then removal of the uterus may be necessary, which will forever deprive the woman of the opportunity to become a mother. In addition, large nodes can impair the functionality of intestinal and urinary structures.

Diagnosis and treatment tactics

The most commonly used diagnostic procedures are:

Laparoscopy;
Hysteroscopy;
Hysterosalpingography;
Laboratory diagnostics, etc.

Treatment of multiple uterine fibroids is most often surgical, but in the initial stages the disease can be defeated by medication through hormonal therapy.

Taking hormonal medications can reduce the size of myomatous nodes, stop their growth, and prevent the development of consequences.

Surgical methods are based on the removal of nodes (myomectomy) through an incision in the peritoneum (laparotomy) or through several punctures in it (laparoscopic myomectomy).

If the situation is complex, then removal of the uterus with appendages and tumor at the same time is indicated. Sometimes evaporation of nodes through ultrasonic influence is used ().

Treatment with folk remedies

As an additional therapy for multiple uterine fibroids, patients often turn to traditional methods, the most popular of which are:

Decoctions based on potato color;
Golden mustache tincture;
Douching with a soda solution;
Infusions of medicinal herbs, etc.

Before turning to folk remedies for help, you must first consult with a leading specialist.

Forecast and prevention of the disease

The prognosis for multiple fibroids is usually favorable, but if a woman delays a visit to the antenatal clinic for a long time, then there is a high probability of developing many complications. Therefore, for a favorable prognosis, it is recommended to immediately contact specialized specialists.

To prevent pathology, experts recommend avoiding abortions and frequent curettages, sunbathing less, eating rationally, and not abusing hormonal contraceptives. In general, prevention is based on eliminating provoking factors and controlling hormonal levels.

Carefully! Video of laparoscopic myomectomy for multiple uterine myomatous nodes (click to open)

Multiple uterine fibroids is a tumor-like disease that occurs in the muscular layer of the uterus (myometrium) and is characterized by the appearance of two or more myomatous nodes.

The severity of the disease lies in the fact that the nodes in the thickness of the uterus have a different structure and origin, and from this each specific node will require an individual and corresponding response.

The disease often debuts at the age of 32 - 33 years. During late reproductive age and early menopause, the growth of multiple fibroids increases. According to WHO, multiple uterine fibroids are 24 - 26% all cases of tumor processes of the reproductive system.

Prognosis for the disease adverse. In most cases, with this pathology, the uterus is removed, which deprives a woman of having children during the reproductive period, and in more advanced forms of the disease can lead to death.

The severity of the pathological process in the uterus can be determined by the following criteria:

Localization of nodes, which depends on their location in the thickness of the myometrium.
The woman's age.
Node size.
The rate of growth of fibroids.

Causes of the disease

Multiple uterine fibroids are mutations of 2 or more smooth muscle cells in the thickness of the myometrium and their subsequent uncontrolled and relatively rapid division.

These disorders occur in a woman’s body due to hormonal imbalance. It has been proven that the development and growth of multiple fibroids is influenced by high levels of estrogen in the blood. And another, less studied factor is heredity.

You can select risk group- women who may be more susceptible to developing the disease:

a history of 2 or more abortions;
late first birth - 35 years or more;
women who are overweight or obese;
women who have endocrinological disorders in the pancreas (diabetes mellitus), thyroid gland (hypothyroidism) or pituitary gland (brain tumor, consequence of TBI (traumatic brain injury));
women suffering from frequent inflammatory diseases of the reproductive system, as well as those with a history of benign or malignant ovarian tumors.

Classification

They are distinguished by size:

Multiple - the diameter of such nodes does not exceed 20 mm, and the overall size of the uterus is characteristic of the 8th week of pregnancy.
Multiple - the diameter of the nodes is from 20 mm to 6 cm, the total size of the uterus does not exceed the 12th week of pregnancy.
Multiple - the diameter of the nodes exceeds 6 cm, the total size of the uterus corresponds to 13 or more weeks of pregnancy.

Depending on location of nodes in the thickness of the myometrium highlight:

, located on the border of the muscle layer and the endometrium (inner lining of the uterus).
, located in the middle of the myometrium.
located between the myometrium and perimeter (outer or serous lining of the uterus).

The classification of multiple uterine fibroids is only conditional, as it can combine several points at once.

Symptoms

headache;
dizziness;
memory and attention impairment;
general weakness;
decreased appetite;
nausea;
drowsiness;
irritability;
depression;
pale skin;
increased heart rate;
pain in the lower abdomen, intensifying before the onset of menstruation or during physical activity;
heavy and prolonged bleeding during menstruation;
bleeding from the vagina between menstrual cycles;
difficulty urinating;
frequent urge to urinate;
constipation;
swelling of the lower extremities.

Diagnostics

Examination by a gynecologist.
The examination consists of collecting complaints, interviewing the patient and conducting an internal gynecological examination in the speculum. With multiple uterine fibroids and sizes, the doctor can palpate the nodes on the surface of the uterus through the anterior abdominal wall.
In the case of a large “born” node, which grows into the thickness of the uterus and descends through the cervix into the vagina, the gynecologist will determine it during an internal gynecological examination.

