Almost 30% of the entire adult female population around the world asks the question: what is fibroid? This disease creeps up unnoticed, and recognizing it at the very initial stage is very difficult. She is like a black cat in a dark room: she is and is not visible. So what kind of disease is this?

Myoma is a benign tumor of the uterus that develops from muscle fibers and connective tissue elements. Depending on the ratio of muscles and connective tissue in the structure of the tumor, in recent times it had a variety of names: myoma, fibroma, fibromyoma. But since fibroid nodes often develop from muscle cells, most doctors today consider the correct term “fibroids” or “leiomyoma”.

Most often, fibroids are a slow-growing tumor, and a tumor capable of relapse and degeneration into a malignant neoplasm. Every woman should know about this!

When does it occur?

The development of uterine fibroids is a benign, hormone-controlled increase in the thickness of the muscular layer of the uterus - the myometrium. And there can be many reasons that contribute to the beginning of this process.

Hormones only control the growth of fibroids, and it occurs spontaneously - after abortion, improper contraception, chronic inflammatory processes in the female organs, hormonal disorders, stress, due to excessive love of tanning, obesity or hereditary predisposition. In short, fibroids form after anything that can provoke tumor growth in our body.

If we had the opportunity to look inside the muscular layer of the uterus at the very beginning of the development of fibroids, we would see an extremely interesting picture. The cells of the uterus spontaneously begin to actively divide. The reasons for this phenomenon are not fully understood, but it has been established that it is primarily associated with increased secretion of estrogen hormones, which stimulate the growth of fibroids. Progesterone, on the contrary, causes its reverse development. This is confirmed by the fact that fibroids increase in size during pregnancy and decrease in size during the postmenopausal period.

At the same time, the normal balance of estrogen and progesterone in the blood does not at all guarantee the absence of fibroids: it can arise with minor fluctuations in hormonal levels.

How is fibroid diagnosed?

Fibroids are most often detected during a medical examination by a gynecologist. In this case, the doctor can only state the fact of the presence of uterine fibroids. In other situations, the first signs of fibroids may be pain in the lower abdomen or lumbar region, bleeding, changes in the menstrual cycle, dysfunction of neighboring organs, for example, frequent urination. The classic manifestations of uterine fibroids are protracted regular menstruation, against the background of which there is often irregular uterine bleeding - metrorrhagia. If such symptoms appear, you should go to an appointment with a gynecologist.

Diagnosing fibroids is not difficult if there is an increase in the size of the uterus, uterine bleeding, or deformation of the uterus by fibroid nodes. It can be detected by palpating the uterus through the anterior abdominal wall. Final confirmation of the diagnosis is provided by ultrasound, hysteroscopy or hysterography. The last two methods are contraindicated for pregnant women. Sometimes doctors may prescribe computed tomography or nuclear magnetic resonance to clarify the diagnosis.

Should she be treated?

Myoma can “resolve” on its own if the body’s hormonal levels change. Conditions contributing to this: small size of fibroids, absence of symptoms and progression over a fairly long period of time. For example, during or after menopause.

However, fibroids are often still operated on. The presence of fibroids in itself is not always an indication for surgery. It all depends on the patient’s condition, the severity of symptoms and the size of the tumor.

Indications for surgery to remove fibroids are pain, rapid growth in the size of the node, suspicion of degeneration into a malignant tumor, impaired blood supply to the fibroid nodes and inflammatory changes in them, failure of the functions of neighboring organs - the bladder, intestines; infertility – when all other causes have already been excluded. If an experienced gynecologist believes that surgery is necessary, then the sooner it is done, the better.

In general, after 40 years and in postmenopausal age, if there are surgical indications, surgery to remove the uterine myoma is necessary, because if the fibroid has not regressed in the first 2 years of postmenopause, its continued existence is accompanied by the risk of oncopathology - adenocarcinoma, sarcoma.

There is also a conservative solution to the problem. Uterine fibroids should be monitored regularly using vaginal ultrasound. In many cases, this is quite enough, and no treatment - neither conservative nor even surgical - is required. If a woman periodically experiences discomfort or pain in the pelvic area, taking non-steroidal anti-inflammatory drugs is effective. But prescribing hormonal drugs in order to reduce the size of the node is completely unjustified.

Today, another treatment method has been developed - transcatheter embolization of myomatous nodes, in which the node is deprived of blood supply and undergoes regression without the slightest harm to the uterus as a whole, but this method still remains experimental and is not widely used.

The most modern method of treating fibroids is immunocorrection using a special vaccine, which promotes the formation of a specific immune response against this disease. This treatment is used in young patients with tiny fibroids and at the very beginning, at the start of the disease. The goal of treatment is to preserve the uterus and enable the patient to give birth at the right time.

What about prevention?

We have already talked about it. This:
– regular visits to the gynecologist for early diagnosis of the disease;
– prevention of abortions;
– reasonable use of hormonal contraceptives under the supervision of a physician.

Uterine fibroids are a benign nodular neoplasm that occurs in the muscular layer of the uterus and can reach very large sizes. The medical literature mentions fibroids weighing 25, 40 and even 63 kg. The disease is diagnosed in 30-50% of women over 30 years of age. In Russia, about 280 thousand operations are performed annually to remove these tumors.

APPOINTMENT WITH A GYNECOLOGIST - 1000 rubles. CONSULTATION ON THE RESULTS OF ANALYSIS or ultrasound - 500 rubles.