After the first stage of diagnosing the disease, additional examination methods are prescribed, which include laboratory and instrumental tests.
Laboratory tests.
A breakdown of the results of a general blood and urine test (normal values of indicators and changes in nodular uterine fibroids) is given in the tables below. A general blood test will indicate the degree of anemia during bleeding caused by a general disease. Table 1. Complete blood count
Table 2. General urine analysis

Instrumental methods:

Ultrasound of the uterus with which you can identify the number of myomatous nodes, determine their size and shape. This examination method is quite informative, fast and relatively cheap.
MRI (magnetic resonance imaging) of the uterus allows you to identify the structure, shape, number and size of fibroid nodes, as well as determine their blood supply and the presence of complications that arose during the course of the disease. The method is more informative compared to ultrasound diagnostics, but more expensive. An MRI is mandatory for this disease.
Hysteroscopy- examination of the vaginal cavity and uterus with a special device - a hysteroscope, which consists of a fiber optic tube and a light source. This examination method is used after ultrasound or MRI, in the presence of submucosal myomatous nodes.
Diagnostic laparoscopy- examination of the pelvic cavity using an endoscope - an optical fiber tube that has a camera that displays an image on a monitor screen and a light source. This method is the most accurate, but invasive (penetrating into the body). The study is resorted to in case of doubt after ultrasound and MRI or in the presence of complications.

Treatment of multiple fibroids

Treatment of multiple uterine fibroids, depending on the complexity of the course, can be conservative or surgical. (medicinal) methods combine the use of hormonal drugs, as well as vitamin therapy. (surgical) methods are used for complicated forms of the disease, as well as for the growth of myomatous nodes. Typically, methods such as myomectomy or hysterectomy are used.

Conservative treatment

When multiple small fibroids occur, it is used wait-and-see tactics, which involves undergoing an ultrasound examination of the uterus 2-3 times a year and, if mild or moderate anemia occurs, taking vitamins and iron supplements:

vitamins B1, B2 and B12(neurorubin, neuromidin, milgama) intramuscularly 2.0 - 3.0 ml or orally 1 - 2 tablets per day (depending on the severity of anemia);
iron(totema, gynotardiferon, sorbifer) orally 1 - 2 times a day;
vitamin C 500 mg 2 times a day;
folic acid 1 capsule 3 times a day.

These medications are taken under the control of a general blood test every 7 - 10 days.

For multiple uterine fibroids, which are characterized by rapid growth, drugs are prescribed that block their growth - gonadotropin releasing hormone antagonists (goserelin, leuprorelin, buserelin).

The dosage and frequency of taking these drugs are individual in each specific case and are decided by your attending physician.

Surgical treatment

Surgical treatment of multiple uterine fibroids is divided into two types:

radical- removal of multiple fibroids throughout the entire uterus.
functional- removal of all uterine nodes while maintaining the integrity of the organ.

Indications for surgical treatment:

multiple large uterine fibroids;
severe anemia;
rapid growth of fibroids - an increase in height of more than 3 weeks in 1 year;
presence that provoked this disease.

Methods of surgical treatment

Myomectomy- removal of multiple fibroids, which is performed in an operating room under general anesthesia. This type of surgical intervention is performed only in the presence of intermuscular and abdominal myomatous nodes.
The operation can be carried out two accesses:
Midline laparotomy- an incision is made in the abdominal wall, the fibroid is brought out into the surgical field and excised, the surgical wound is sutured, and drainage is placed. The duration of hospitalization is 10 - 14 days.
Laparoscopy- 3-4 incisions are made in the lower abdomen, an endoscope, a camera and an electrocoagulator are inserted inside. Using an electrocoagulator, the fibroid is cut off and removed through one of the incisions. Postoperative wounds are sutured and drainage is placed. The duration of hospitalization is 5 - 7 days.
Hysterectomy- complete removal of the uterus, which is performed in the operating room under general anesthesia. This method is used in almost 90% of cases when multiple uterine fibroids occur. Access and duration of hospitalization are indicated above.

Complications

necrosis of multiple uterine fibroids;
degeneration of fibroids into a malignant tumor;
infertility;
compression of the inferior vena cava by multiple fibroids, which manifests itself in increasing swelling of the entire surface of the lower extremities and the anterior abdominal wall, a decrease in blood pressure and pulse rate;
compression of the aorta by fibroids, which is manifested by fainting, shock, and the onset of coma;
compression of the ureters by fibroids, which is accompanied by anuria (lack of urine), vomiting and loss of consciousness.

Prevention

rational nutrition;
fight against physical inactivity and excess weight;
compliance with the work and rest regime;
giving up bad habits;
pregnancy planning;
undergoing annual examinations with a gynecologist;
sanitary educational work among the population.

The formation of leiomyomatous nodes can be single, but multiple uterine fibroids are much more common. The predominant location of nodular formations is outside or inside the muscular wall of the uterine body, but it is quite possible to detect submucosal leiomyoma or cervical-isthmus localization of nodes. A benign tumor can be large, but often multinodular uterine fibroids are formed from several small formations.

In each case, examination and treatment are carried out according to an individual plan, especially in situations where a woman wants to conceive and carry a pregnancy. Multiple uterine fibroids with menstrual bleeding and large nodes may be a reason for surgical intervention.

You can treat with folk remedies, but only after consulting a doctor and in the absence of indications for surgery.

Classification of multinodular leiomyoma

Myomatous nodes can be located anywhere in the uterus. Typical options:

submucosal;
interstitial;
subserous;
intraligamentary;
isthmus.

Multiple uterine fibroids, depending on the number and size of nodes, come in 3 varieties, which are presented in the table.

Treatment and management tactics largely depend on the type of tumor: the doctor will choose only conservative methods of therapy for small forms of the tumor in a woman who wants to carry a pregnancy to term.