What is uterine fibroid

Uterine fibroids are a benign tumor that develops in the walls of the cervix or in the uterus itself. In gynecological practice, fibroids of various sizes are encountered, ranging from a few millimeters to tens of centimeters. As a rule, several fibroids develop simultaneously.

Tumors are divided:

• By the number of nodes – single and multiple;
• By localization - submucosal, subperitoneal, interligamentous, intermuscular, cervical and isthmus. In 95% of cases, the tumor is located in the body of the uterus and only in 5% in its cervix.

Because uterine fibroids occur due to improper mitosis (a stage of cell division), all cells of the same tumor are identical. “Daughter” neoplasms can develop from previously existing neoplasms. therefore, even small fibroids need to be treated.

Causes and classification

The previously existing statement about the hereditary predisposition to the appearance of myomatous nodes is today controversial and the final pathogenesis of this disease is still unclear.

Presumably, the reasons for the development of this benign tumor are:

• mechanical damage to the walls of the uterus;
• hormonal imbalance;
• excess weight;
• gynecological diseases;
• pathologies of the cardiovascular system.

Risk factors

Fibroids are observed in every third woman and those who are most susceptible to it are those who are overweight and did not have the opportunity or desire to give birth to a child before the age of thirty. The appearance of fibroids is usually associated with hormonal imbalance, so women with hormonal imbalances, those who frequently have abortions, uncontrollably taking hormonal contraceptives, suffering from endocrine diseases - diabetes, etc. are at risk.

Surgeries with possible damage to the internal genital organs and untreated chronic infectious diseases can also lead to the formation of a benign uterine tumor.

Hereditary factors play an important role in the formation of fibroids. If sisters, grandmothers, aunts and mothers had benign tumors of the pelvic organs, then the likelihood of fibroids in the direct hereditary line is very high. Of course, this fact is not a death sentence, but a woman with poor heredity should regularly visit a gynecologist, undergo ultrasound examinations and donate blood for hormones.

Symptoms of fibroids

In approximately 20-30% of cases, symptoms of uterine fibroids are not expressed. The disease is detected by chance during a preventive medical examination or during an ultrasound scan prescribed for completely different reasons.

Availability Uterine fibroids can be suspected if:

• Increased menstrual bleeding, in which clots often appear.
• The appearance of acyclic (irregular, outside the cycle) bleeding of varying intensity.
• the occurrence of pain in the lower abdomen, a feeling of heaviness or discomfort.
• Pain during sexual intercourse.
• Miscarriages (miscarriages), frozen pregnancies, etc.

The pain becomes most intense when a complication occurs in the form of torsion of a subperitoneal myomatous node.The doctor can feel the large size of the tumor by pressing on the abdomen.

Submucosal uterine fibroids

Submucosal fibroids are formed from the uterine muscle layer, are submucosal fibroids, and grow into the uterine cavity.

Provoking causes: hormonal and metabolic disorders, chronic gynecological inflammation, factors affecting the suppression of the ovaries, thyroid gland, adrenal glands, frequent and multiple abortions.

Symptoms of submucous uterine fibroids:

• The disease begins with bleeding appearing in the middle of the menstrual cycle, and there are very large blood clots.
• Cramping pain occurs. The patient feels weakness and malaise associated with anemia caused by bleeding.
• Large fibroids can put pressure on adjacent uterine organs. This leads to frequent urination, and if it grows towards the back wall of the uterus, compression of the rectum occurs.
  

Although submucous fibroids are a benign tumor, there is a small percentage where they become malignant.

How is fibroid different from a malignant tumor - cancer?

Uterine fibroids are a benign tumor, which, unlike malignant ones, is surrounded by a special capsule. Thanks to this, it remains within the zone of occurrence, even increasing in growth, while the malignant tumor spreads to other organs, giving metastases.

The structure of the tumor itself is also different - it does not destroy the surrounding tissue and does not poison the body.

Why treat uterine fibroids: complications

Malignant degeneration is not typical for myomatous nodes, however, with rapid growth, they may compress internal organs,which interferes with the normal functioning of the body. Over time, very severe uterine bleeding appears, which is life-threatening for the woman.This disease often causes infertility.

If conception does occur, the presence of fibroids will definitely negatively affect the pregnancy - the prognosis, as a rule, is always disappointing. Due to changes in hormonal levels, during pregnancy, fibroids often increase in size, interfering with the normal development of the fetus. There are often cases when a tumor simply displaces it from the uterus or provokes it. Therefore, it is best to check for the presence of fibroids before conception, when planning a pregnancy.

Pregnancy and fibroids are compatible if the neoplasm is small.

But in any case, the course of such a pregnancy and the birth itself will always be complicated, so the patient will most likely be recommended for a cesarean section. During this operation, they try to remove all myomatous nodes. And although this does not provide a 100% guarantee that they will not appear again, it may save you from unnecessary surgical interventions in the future.

Diagnosis of neoplasm

Fibroids of any type are diagnosed when reporting complaints or during a routine examination.

In the early stages, fibroids cannot be seen on a normal one. If a neoplasm is suspected, the doctor recommends that the patient undergo a test, which makes it possible to determine the position, size and structure of the formation. If there is a tumor, the gynecologist will see in the imagethe focus is round in shape, having a denser structure compared to the myometrium.The enlargement of the uterus indicates how many weeks it looks like it is pregnant (length in weeks).

Due to the fact that the pathology is often accompanied by other diseases that have similar causes, for example, hormonal disorders, the doctor simultaneously assesses the condition of the endometrium (inner layer of the uterus) and ovaries, and differentiates the neoplasm from tumors of the uterine appendages.

In combination with an ultrasound examination, general blood and urine tests, smears for oncocytology and flora, colposcopy, a functional test for ovarian function, and a pregnancy test may be required. To exclude the development of anemia, if there has been bleeding, you need to conduct a clinical blood test to find out the level of hemoglobin in the blood.

Large fibroids can be easily diagnosed with a simple gynecological examination.When palpating the abdomen, the uterus is enlarged, dense nodes are felt. If a large tumor is detected, it is carried out, you need to determine the location and size of the fibroid. It is also necessary to do the endometrium. The procedure is done for the purpose of a biopsy to rule out the presence of cancer cells.

Ultrasound with Doppler and alternative diagnostics - MRI

Proliferating fibroids are ideally diagnosed using. This examination is also necessary if there is a suspicion of malignant degeneration of a myomatous node (cancer) or endometrial tumor and ovarian tumor. Using color Doppler ultrasound, it is possible to assess blood flow and establish vascular resistance, the presence of intense neovascularization and other signs indicating the quality of tumors.

An alternative examination is magnetic resonance therapy. MRI gives fairly clear results in diagnosing these tumors, but such a study is dangerous, since it is associated with little-studied magnetic scanning, so it is not prescribed unnecessarily.

Treatment of uterine fibroids of different sizes

Myoma is a dangerous disease, but it is not a death sentence.The treatment method for uterine fibroids is chosen based on its size, growth rate, age of the patient and the woman’s desire to preserve reproductive function.

• If the disease is detected in the initial stage, then light therapy will most likely be carried out, aimed at stopping the growth and reducing the fibroids.
• If numerous nodes of different types and sufficiently large sizes are observed, the doctor will suggest a surgical treatment method, which in most cases is successful.
• The third option is combination treatment with a combination of surgical and drug treatment.

Whatever option is proposed, you must agree, because fibroids themselves disappear in very rare cases and you definitely shouldn’t hope for a miracle.

Treatment of small fibroids

If the tumor is small in size, the patient is prescribed complex drug therapy. Proper treatment can slow or even stop tumor growth.Drug therapy for the treatment of fibroids includes drugs that reduce the size of nodes, hormones, immunomodulators, vitamin therapy, and drugs to normalize periodic blood flow.

Treatment of large fibroids without surgery

Conservative treatment for large tumor sizes is carried out:

• If the patient wishes to preserve reproductive function;
• Myoma does not exceed the size of a 12-week pregnancy;
• The disease is asymptomatic or there are concomitant diseases with a high surgical risk.

Often, conservative therapy for large fibroids is considered by the doctor as a preparatory stage for surgery.

Curettage of the uterine cavity for fibroids

Curettage of the uterus can be the main or additional treatmentfibroids, the procedure is also carried out for diagnostic purposes.

Why is curettage performed for fibroids?

If, during diagnostic curettage, the doctor removes a sumbucous myoma (pedunculated), all manipulations also become therapeutic, because they eliminate bleeding and the source of pain.

How to prepare for the procedure

If a patient with uterine fibroids is prescribed gynecological curettage, she should:

• on the day of the procedure, take a shower;
• refrain from food (do not overeat the day before);
• give a cleansing enema;
• remove hair from the external genitalia.

The manipulation is preceded by tests, a list of which will be provided by the gynecologist. The procedure can be performed under local or general anesthesia. carried out under the control of a hysteroscope. Using g hysteroscopy You can evaluate the uterine cavity visually, determine the presence of submucosal fibroids, and endometrial pathology.

After scraping

The first days after curettage of the uterus, bleeding is possible; this phenomenon is normal. It is important to pay maximum attention to intimate hygiene, to avoid physical overload, hypothermia and overheating, and not to have sex.

Treatment of large fibroids

If large or rapidly growing tumors are detected, as well as in case of pain, surgical treatment is indicated. It can be organ-saving (when some nodes are removed) and radical (in this case, the uterus is removed completely).

Modern methods of removing myomatous nodes include:

• Embolization of the uterine arteries, which consists in stopping the blood flow to the fibroid, as a result of which its tissue is replaced by connective tissue;
• FUS ablation – destruction of tumor nodes using ultrasound.

With these methods, it is possible to get rid of pathology without surgery.

Treatment of submucous fibroids

Treatment can be carried out in two ways, conservative and surgical. The conservative method inhibits tumor growth. This method is recommended for women of older reproductive age. You need to wait until menopause and there is a chance that by that time the tumor will resolve on its own. Conservative treatment involves the use of hormonal drugs (duphaston, premolute) - the gynecologist selects the drug based on the results of hormone tests.

As for operations, the decision depends on the age of the patient. If a woman is of reproductive age and there are no contraindications, then it is better to perform an operation in which the uterus is preserved and the node is removed. For women who have reached menopause, it is recommended to undergo an operation in which the node is removed along with the uterus. There is an option when such an operation is performed, but the cervix is ​​left.

Surgical treatment of fibroids using low-traumatic methods

There are clear indications in which cases urgent surgical intervention is necessary:

• for pain;
• for bleeding and anemia;
• for uterine fibroids larger than 12 weeks;
• with rapid growth of fibroids;
• in case of dysfunction of neighboring organs.

Surgery for fibroids most often involves laparoscopic intervention. This technique makes it possible to remove the tumor with a minimal level of trauma and is safe for the patient. A mini laparotomy can also be used, in which a small incision is made in the suprapubic abdomen and large fibromatous nodes are removed. Strip abdominal surgery (radical removal of the uterus with or without appendages) is used extremely rarely and only for patients who do not plan a future pregnancy.