Symptoms of pathology

With small multiple leiomyoma, there may be no manifestations in the form of uterine bleeding, but the following symptoms more often occur:

heavy periods;
intermenstrual bleeding;
cycle disruption;
infertility.

All these manifestations are possible with large fibroids and in the presence of a dominant node not exceeding 6 cm in size. In addition, there will be the following symptoms:

pain of varying severity;
troubles associated with the functions of the bladder and rectum;
changes in the blood in the form of anemia.

Large leiomyoma always leads to pronounced changes in the rhythm and size of menstruation, which becomes an indication for surgery. Drug treatment and folk remedies therapy can be used for small tumors and minimal symptoms.

Diagnostics

During a routine gynecological examination, the doctor will use palpation to detect a lumpy, enlarged uterus, which will be the basis for a preliminary diagnosis. During an ultrasound, the specialist will count the number of nodes and the size of each tumor-like formation. In most cases, this is enough to start treatment. In difficult situations and when planning surgery, the doctor will prescribe a tomography (MRI or CT).

If a woman is planning a pregnancy, then the condition of the ovaries and endometrium must be assessed. The presence of the following pathology options is of great importance for the choice of treatment tactics:

endometrial hyperplasia;
uterine body polyp;
polyp of the cervical canal;
ovarian cyst;
endometriosis of any location.

Gynecological diseases associated with leiomyoma create difficulties for therapy. With uncomplicated small fibroids, the desired pregnancy will definitely occur during therapy. The larger the size of the benign tumor, the less chance of successful conception.

Therapy

If multiple uterine fibroids are detected, treatment is carried out individually, taking into account the woman’s age and desire to have a child. The most favorable outcome of treatment and prognosis for pregnancy in women with small leiomyoma is when the doctor uses the following complex treatment:

hormone therapy using medications that create optimal conditions for conception;
correction of menstrual disorders;
reduction of blood loss;
treatment of anemia;
influence of folk remedies.

For multiple medium-sized leiomyomas, combination therapy is used. At stage 1, it is necessary to remove the dominant node, at stage 2, drug treatment and folk remedies therapy should be used. In some cases, according to indications, the method of uterine artery embolization is used, which makes it possible to reduce the size of the uterus without surgery.

Large leiomyoma is an indication for surgery. It is useless to treat with folk remedies and hormones. With such a uterus, it is impossible to conceive and carry a pregnancy, so it is optimal to remove the defective reproductive organ.

An important condition for successful treatment of multiple leiomyoma is the timely initiation of treatment measures. As long as the nodes do not exceed 20 mm, the chances of recovery are optimal. This is especially true for women who want to fulfill their dream and have a baby.

Even in the period of high technology and the most accurate diagnostics, a woman’s health is susceptible to a huge number of diseases, especially gynecological ones. One of the most common diseases of this kind is multiple uterine fibroids, which is diagnosed in 10–25% of women.

Multiple uterine fibroids are a common gynecological disease

Fibroids are a benign tumor that forms in the muscle layer of the body or cervix. Multiple fibroids are characterized by a different number of nodes (interweaving of smooth muscle fibers).

Scientific classification

Depending on the overall size of the nodes, multiple uterine fibroids are divided by scientists into the following types:

small fibroids (size no more than 20 mm);
medium (size less than 60 mm);
large (more than 60 mm in diameter).

An equally important factor is where exactly the fibroids are located. The presence of various symptoms, pain, danger to the woman, threat to her reproductive health, as well as the treatment method and the complexity of the operation depend on this.

Based on the location of the nodes, they are distinguished:

submucosal myoma (submucosal nodes) – located closer to the uterine cavity itself;
interstitial (intermuscular nodes) - located in the muscular layer of the uterine wall;
subserous (subperitoneal nodes) – the outer side of the uterus;
intraligamentary fibroids (interligamentous nodes);
cervical fibroid.

Placement of fibroids in the body of the uterus

Symptoms and prevention of the disease

The most typical symptoms that may indicate the presence of fibroids are heavy bleeding during the menstrual cycle, heavier and longer than usual; feeling of pressure and pain in the lower abdomen. As the disease progresses, the pain can become sharp and cutting. One of the rare symptoms is infertility.

Detection of the disease is possible even with a simple examination by a gynecologist, not to mention an ultrasound.

Therefore, every woman should monitor her condition - undergo routine examinations and not let the matter develop to large nodes, the treatment of which requires urgent surgery.

Like all diseases, multiple uterine fibroids do not exclude preventive measures. To prevent its occurrence, you need to monitor your hormonal levels, spend less time in the sun, avoid sudden changes in temperature, attend routine examinations, use contraceptives, in order not to have abortions later due to an unplanned pregnancy, and immediately undergo treatment rather than wait, until the disease goes away on its own.

Pressing pain in the lower abdomen may be a symptom of fibroids

Pregnancy with fibroids

Doctors speak of an unconditional connection between pregnancy and this disease. After all, the disease directly depends on the hormonal state of the woman, and bearing a child can aggravate the condition. Due to hormonal surges in the body, myomatous nodes accelerate growth, and the size will sharply move from medium to large, that is, over 6 cm. And an increase in their size can lead to late toxicosis; large fibroids can even cause miscarriages.

Multiple uterine fibroids are one of the most frequently detected pathologies that occur during pregnancy, and often require urgent treatment, due to the threat of obstruction of the development of the fetus and its gestation.