The prognosis for fibroids is generally favorable even after complete removal of the organ. Regular visits to the doctor and ultrasound monitoring are required. For small tumors, the gynecologist may recommend herbal remedies that have anti-inflammatory and absorbable properties. Physiotherapeutic procedures are also used, such as radon baths, magnets, and electrophoresis.

Where in St. Petersburg can you treat uterine fibroids without surgery?

At the Diana Clinic, gynecologists have extensive experience in diagnosing and treating uterine fibroids of various locations. If the presence of this neoplasm is suspected, patients are prescribed a full range of studies to determine treatment tactics.

We use only safe, modern techniques that allow us to completely restore a woman’s sexual and reproductive health.You can make an appointment with a gynecologist at a convenient time - he works seven days a week and without lunch breaks.

Myoma is one of the most common gynecological pathologies of a non-inflammatory nature, which, according to many modern experts, is not a true tumor.

This is a benign, hormonally controlled hyperplasia of the muscular layer of the uterine wall of mesenchymal origin, which develops as a result of somatic cell mutation that occurs under the influence of various damaging factors.

It is presented in the form of a tumor consisting of intertwined muscle and connective tissue fibers. In clinical practice, fibroids of the uterine body and cervical fibroids occur.

What is it?

Uterine fibroids are a benign tumor that arises in the muscular layer of the uterus - the myometrium. It is one of the most common diseases in women, reaching a frequency of 12 - 25% of all gynecological diseases.

The highest incidence of uterine fibroids occurs in the late reproductive period and before menopause. There is an opinion that the true prevalence of fibroids is much higher and reaches more than 70% both in Russia and abroad.

Causes of uterine fibroids

Myoma is a polyetiological disease, the following risk factors may play a certain role in its development:

• hormonal imbalance;
• inflammatory pathology of the female genital area;
• the use of intrauterine contraceptives, for example, spirals;
• complicated course of labor;
• performing abortions;
• adenomyosis;
• obesity;
• disease of the thyroid gland, adrenal glands, organs of the hypothalamic-pituitary system.

Myoma is a hormonal-dependent tumor, evidenced by the following facts:

• Receptors for sex hormones are found in the tumor tissue;
• as a rule, after the onset of menopause and a sharp decline in the level of sex hormones, tumors undergo reverse development;
• Most often, fibroids appear in women of reproductive age, whose bodies have a high content of estrogen;
• After menopause, fibroids can appear in women who take estrogen-containing medications.

Classification

Depending on the location of fibroids, there are several terms in clinical practice:

1. Pedunculated uterine fibroids are not a separate gradation, since pedunculated fibroids can have submucosal and subserous fibroids. Within the definition, the size of the pedicle, fibroids on a wide or narrow base can be noted.
2. Interstitial or intramuscular fibroids - a neoplasm located in the muscular wall of the uterus.
3. Submucosal or submucosal fibroid - a tumor grows right inside the uterus under the mucous membrane and extends into the lumen of the uterus.
4. Subserous fibroids - a neoplasm located on the outer surface of the uterus and is separated by a membrane that separates the uterus and abdominal organs.

The first signs of uterine fibroids

In the initial stage, small uterine fibroids are not accompanied by noticeable symptoms. It can be detected during the next gynecological examination.

As uterine fibroids grow, the first signs may appear:

• long, heavy and irregular menstruation;
• constipation;
• infertility;
• bleeding;
• anemia;
• frequent urination;
• heaviness and constant pain in the lower abdomen;
• bleeding during sexual intercourse;
• lower back pain;
• abdominal enlargement not associated with significant weight gain;
• frequent miscarriages.

Why is pedunculated uterine fibroid dangerous? When the “leg” is twisted, inflammation and rupture of the tumor occurs. This causes severe bleeding, severe pain in the lower abdomen and fever. This condition can be fatal.

Symptoms

When the nodes are large, the function of neighboring organs is impaired: constipation, disturbances in bladder emptying, and frequent urination. In some cases, tumor nodes can cause compression of the ureter with further disruption of the outflow of urine from the kidney, which leads to the death of the kidney. Symptoms of compression of neighboring organs more often appear with large sizes of nodes and low localization of nodes.

1. Interstitial uterine fibroids (with intermuscular nodes) lead to longer, heavier and more painful menstruation. Especially often, heavy, prolonged and painful menstruation is observed with a combination of uterine fibroids and adenomyosis. Also, with intermuscular growth of the node, part of it can grow towards the uterine cavity. With this localization of fibroids, the same symptoms are observed as with submucous growth of the node, and their severity depends on the size of the submucosal fragment of the node.
2. For the submucosal location of the node (submucous fibroids), heavy menstruation is most typical, and with large sizes, when the node begins to occupy a large area of ​​the uterine cavity, bleeding from the genital tract loses its cyclicity, and sometimes does not stop at all. With this location of the node, the patient almost always develops anemia due to heavy bloody discharge from the genital tract. Submucous fibroids can cause cramping pain, most often occurring during menstruation. The submucosal node is a kind of “foreign” body for the uterus, from which it is trying to free itself. Sometimes such nodes can even be “born” on their own. This process is accompanied by very severe cramping pain and bleeding.
3. Subserous (subperitoneal) fibroids often manifest clinically as painful symptoms. The pain is localized in the lower abdomen and/or lower back. Their appearance is associated with tension in the ligamentous apparatus of the uterus and the pressure of growing fibroids on the nerve plexuses of the pelvis. If blood circulation in the node is impaired, the pain is acute and very intense.