But under no circumstances should you panic. If the diameter of the fibroids is not large, then the course of pregnancy is generally not in danger. But each patient should consult with several specialists.

A year after fibroid removal, you can plan a pregnancy

Treatment of the disease

Several types of treatment are used. The use of one or another method is considered only individually, taking into account the size of the fibroid, its location, growth rate, and the woman’s age. After all, the stage that involves hormonal intervention (inducing artificial menopause) cannot be applied in the long term to women under 30 years of age.

After drug treatment has been carried out, which should have led to a reduction in the nodes, surgical intervention follows, all stages and subtleties of which the specialist determines by analyzing only a specific case. Now doctors have abandoned the previous method of complete removal of the uterus and always try to preserve the reproductive organ during surgery, so multiple uterine fibroids have ceased to frighten with unconditional infertility.

The type of surgery to remove fibroids is prescribed by the attending physician

The operation is performed in several ways: with access through the vagina, through an incision in the lower abdomen, through several small incisions and using a hysteroscope.

The most acceptable method now is embolization. The method involves blocking the blood vessel that goes to the node, thereby stopping its nutrition, and it significantly decreases in size (up to 65% per year).

Emergency intervention is used only due to acute symptoms, a threat to the woman’s health, or the large size of the nodes. Therefore, you should not immediately panic.

It is best to undergo treatment before planning a pregnancy, so that no complications arise later. After all, large nodes will later threaten the child’s health.

The main warning of all doctors is not to start self-therapy, not to rely on folk remedies and that the disease will go away on its own over time.

The scary thing is that in the modern world the disease is getting younger. And an increasing number of women under 30 are being affected. Therefore, everyone should take time to worry about their health. Especially if pregnancy is planned in the future.

vrachlady.ru

Development of multiple uterine fibroids: dynamics and treatment of pathology

Multiple uterine fibroids are a type of benign formation in the uterine muscle tissue, which is characterized by the development of several lesions at once. In general, the nature of the development of the considered form of myomatous lesion is characterized by a higher rate, compared to a single form, and an increased risk of developing into malignant forms in later stages.

The nature and dynamics of the development of pathology

In order to find out what it is - a multiple form of myomatous growth in the uterus, one should consider the dynamics of the development of the disease, the causes of its occurrence and its characteristic manifestations.

Multiple uterine fibroids develop against the background of hormonal imbalance, as well as possible foci of inflammation in the uterine cavity. The lesion is formed by a specific node in the myometrium, and at the initial stage it is represented by a small neoplasm.

In some clinical cases, multiple uterine fibroids are accompanied by the following symptoms:

specific painful manifestations localized in the groin and lower back;
menstrual irregularities;
an increase in the volume and intensity of menstrual bleeding;
anovulatory spotting;
difficulties conceiving a child, which can develop into infertility.

Heavy menstrual bleeding can also lead to the development of anemia, general conditions of apathy and increased anxiety.

A woman who has been diagnosed with myomatous pathology may experience attacks of instant weakness, nausea, and dizziness.

In uterine pathologies, fibroids are often a concomitant disease. An important factor in studying the dynamics of the development of this pathology is timely comprehensive diagnosis and identification of possible concomitant diseases, as well as the clinical prognosis of their parallel progress.

Forms of the disease

Before treating a myomatous lesion, it is necessary to establish the form of its development and make a medical prognosis for its further clinical behavior.

Depending on the number of neoplasms, the pathology can be single or multiple (when at least 2 nodules develop).

In addition, according to the type of location relative to the uterine walls, there are:

intraligamentary myoma (localization of formation - the main ligament of the uterine layers);
intramural (develops in the muscular layers of the uterine walls);
submucous type (forms under the endometrial layer and grows inside the uterine cavity);
subserous type (the node is located outside the uterine walls, under the connective tissue).

It is best to treat the first two types of myomatous pathology in the early stages, when the size of the tumors is still small. The other two types may require surgical intervention because they are quite difficult to diagnose and are less common in clinical practice.

Diagnosis and treatment

Multiple uterine fibroids are diagnosed using special laboratory research methods:

diagnostic laparoscopy;
hysteroscopy.

The accuracy of diagnosis using ultrasound is quite high. Ultrasound can detect the presence of nodules up to 5 millimeters in diameter. This, in turn, contributes to faster and more effective treatment and reduces the likelihood of relapse.

Multiple uterine fibroids in the early stages of development can be treated conservatively. However, due to its difficult diagnosis and detection in late phases, much more often doctors recommend a surgical route to eliminate the pathology.

Myomatous lesions of the uterus of small sizes are treated using a range of medications aimed at inhibiting the growth and development of fibroids and its further atrophy.

However, if the uterine fibroids are multiple and have reached significant proportions, it will be much more effective and safer to resort to surgical removal of the pathological growth. For the purpose of surgical removal of fibroids, the traditional curettage method is used,

using a modern device - a hysteroscope, equipped with a miniature video camera.

With its help, the surgeon can more effectively calculate all manipulations and control the entire procedure. After cleansing the uterine tissue from pathological growth, the area where the lesion was localized is cauterized using antiseptics or electric current.

After the operation, the resulting material is sent for histological examination in order to identify cells that have transformed into malignant forms.

It is worth noting that uterine fibroids tend to recur, and the return of the disease can be avoided only by carefully following all medical recommendations regarding the period of rehabilitation and recovery.

Rehabilitation and preventive measures

Large multinodular uterine fibroids require particularly careful treatment based on preliminary therapy, surgical intervention and rehabilitation treatment measures. Comprehensive and well-designed prevention is also of great importance to reduce the likelihood of recurrent manifestations.

In particular, an important factor in the patient’s recovery after treatment of multiple uterine fibroids and removal of foci of myomatous lesions is a properly selected diet rich in vitamins and nutrients.

Vegetables and fruits should predominate, but the consumption of meat products should be reduced to a minimum.

The psycho-emotional state of the recovering patient is also important. It is recommended to eliminate as many stress factors as possible from everyday life, stabilize emotional tone, and get rid of the feeling of depression.

Multiple uterine fibroids are quite dangerous because they are associated with an increased likelihood of relapses and progression to malignant pathologies. Therefore, treatment of multinodular uterine fibroids and comprehensive recovery after the disease must begin as early as possible.

womanhealth.guru

Multiple uterine fibroids

Multiple uterine fibroids are a tumor-like disease that occurs in the muscular layer of the uterus (myometrium) and is characterized by the appearance of two or more myomatous nodes.

The severity of the disease lies in the fact that the nodes in the thickness of the uterus have a different shape, structure, origin, and therefore each specific node will require an individual diagnostic approach and, accordingly, treatment.

The disease often debuts at the age of 32 - 33 years. During late reproductive age and early menopause, the growth of multiple fibroids increases. According to WHO, multiple uterine fibroids account for 24 - 26% of all cases of tumor processes of the reproductive system.

The prognosis for the disease is unfavorable. In most cases, with this pathology, the uterus is removed, which deprives a woman of having children during the reproductive period, and in more advanced forms of the disease can lead to death.

The severity of the pathological process in the uterus can be determined by the following criteria:

Localization of nodes, which depends on their location in the thickness of the myometrium.
The woman's age.
Node size.
The rate of growth of fibroids.

Causes of the disease

The cause of multiple uterine fibroids are mutations of 2 or more smooth muscle cells in the thickness of the myometrium and their subsequent uncontrolled and relatively rapid division.

These disorders in a woman’s body occur due to hormonal imbalance. It has been proven that the development and growth of multiple fibroids is influenced by high levels of estrogen in the blood. And another, less studied factor is heredity.

We can distinguish a risk group - women who may be more predisposed to developing the disease:

a history of 2 or more abortions;
late first birth - 35 years or more;
women who are overweight or obese;
women who have endocrinological disorders in the pancreas (diabetes mellitus), thyroid gland (hypothyroidism) or pituitary gland (brain tumor, consequence of TBI (traumatic brain injury));
women suffering from frequent inflammatory diseases of the reproductive system, as well as those with a history of benign or malignant ovarian tumors.

Classification

By size they are distinguished:

Multiple small uterine fibroids - the diameter of such nodes does not exceed 20 mm, and the overall size of the uterus is characteristic of the 8th week of pregnancy.
Multiple medium-sized uterine fibroids - the diameter of the nodes is from 20 mm to 6 cm, the total size of the uterus does not exceed the 12th week of pregnancy.
Multiple large uterine fibroids - the diameter of the nodes exceeds 6 cm, the total size of the uterus corresponds to 13 or more weeks of pregnancy.

Depending on the location of the nodes in the thickness of the myometrium, the following are distinguished:

Submucosal nodes located at the border of the muscular layer and the endometrium (inner lining of the uterus).
Intermuscular nodes located in the middle of the myometrium.
Abdominal ligaments located between the myometrium and perimeter (outer or serous lining of the uterus).

The classification of multiple uterine fibroids is only conditional, as it can combine several points at once.

Symptoms

headache;
dizziness;
memory and attention impairment;
general weakness;
decreased appetite;
nausea;
drowsiness;
irritability;
depression;
pale skin;
increased heart rate;
pain in the lower abdomen, intensifying before the onset of menstruation or during physical activity;
heavy and prolonged bleeding during menstruation;
bleeding from the vagina between menstrual cycles;
difficulty urinating;
frequent urge to urinate;
constipation;
swelling of the lower extremities.

Diagnostics

Examination by a gynecologist. The examination consists of collecting complaints, interviewing the patient and conducting an internal gynecological examination in the speculum. With multiple uterine fibroids of medium and large size, the doctor can palpate the nodes on the surface of the uterus through the anterior abdominal wall.
In the case of a large submucosal node “in birth”, which grows into the thickness of the uterus and descends through the cervix into the vagina, the gynecologist will determine it during an internal gynecological examination.
After the first stage of diagnosing the disease, additional examination methods are prescribed, which include laboratory and instrumental tests.
Laboratory tests. A breakdown of the results of a general blood and urine test (normal values of indicators and changes in nodular uterine fibroids) is given in the tables below. A general blood test will indicate the degree of anemia during bleeding caused by a general disease. Table 1. General blood test
Table 2. General urine analysis

Instrumental methods:

An ultrasound of the uterus can be used to identify the number of myomatous nodes and determine their size and shape. This examination method is quite informative, fast and relatively cheap.
MRI (magnetic resonance imaging) of the uterus allows you to identify the structure, shape, number and size of fibroid nodes, as well as determine their blood supply and the presence of complications that have arisen during the course of the disease. The method is more informative compared to ultrasound diagnostics, but more expensive. An MRI is mandatory for this disease.
Hysteroscopy is an examination of the vaginal cavity and uterus with a special device - a hysteroscope, which consists of a fiber optic tube and a light source. This examination method is used after ultrasound or MRI, in the presence of submucosal myomatous nodes.
Diagnostic laparoscopy is an examination of the pelvic cavity using an endoscope - an optical fiber tube that has a camera that displays an image on a monitor screen and a light source. This method is the most accurate, but invasive (penetrating into the body). The study is resorted to in case of doubt after ultrasound and MRI or in the presence of complications.