Pain accompanies the development of fibroids in every third woman and can have different origins. With small interstitial nodes, painful menstruation is observed. Constant aching pain is observed with pronounced growth of nodes. With necrosis of the node, the pain syndrome is pronounced, an increase in body temperature and intoxication may occur. Also, an emergency situation may arise if the patient has pedunculated subserous nodes. When the “leg” is thin, the knot is twisted; The power supply in the node is interrupted. This situation often manifests itself as an acute condition: severe pain, with the possible development of peritonitis. In such a situation, urgent surgical intervention is required.

Diagnostics

The diagnostic process for suspected myomatous formation involves the following measures:

1. Anamnesis collection. Particular importance is given to the age criteria of the patient, since such myomatous pathology is found mainly in women of reproductive age. As a rule, women have complaints regarding menstruation, which can become longer, heavier, painful, and irregular.
2. Ultrasound diagnostics of the pelvic organs helps to accurately identify myomatous formation, determine its parameters and location.
3. Gynecological examination. It is carried out on a gynecological chair using the necessary instruments. The size of the uterine body, the location of the ovaries, the shape and mobility of the cervix, etc. are taken into account.
4. Diagnostic curettage. Usually performed to determine endometrial changes, as well as to exclude cervical or uterine cancer.
5. Hysterographic study. Hysterography refers to radiopaque techniques that allow you to visually see the uterine cavity. To do this, the patient is injected with a contrast agent into the body of the uterus, and then an image is taken.
6. Laparoscopy. A similar technique refers to surgical methods. The laparoscope is inserted through punctures in the peritoneum and displays an image of the organ being studied on the monitor. During the procedure, it is possible to obtain biomaterial for histology or removal of small tumors, etc.
7. Hysteroscopic examination. Helps visualize the uterine cavity. It is carried out using special equipment that is inserted into the uterus. This method is not only diagnostic, but also therapeutic. In this way, various polyps are removed and biomaterial is obtained for histological examination.

The approach to the treatment of uterine fibroids is determined in accordance with the stage of formation.

How to treat uterine fibroids?

There are two main methods of treating uterine fibroids:

1. Conservative treatment – ​​with the help of medications and non-invasive procedures.
2. Surgical treatment - through surgery.

The choice of treatment method depends on the severity of the clinical symptoms of uterine fibroids, the size of the fibroid node, the woman’s age, and the intention to have children in the future.

The conservative method is based on the use of hormonal drugs orally and by injection, as well as symptomatic therapy (pain relief, treatment of anemia, reduction of blood loss, etc.). Conservative therapy is effective only in controlling tumor growth. It is impossible to eliminate uterine fibroids conservatively. Therefore, the non-surgical treatment method is used mainly in women of advanced childbearing age.

At the same time, tumor growth is inhibited until the onset of menopause. At this time, there is a high probability of spontaneous resorption of the tumor.

Treatment of fibroids without surgery

Non-surgical treatment of uterine fibroids is a set of measures, including adherence to an appropriate diet, the use of immunomodulators, herbal medicine, approved physiotherapeutic procedures, and the use of hormonal medications.

The course of treatment consists of the following stages:

• Anti-inflammatory therapy for infectious processes in the gynecological area;
• Activation of the immune system with special drugs;
• Adjustment of diet and diet;
• Normalization of the endocrine system;
• Formation of an even psycho-emotional background;
• Elimination of bleeding;
• Treatment of anemia;
• Bringing the menstrual cycle back to normal.

At home, treatment of uterine fibroids without surgery involves the use of the following medications:

1. Antiprogestogens. Mifepristone (RU-486) ​​is often used as preparatory therapy before surgery or for the treatment of fibroids. This drug not only eliminates the symptoms of the pathology, but also helps reduce the size of the formation.
2. Gonadotropin-releasing hormone agonists. Drugs in this group include: triptorelin - (Decapeptyl, Diferelin, Decapeptil Depot), buserelin, goserelin (Zoladex), leuprorelin (Lucrin Depot). The disadvantage of using these drugs for the treatment of uterine fibroids is that after the end of therapy, the nodes can be restored in size, and long-term use of these drugs is not permissible, as it can lead to the development of osteoporosis and other consequences for the female body due to a lack of estrogen. Within six months of using these products, the size of fibroids can be reduced by 50%, and the intensity of fibroid symptoms can also decrease. These medications are often used to shrink uterine fibroids before surgery to reduce blood loss during surgery.
3. Combined oral contraceptives. These include the following combinations: desogestrel with ethinyl estradiol (Mersilon, Marvelon, Novinet), ethinyl estradiol with norgestrel (Ovidon, Rigevidon). These remedies effectively help reduce the symptoms of uterine fibroids, such as pain in the lower abdomen and bleeding. However, for the treatment of uterine fibroids in order to reduce its size, tablets of this group are not a priority, since they do not always lead to a reduction in nodes. Under the influence of such therapy, only nodes whose initial size did not exceed 1.5 cm can shrink in size.
4. Gestagens. The use of such drugs today is a controversial issue, since some doctors believe that the use of such drugs, and especially dydrogesterone (Duphaston) for uterine fibroids, is unacceptable. Others believe that the use of this drug is completely justified, since it is the lack of progesterone that causes the growth of fibroids. The effectiveness of therapy with drugs such as linestrenol (Orgametril, Escluton), medoxyprogesterone acetate (Provera, Depo-Provera), nor-ethisterone (Norkolut, Primolut-Nor) for uterine fibroids has not been proven. , so many gynecologists do not recommend these drugs. However, the use of these agents in cases of combination of endometrial hyperplasia and uterine fibroids is justified. The growth of fibroids occurs not simply from a deficiency or excess of any hormone, but rather from an imbalance between hormones, so the use of such drugs should not be carried out everywhere, but only when indicated.
5. Antigonadotropins. Danazol (Vero-Danazol, Danazol, Danoval, Danol, Danogen), gestrinone (Nemestran). For uterine fibroids, treatment with these drugs is rarely used, since they cannot reduce the size of the nodes, but only help reduce the intensity of the symptoms of fibroids; moreover, they have a number of undesirable side effects, such as acne, voice changes, and hair growth on the body and face. These medications for fibroids can only be used if other treatments are ineffective.