Treatment of multiple fibroids

Treatment of multiple uterine fibroids, depending on the complexity of the course, can be conservative or surgical. Conservative (medicinal) methods combine the use of hormonal drugs, as well as vitamin therapy. Operative (surgical) methods are used for complicated forms of the disease, as well as for the growth of myomatous nodes. Common methods used include laparoscopy, embolization, myomectomy or hysterectomy.

Conservative treatment

If multiple small fibroids occur, expectant management is used, which involves undergoing an ultrasound examination of the uterus 2-3 times a year and, if mild or moderate anemia occurs, taking vitamins and iron supplements:

vitamins B1, B2 and B12 (neurorubin, neuromidin, milgama) intramuscularly 2.0 - 3.0 ml or orally 1 - 2 tablets per day (depending on the severity of anemia);
iron (totema, gynotardiferon, sorbifer) orally 1 - 2 times a day;
vitamin C 500 mg 2 times a day;
folic acid 1 capsule 3 times a day.

These medications are taken under the supervision of a general blood test every 7 to 10 days.

For small and medium-sized multiple uterine fibroids, which are characterized by rapid growth, drugs are prescribed that block their growth - gonadotropin releasing hormone antagonists (goserelin, leuprorelin, buserelin).

The dosage and frequency of taking these drugs are individual in each specific case and are decided by your attending physician.

Surgical treatment

Surgical treatment of multiple uterine fibroids is divided into two types:

radical - removal of multiple fibroids throughout the entire uterus.
functional - removal of all uterine nodes while maintaining the integrity of the organ.

Indications for surgical treatment:

multiple large uterine fibroids;
severe anemia;
rapid growth of fibroids - an increase in height of more than 3 weeks in 1 year;
the presence of complications caused by this disease.

Methods of surgical treatment

Myomectomy is the removal of multiple fibroids, which is performed in an operating room under general anesthesia. This type of surgical intervention is performed only in the presence of intermuscular and abdominal myomatous nodes. The operation can be carried out in two ways:
Median laparotomy - an incision is made in the abdominal wall, the fibroid is brought out into the surgical field and excised, the surgical wound is sutured, and drainage is placed. The duration of hospitalization is 10 - 14 days.
Laparoscopy - 3-4 incisions are made in the lower abdomen, an endoscope, a camera and an electrocoagulator are inserted inside. Using an electrocoagulator, the fibroid is cut off and removed through one of the incisions. Postoperative wounds are sutured and drainage is placed. The duration of hospitalization is 5 - 7 days.
Hysterectomy is the complete removal of the uterus, which is performed in the operating room under general anesthesia. This method is used in almost 90% of cases when multiple uterine fibroids occur. Access and duration of hospitalization are indicated above.

Complications

necrosis of multiple uterine fibroids;
degeneration of fibroids into a malignant tumor;
infertility;
compression of the inferior vena cava by multiple fibroids, which manifests itself in increasing swelling of the entire surface of the lower extremities and the anterior abdominal wall, a decrease in blood pressure and pulse rate;
compression of the aorta by fibroids, which is manifested by fainting, shock, and the onset of coma;
compression of the ureters by fibroids, which is accompanied by anuria (lack of urine), vomiting and loss of consciousness.

Prevention

rational nutrition;
fight against physical inactivity and excess weight;
compliance with the work and rest regime;
giving up bad habits;
pregnancy planning;
undergoing annual examinations with a gynecologist;
sanitary educational work among the population.

Dimensions of uterine fibroids
Contraindications for uterine fibroids
Diagnosis of uterine fibroids

eva-health.ru

Multiple uterine fibroids

Unfortunately, today, many women are faced with various gynecological diseases. Uterine fibroids are also diagnosed very often.

Mostly women of reproductive age are affected. Myoma in the uterine cavity is a benign neoplasm. Such neoplasms can be localized both inside and outside the reproductive organ. Myoma nodes are formed due to the muscular layer of the uterine cavity. Myoma tumors can be single, when only one node is formed, and multiple, when several nodular formations are involved in the pathological process.

More often, doctors diagnose multiple fibroid tumors. The prognosis of the disease directly depends on its size, location, rate of growth and development.

Characteristic

Multiple uterine fibroids are a benign tumor. It is formed in the muscle tissue of the uterus, with a certain number of nodal formations.

The disease develops in a latent form; the patient may not be aware of the concomitant disease until the fibroid formations begin to actively progress in development. During this period, the woman may experience the first manifestations of the pathological process. This neoplasm can form in various sizes, shapes and quantities. If you study medical statistics, you can find out that multiple fibroids are diagnosed in almost 87% of patients, compared to other fibroids. With such tumor processes, it is imperative to carry out effective treatment. Otherwise, the nature of the neoplasm will develop into malignant. .

As practice shows, almost every woman seeks medical help only when the pathological process is already at an advanced stage.

Thus, in most cases, doctors are faced with the task of removing myoma formation already at the last stage of development.

Reasons

Even thanks to modern medicine, experts still cannot determine the true causes of the appearance of fibroid tumors in the female body.

Many doctors are inclined to argue that certain factors contribute to damage to mature cells, and over time they begin to develop abnormally. Also, hormonal instability of the female body, namely increased estrogen levels, plays a large role in the formation of fibroid nodes. When estrogen exceeds normal levels, the body is stimulated to accelerate the development of increased concentrations of progesterone. Because of this, uterine cells grow uncontrollably and rapidly and provoke the formation of fibroid nodes. Provoking factors for the development of multiple fibroids can be:

a large number of instrumental interventions in the uterine cavity (abortions, curettage and various operations;
injury to the pelvic organs;
regular physical activity;
psycho-emotional disorders;
inflammatory processes;
genetic predisposition;
overweight.

Also, provoking factors may include: untimely puberty, long-term use of oral hormonal contraceptives, substance metabolism, impaired metabolism, long-term use of the intravaginal device, including disorders of the endocrine system.

Symptoms

When the fibroid nodes reach a large size, the woman begins to notice the first manifestations of the pathological process.

The main symptoms include:

Cramping pain attacks during the menstrual cycle, however, if the tumor process is still at the stage of formation, then the pain syndrome can occur between periods;
The formation can put pressure on nearby organs and tissues and subsequently disrupt the blood supply;
heavy bleeding during menstruation;
The appearance of intermenstrual discharge;
increase in abdominal volume;
Frequent urge to urinate;
regular constipation;
Sensation of a foreign body in the lower abdomen.

In some cases, due to large nodes, compression begins in the inferior vena cava. This can cause tachycardic symptoms, difficulty breathing, etc.

However, in general, in each patient the formation of nodules occurs with individual symptoms, which depend on the volume and number of nodules, accompanying pathological processes, etc.

Varieties

Multiple myoma nodes can be interstitial, subserous and submucosal. Also, such formations are small, medium and large.

A large multiple neoplasm is a cluster of uterine formations with a diameter of about six centimeters. Such tumors are the most serious and cause critical condition in women. The average multiple fibroid is a cluster of two or three formations ranging in size from two to six centimeters. Small fibroids are multiple formations with a diameter of less than two centimeters.

Multiple fibroids can develop over a long period of time and with an uneven course. Therefore, it is very important to diagnose the formation of nodes at an early stage. Submucous multiple fibroids are localized under the mucous membrane of the uterine cavity. This type is characterized by the rapid growth of nodes and their increase in volume. Also, patients have pronounced manifestations of the pathological process. This picture makes it possible to diagnose the formation at an early stage, which has a positive effect on the outcome of the treatment. Interstitial and interstitial-subserous fibroids are localized directly in muscle tissue. These formations have different development patterns.

Doctors cannot determine the exact prognosis of the operation. It depends on the location of the node, its volume, etc.

Multiple uterine fibroids and pregnancy

With multiple myomatous nodes in the uterine cavity, pregnancy may be difficult to achieve, since the nodes interfere with passage through the fallopian tubes.

If the nodes are small in size, they are not able to influence conception, as well as the course of pregnancy. If pregnancy occurs with multiple fibroids, there may be complications if one or more nodes are close to the placenta.

Small nodules cannot harm the fetus, but if the nodes begin to grow, then the risk of premature birth and various complications during fetal development and during delivery itself increases.

In addition, according to statistics, multiple uterine fibroids can provoke placental abruption.

Complications

Uterine fibroids are classified as asymptomatic diseases. A woman can live with a tumor process for years and not know about it. What’s most interesting is that when menopause occurs, in 40% of cases it resolves on its own. But there are also not so joyful moments. If the disease is not diagnosed in time and treatment is not started in a timely manner, then in the end the woman may find herself without a uterus.

If myomatous neoplasms cause regular bleeding, then after some time the woman may become anemic and the hemoglobin level may drop to critical levels. Against this background, the patient is constantly in a state of weakness, which is accompanied by dizziness. Often dizziness ends in loss of consciousness. If the disease is advanced, it may be necessary to remove the uterus itself, which will forever deprive the possibility of motherhood.

Therefore, at the first sign of suspicion of this disease, you should seek qualified help in order to avoid serious consequences. In addition, it is worth knowing that large nodes can disrupt the functionality of the intestinal and urinary systems.

Diagnosis and treatment

To make a final diagnosis, doctors prescribe the following to the patient:

ultrasound examination of the reproductive organ;
diagnosis of fallopian tube patency using hysterosalpingography;;
magnetic resonance imaging;
examination of the cervical canal and the walls of the uterine cavity;
General analysis of urine and blood.

The patient can be saved from multiple myoma formation only through surgery. It is important to know that in the initial stages the disease can be cured with medication. In this case, the patient is prescribed hormonal drugs. These drugs can significantly reduce the size of fibroids and stop their growth.

The operation is based on the fact that the node is removed as a result of an incision in the abdominal cavity. If the situation is severe enough, then excision of the genital organ along with the appendages is recommended. In some cases, evaporation of nodes using ultrasonic waves is used.

Prognosis and prevention

As a rule, almost 85% of patients who have undergone surgery to remove multiple fibroids tolerate everything perfectly. They recover quickly, and after 10 days they can begin everyday chores. The remaining 15% of cases did not end with such success. The patients themselves are directly to blame for this. Their pathological process was diagnosed already at the final stage of development.

Therefore, doctors urgently ask that every woman undergo a preventive examination by a gynecologist at least once a year. To prevent the formation of fibroid nodes, a woman should beware of various instrumental interventions in the uterine cavity, namely abortion. Also, it is not recommended to take hormonal medications without a prescription from a specialist.