FUS ablation of fibroids

A method of treating fibroids based on heating the tissue of the nodes with high-intensity focused ultrasound, due to the transfer of a large amount of energy to a clearly localized area, after application of which destruction of the tissue of the node occurs - thermal necrosis. The principle of operation is very similar to the concentration of sunlight with a magnifying glass. The pinnacle of development of the method today is the combination of a focused ultrasound source (emitter mounted in the table) and an MRI machine. Ultrasound is performed through the anterior abdominal wall. The MRI scanner controls the localization and, most importantly, the heating temperature in real time.

The method allows destruction of a clearly limited area without damaging healthy tissue. The zone between the “treated” and healthy tissue is only a few rows of cells. Thus, focused ultrasound today has come closer than ever to the concept of “ideal surgical instrument.” The procedure does not require the insertion of instruments into body cavities, anesthesia or hospitalization, however, it is not possible in all cases and requires the correct selection of patients. The substrate for the effects of focused ultrasound is the connective tissue located in the fibroids.

Connective tissue accumulates energy well and allows it to reach the temperature necessary for thermal necrosis. Thus, so-called fibroids, which make up 70% of all fibroids, respond very well to treatment using FUS. Leiomyomas, or cellular fibroids, are absolutely not suitable for treatment using the FUS method due to the lack of a substrate for exposure and a high-intensity blood supply, which does not allow sufficient heating of the tissue.

During the period of testing the method and its introduction into clinical practice, improper selection of patients caused frequent relapses and was mistakenly interpreted as the ineffectiveness of the method. To assess the possibility of performing FUS ablation, the patient must undergo an MRI, which determines the type of fibroid. Recently, numerous works by various authors, based on retrospective studies of treated patients, have shown the high effectiveness of the method, which is not inferior in terms of performance to other methods of treating uterine fibroids, provided that it is used correctly.

Indications for the use of FUS ablation for uterine fibroids are standard indications for organ-saving treatment for uterine fibroids. Depending on the clinical tasks set by the gynecologist, the technology can be used in four tactical options. 1. Organ-saving treatment of uterine fibroids. 2. Prevention of clinical manifestations of uterine fibroids (which allows you to abandon the expectant outpatient practice regarding the growth of fibroids). 3. Preparation of the fibroid node for transcervical myomectomy (as a result of FUS destruction, the size of the node and the intensity of blood flow are reduced, which significantly reduces the risk of possible complications and facilitates the operation); 4. In order to delay surgical treatment.

Unlike other methods, FUS-MRI ablation of uterine fibroids is a non-invasive, organ-saving method, without hospitalization, without pain, it gives a woman the highest chance of a successful pregnancy compared to other methods, and has a minimal percentage of complications among all used methods of treating uterine fibroids (currently less than 0.05%). The method has received recognition in many countries CE (Europe), FDA (USA), MHLW (Japan), CFDA (China), ANVISA (Brazil), Canada FDA, KFDA (Korea), Russian Federation, Taiwan.

Uterine artery embolization (UAE)

This is the introduction of special plastic balls into the uterine arteries in order to stop the blood supply to certain areas of the uterus and fibroids. The UAE procedure has very limited indications for use and is used mainly in women over 40 years of age with submucosal myomatous nodes and severe uterine bleeding.

The use of uterine artery embolization methods in women of reproductive age, according to the recommendations of the European and American Societies of Obstetricians and Gynecologists, is prohibited. There are a huge number of publications in the literature illustrating the consequences of unsuccessful uterine artery embolization. As a rule, these are young nulliparous women aged 25–35 years who lost the opportunity to have children as a result of the UAE procedure for small fibroids that did not require treatment at all.

When is surgery to remove the uterus for fibroids indicated?

Indications for radical surgical treatment of uterine fibroids:

1. Tumor size from 12 weeks (a voluminous tumor compresses neighboring organs and blood vessels, interfering with their normal functioning);
2. Rapid growth of myomatous node (from 4 weeks per year);
3. Myoma causes massive bleeding;
4. Severe pain syndrome;
5. Torsion of the leg and necrotization of the myomatous node;
6. Birth of a submucosal myomatous node;
7. Combination of endometriosis and fibroids;
8. Suspicion of malignancy of fibroids.

Depending on the size, location and type of fibroids, the doctor selects the most convenient type of operation to eliminate it. Myomectomy today is performed in three ways:

• laparoscopy - through a small hole in the abdomen;
• through the vagina using a special instrument - hysteroscopy;
• strip surgery - open, through an incision in the lower abdomen (very rare);
• if gentle operations are not possible, and it is impossible to stop the growth of fibroids by other means, treatment involves complete resection of the uterus - hysterectomy.