The main preventive measures are aimed at eliminating the provoking factor. It is very important for every woman to control her hormonal levels.

wmedik.ru

2018 Blog about women's health.

21.11.2018

Many women face various gynecological diseases. Uterine fibroids are also diagnosed very often.

Women of reproductive age suffer. Myoma in the uterine cavity is a benign neoplasm. Such neoplasms can be localized both inside and outside the reproductive organ. Myoma nodes are formed due to the muscular layer of the uterine cavity. Myoma tumors can be single, when only one node is formed, and multiple, when several nodular formations are involved in the pathological process.

More often, doctors diagnose multiple fibroid tumors. The prognosis of the disease directly depends on its size, location, rate of growth and development.

Characteristics of multiple fibroids

Multiple uterine fibroids are a benign tumor. It is formed in the muscle tissue of the uterus, with a certain number of nodal formations.

As practice shows, almost every woman seeks medical help only when the pathological process is already at an advanced stage.

Thus, in most cases, doctors are faced with the task of removing myoma formation already at the last stage of development.

Causes of multiple fibroids

Even thanks to modern medicine, experts still cannot determine the true causes of the appearance of fibroid tumors in the female body.

Doctors say that certain factors contribute to the damage of mature cells, and over time they begin to develop abnormally. A role in the formation of fibroid nodes is played by hormonal instability of the female body, namely increased estrogen levels.

When estrogen exceeds normal levels, the body is stimulated to accelerate the development of increased concentrations of progesterone. Because of this, uterine cells grow uncontrollably and rapidly and provoke the formation of fibroid nodes. Provoking factors for the development of multiple fibroids can be:

a large number of instrumental interventions in the uterine cavity (abortions, curettage and various operations;
injury to the pelvic organs;
regular physical activity;
psycho-emotional disorders;
inflammatory processes;
genetic predisposition;
overweight.

Provoking factors may include: untimely puberty, long-term use of oral hormonal contraceptives, substance metabolism, impaired metabolism, long-term use of the intravaginal device, including disorders of the endocrine system.

Multiple fibroids: symptoms of pathology

When the fibroid nodes reach a large size, the woman begins to notice the first manifestations of the pathological process.

The main symptoms include:

Cramping pain attacks during the menstrual cycle, however, if the tumor process is still at the stage of formation, then the pain syndrome can occur between periods;
The formation can put pressure on nearby organs and tissues and subsequently disrupt the blood supply;
heavy bleeding during menstruation;
The appearance of intermenstrual discharge;
increase in abdominal volume;
Frequent urge to urinate;
regular constipation;
Sensation of a foreign body in the lower abdomen.

In some cases, due to large nodes, compression begins in the inferior vena cava. This can cause tachycardic symptoms, difficulty breathing, etc.

However, in general, in each patient the formation of nodules occurs with individual symptoms, which depend on the volume and number of nodules, accompanying pathological processes, etc.

Types of uterine fibroids

Multiple myoma nodes can be interstitial, subserous and submucosal. Also, such formations are small, medium and large.

This picture makes it possible to diagnose the formation at an early stage, which has a positive effect on the outcome of the treatment. Interstitial and interstitial-subserous fibroids are localized directly in muscle tissue. These formations have different development patterns.

Doctors cannot determine the exact prognosis of the operation. It depends on the location of the node, its volume, etc.

Multiple uterine fibroids and pregnancy

With multiple myomatous nodes in the uterine cavity, pregnancy may be difficult to achieve, since the nodes interfere with passage through the fallopian tubes.

Small nodules cannot harm the fetus, but if the nodes begin to grow, then the risk of premature birth and various complications during fetal development and during delivery itself increases.

In addition, according to statistics, multiple uterine fibroids can provoke placental abruption.

Complications from lack of treatment

Therefore, at the first sign of suspicion of this disease, you should seek qualified help in order to avoid serious consequences. In addition, it is worth knowing that large nodes can disrupt the functionality of the intestinal and urinary systems.

Diagnosis of uterine fibroids - examinations

To make a final diagnosis, doctors prescribe the following to the patient:

ultrasound examination of the reproductive organ;
diagnosis of fallopian tube patency using hysterosalpingography;;
magnetic resonance imaging;
examination of the cervical canal and the walls of the uterine cavity;
General analysis of urine and blood.

The patient can be saved from myoma formation only through surgery. It is important to know that in the initial stages the disease can be cured with medication. In this case, the patient is prescribed hormonal drugs. These drugs can significantly reduce the size of fibroids and stop their growth.

The operation is based on the fact that the node is removed as a result of an incision in the abdominal cavity. If the situation is severe enough, then excision of the genital organ along with the appendages is recommended. In some cases, evaporation of nodes using ultrasonic waves is used.

Prognosis and prevention

Almost 85% of patients who have undergone surgery to remove multiple fibroids tolerate everything perfectly. They recover quickly, and after 10 days they can begin everyday chores. The remaining 15% of cases did not end with such success. The patients themselves are directly to blame for this. Their pathological process was diagnosed already at the final stage of development.

Therefore, doctors urgently ask that every woman undergo a preventive examination by a gynecologist at least once a year.

To prevent the formation of fibroid nodes, a woman should beware of various instrumental interventions in the uterine cavity, namely abortion. Also, it is not recommended to take hormonal medications without a prescription from a specialist.