Hysterectomy and laparotomy are the most popular surgical methods, as they have a number of advantages: rapid recovery after surgery, preservation of the ability to become pregnant and bear a child in the future, and almost complete absence of traces from the operation.

Prevention

Prevention of uterine fibroids consists of following a diet, sleep and rest patterns, and reducing stressful situations. An important method of preventing uterine fibroids is timely pregnancy and childbirth (up to 25 years), as well as preventive examinations by a gynecologist.

Uterine fibroids are a benign tumor. But such education also requires monitoring and treatment. Therefore, it is important not to ignore the gynecologist’s appointments. Oncology is a branch of medicine that studies the causes and mechanisms of tumor formation. It can be either benign or malignant tumor. Each of them has its own signs, characteristics and methods of struggle.

Uterine fibroids

Uterine fibroids are benign tumors; they are formed from the muscular layer of the uterus. If the tumor also includes connective tissue fibers, then they speak of fibromyoma.

Previously, the structure of morbidity was dominated by middle-aged women who had already given birth, but now cases of pathology in girls are becoming more common. Among all tumors, benign tumors account for about 20% of cases, which places it among the most common diseases of a tumor nature.

Fibroids can reach significant sizes, put pressure on adjacent organs and affect a woman’s ability to conceive and become pregnant, as well as cause a number of other problems.

These are the reasons that lead to the development of education:

1. Hormonal disruption in the body caused by ovarian pathology, miscarriage, menopause;
2. Changes in the level of sex hormones can be caused by abnormalities in the functioning of the thyroid gland or other endocrine glands.
3. A woman's hormonal state is influenced by the type of contraception she uses. Both the IUD and oral contraceptives contain an additional portion of hormones.
4. The risk of the disease increases in women who became pregnant with their first child late or did not become pregnant at all.
5. Uterine fibroids are more likely to appear in a woman who often suffers from inflammatory diseases of the female reproductive system (endometriosis, vaginitis).
6. If the tumor occurs at a young age, then scientists associate this with damage to the cells of the muscular layer of the uterus during the period of intrauterine development.
7. The development of fibroids is influenced by weight: women who are prone to obesity are more likely to get this type of tumor.
8. It has been determined that frequent visits to the solarium are related to the occurrence of the disease.
9. If a woman has had an abortion several times or had miscarriages, then she has the risk of not only developing chronic inflammatory diseases of the body and cervix, but also developing a tumor process.
10. Stress is a trigger for both benign and malignant processes.

In addition to the immediate causes that lead to a tumor, there are also factors that can contribute to the development of the pathological process:

• late menstruation occurring after 15 years;
• heavy discharge during menstruation;
• love for meat products;
• belonging to the Caucasian race;

Any benign formation has its own characteristics that make it possible to distinguish it from malignant one.

These are the following parameters:

1. They develop from normal cells of the organ in which they are formed and are similar in appearance and function to their predecessors.
2. The growth of such a tumor occurs slowly, sometimes taking several years. Under the influence of various hormones, tumor formation can either accelerate growth or undergo reverse development.
3. No matter what size the formation reaches, it does not grow into the surrounding tissues.
4. The tumor is not prone to metastasis, that is, it does not penetrate other organs.
5. Education is most often enclosed in a capsule.
6. The prognosis is favorable regardless of how large the formation is.

A tumor is a formation that begins with the action of certain factors when normal cells of an organ begin their uncontrolled division.

Uterine fibroids do not immediately begin to manifest themselves, but at a certain stage the woman notices the following symptoms:

• the initial symptoms of the pathology may be pain in the lower abdomen not associated with menstruation;
• there is pain during sexual intercourse;
• tumor growth is accompanied by discomfort in the area of ​​adjacent organs: a feeling of heaviness in the stomach, frequent urination, up to urinary retention. However, this is more typical for a large tumor;
• Uterine fibroids are accompanied by an enlarged abdomen. When determining the size of a formation, they are guided by the gestational age corresponding to this size;
• Often the tumor manifests itself by the appearance of bleeding, which can be more or less profuse, and occurs spontaneously, not on time with the expected menstruation.

Regardless of the fact that the tumor is benign, its growth in the body is accompanied by general malaise, weakness, nausea, and increased fatigue.

As soon as the first symptoms of abnormalities appear, you need to consult a doctor for further examination. Uterine fibroids are manifested by the appearance of nodes; they are usually multiple in nature and do not form singly.

An examination by a gynecologist, as well as an ultrasound, helps determine the presence of pathology. The tumor is often the cause of infertility, since the possibility of implantation of the fetus into the uterine wall and subsequent maintenance of pregnancy is impaired.

Uterine fibroids have several stages of development: at the first stage, the focus where the tumor will develop is determined, then the formation grows without signs of differentiation, and at the last stage, differentiation of the cells included in the tumor occurs.

Myoma can be simple or proliferating in structure and location. A simple tumor is a small formation that is filled with extracellular matrix. In the proliferating form, uterine fibroids have larger sizes without a matrix. If the fibroid grows quickly, it will be proliferative, and if it grows slowly, it will have a simple structure. It is possible for one type of tumor to transform into another.

Until the fibroid reaches a certain size, it does not bother the patient. However, although the growth of a tumor depends on the level of hormones in a woman’s body, you should not just hope that it will go away on its own.

Uterine fibroids require action to eliminate the tumor, prevent its growth and combat complications.

The fight in these 3 areas is carried out through surgical and conservative intervention: the selection of methods is carried out depending on the type of tumor, its size and the condition of the woman’s body.

There are several methods for treating the tumor.

The surgical method involves removing the myomatous node; at the moment there is no need to perform intracavitary surgery; laparoscopic removal is sufficient. This is the introduction of an optical device through holes in the abdominal cavity; after visualization, the anatomical formation is eliminated. After the tumor is removed, the muscle tissue defect is restored, all bleeding areas are cauterized, and clots are removed.

Article last updated 12/07/2019

Uterine fibroids can appear in a woman at any age. The exception is the period before puberty and menopause. This is a benign formation consisting of muscle and fibrous tissue. It can be one or several. The sizes often range from 2-3 cm to 10-15 cm. Sometimes they can reach 25 cm.

About 25% of women over the age of 35 are diagnosed with uterine fibroids. Despite the fact that the tumor itself is benign, many are concerned with the question: can uterine fibroids develop into cancer, and how to avoid this disease? With timely diagnosis, treatment and prevention, negative consequences can be avoided.

Not every woman who has this disease can immediately understand this. According to statistics, about 30% of patients learn about the diagnosis by chance during an ultrasound scan. Small formations usually do not bother you, so they can only be recognized with regular examinations.

Symptoms appear when the fibroid grows in size. The following signs will indicate a problem:

• aching pain in the abdomen and lower back outside of menstruation;
• cycle violation: increase or decrease;
• increased pain during menstruation;
• problems with reproductive function;
• heavy periods, heavy bleeding, and, conversely, too scanty discharge;
• abnormal abdominal enlargement;
• disturbance of urination and defecation.

The consequences of the disease can cause severe harm to the female body - lead to infertility, inability to bear a child, anemia, depression and even the need to remove the uterus.

The exact causes of active cell division in the wall of the organ and the occurrence of neoplasms have not been fully determined by science. Thus, the disease can occur due to a genetic predisposition - if it has already been present in the family or among close relatives before. The second reason is changes in hormonal levels. In particular, estrogen and progesterone influence the development of fibroids. Therefore, during pregnancy, when hormone levels are much higher, the formation grows faster. During menopause, it stops growing and decreases over time.

In addition, inflammation of the ovaries, the presence of cysts, and previous abortions contribute to the formation of nodes.

When can fibroids turn into cancer?

A characteristic feature of the disease is unpredictability. The neoplasm can remain the same size for a long time, increase or, conversely, shrink and even disappear. However, this is not a reason to simply wait and hope for a positive outcome.

Statistics show that in 1.5% of cases the pathology develops into cancer. Early diagnosis, proper treatment, and adherence to certain rules for uterine fibroids will help avoid the occurrence of cancer.

You should know that the following factors contribute to its development:

• bad habits. Drinking alcohol and smoking lead to intoxication of the body. Therefore, you need to lead a healthy lifestyle, have good sleep;

• overweight. Because of it, metabolism is disrupted. In addition, adipose tissue puts pressure on the uterus. Therefore, overweight women are recommended to lead a moderately active lifestyle;
• poor nutrition. Excessive consumption of animal fats and carbohydrates is fraught with negative consequences. To combat the disease, you need food rich in fiber, microelements, and vitamins. The latter can be used separately as prescribed by a doctor. It is important that the body receives enough vitamin E;
• physical activity. Intense exercise can lead to increased blood flow to the pelvic organs. This is a kind of nutrition that promotes cell growth. The more education, the greater the risk of cancer;
• injuries. They have a beneficial effect on the proliferation of pathological cells;
• stress. It is a well-known fact that most diseases appear and develop when a person is depressed or experiences stress. Cancer is no exception. Therefore, you need to try to be less nervous. A stable emotional state is beneficial to the body;
• Warming up. If heat is applied close to the uterus, blood circulation increases, which again contributes to unnecessary nutrition of the cells.

As mentioned earlier, fibroids generally do not bother you and can remain at the same size for a long time.

A sudden change in the clinical picture is an alarming signal that indicates changes in the uterus. Thus, bright red discharge, the appearance of pain of varying intensity, a sharp increase in the node, may indicate the degeneration of the tumor into cancer. This is especially dangerous for women who have entered menopause.

But don’t rush to draw conclusions without a doctor’s opinion. To determine whether a node is malignant or not, a thorough examination is necessary:

• Ultrasound determines the location of the node, size, and degree of damage;
• hysteroscopy and lateroscopy are tests that detect the presence of cancer cells.

However, there is no need to panic prematurely, because in the vast majority of cases, fibroids do not degenerate into cancer. To prevent the disease, you need to be regularly examined, treated on time, lead a healthy lifestyle and, most importantly, think positively.

Oncology treatment

If the examination shows the presence of cancer cells, then you need to contact an oncologist. The treatment method depends on the degree of the disease, the area and nature of the affected tissue. Some types of cells can grow very quickly, while others, on the contrary, develop slowly and almost do not metastasize. In both cases, surgery is inevitable.

The tumor must be removed. Unfortunately, in most cases, together with other organs - the uterus, and sometimes the ovaries, regional lymph nodes. This is a kind of prevention of metastases, since in the future any cyst can cause a relapse.

In addition, radiation or chemotherapy is given before or after surgery. These procedures help stop the development of the node and prevent metastases. As with ordinary fibroids, vitamins, microelements, and antioxidants help you recover faster.