Submucosal fibroids are a benign hormone-dependent formation localized in the submucosal layer of the uterine wall. The basis of its structure is the smooth muscle cells of the myometrium. Most often it is asymptomatic.

However, it can provoke menorrhagia, increasing anemia, cramping pain during menstrual bleeding, difficulties in conceiving and bearing a child.

For diagnostic purposes, ultrasound scanning with transvaginal access, hydrosonographic, angiographic, Doppler examination, and hysteroscopy are used. Correction tactics are selected in accordance with the characteristics of the pathology. Surgical, organ-preserving or radical, conservative and combined treatment is possible.

Submucosal fibroids (leiomyoma) are detected in a third of all diagnosed fibroids. The disease manifests itself in women of childbearing age and is common in patients aged 33-40 years. The disease does not occur before menarche. During menopause, tumors of submucosal localization develop extremely rarely, and existing nodes undergo regression.

There is a relationship between pathology and infertility - in every fifth case of problems with conception, the presence of submucosal fibroids is the only pathology of the reproductive system that is determined in the patient.

Source: avtoemali33.ru

The most common provocateurs of submucosal myomatous nodes are hormone imbalance and impaired susceptibility of myometrial cells to the effects of sex hormones. The progression of a submucosal tumor can be facilitated by:

• Genetic predisposition. Changes in the susceptibility of smooth muscle cells to hormonal substances may be genetically determined.
• Dysfunction of the hypothalamic-pituitary system. In the case of traumatic injuries or vascular disorders of the brain, during psycho-emotional overload, a hormone imbalance occurs: the concentrations of luteinizing and follicle-stimulating hormones change.
• Violation of the endocrine function of the ovaries. In the case of inflammatory pathologies (adnexitis, salpingitis, oophoritis), injury, and cancer, the nature of the production of progesterone, estrogen and the balance between these substances changes.
• Traumatization of the myometrium. Changes in the susceptibility of smooth muscle cells as a result of invasive manipulations and abortions.
• Extragenital factors. A number of pathologies can provoke disturbances in the process of synthesis of sex hormones. These diseases include diabetes, thyroid pathologies, and obesity.
• Uncontrolled use of hormonal contraception. Due to prolonged use of contraceptives, disturbances in the biosynthesis of hormones that are involved in the regulation of the ovulatory cycle may occur.
• Congestion in the pelvis. A sedentary lifestyle and lack of sexual activity can provoke stagnation of venous blood, which can cause hormonal imbalance.

The influence of provocateurs stimulates the formation of an active zone near the microvascular bed of the myometrium. In the cells of the active zone, an acceleration of metabolic reactions and an increase in tissue permeability are observed. Subsequently, an accumulation of zone cells into nodes is observed.

Over time, the susceptibility of proliferating tissue to the influence of hormonal substances decreases, and its own autocrine-paracrine growth mechanisms are launched.

Trophism of myomatous nodes occurs due to vessels that have lost adventitia. Due to the progressive growth of fibroids, the area of ​​​​rejection of the endometrial layer increases, the ability of muscle tissue to actively contract decreases, which is why menstrual bleeding becomes longer, more intense and painful.

Species

Fibroids of submucosal localization differ in the number of nodes, location, size and morphology. When determining classification categories, the following criteria are applied:

Symptoms

Manifestations of fibroids are determined by the period of occurrence, size indicators, and growth rate. At the beginning of development, the signs are not determined; the tumor is discovered accidentally during an examination or ultrasound examination.

The first most characteristic symptom of the growth of a submucosal fibroid node is menorrhagia - intense menstrual bleeding of greater than normal duration, possibly with clots. During the intermenstrual period, bleeding may occur. As a result of blood loss, a woman's anemia progresses: signs of general malaise, pale skin, dizziness, deterioration in performance, and headaches appear.

According to statistical information, pain in the case of a submucosal tumor node is observed in 20-50% of women. Pain occurs during menstrual bleeding and is cramping in nature. Pain syndrome occurs in the lower abdomen and radiates to the lumbosacral region.

Submucosal fibroids, unlike subserosal fibroids, do not affect organs located in the immediate vicinity. Fibroids can provoke reproductive dysfunction - problems with conceiving and bearing a child.

Consequences

Submucosal fibroids may subsequently be complicated by severe metrorrhagia and progression of anemia. Due to significant deformations of the uterine cavity, the likelihood of infertility, spontaneous termination of pregnancy, and pathologies of pregnancy and delivery increases.

If an ascending infection occurs, the tumor can fester and abscess, causing the temperature to rise, chills, pain in the lower abdomen to appear, and the general condition to worsen.

The most dangerous complication is the “birth” of a submucosal node. This process is accompanied by cramping, dagger-like pain, bleeding, and the risk of infection is very high. Malignancy or malignancy of the myomatous node is extremely rare.

Diagnostics

The non-specificity of the clinical picture of submucosal myomatous nodes determines the significant importance of physical and instrumental techniques in the process of diagnosing tumor pathology. The diagnostic search plan includes:

• Examination by a gynecologist. Bimanual palpation can reveal an increase in the size of the uterus.
• Ultrasound scanning with transvaginal access, Dopplerography, hydrosonography. Using these methods, the size and structure of neoplasms are determined, pathologies of endometrial tissue are identified, and the thickness of the myometrium and the intensity of blood supply are assessed.
• Hysteroscopic examination. In the organ cavity, a neoplasm of an oval or round shape is detected, having a smooth surface of a pale pink hue, or multiple nodes “on legs” that hang into the organ cavity.
• Angiographic examination. When visualizing the blood flow of the uterus, it is possible to confirm the absence of neovascularization and differentiate a benign node from a malignant one.
• X-ray television hysterosalpingography study. A change in the shape of the organ cavity with fragments of clearing or filling disorders is determined. Now it is prescribed occasionally.
• Magnetic resonance or computed tomography examination of the uterus. It is possible to accurately assess the topography of tumor nodes.
• A general clinical blood test for submucosal myoma often reveals erythropenia, low hemoglobin concentration due to the progression of anemia.

Differential diagnosis is necessary with pregnancy, polyposis, internal endometriosis, sarcoma. During diagnosis, consultations with an endocrinologist and gynecological oncologist may be required.

Treatment

Determining correction tactics depends on the following factors:

• patient's age;
• a woman’s desire to preserve reproductive function;
• size of fibroids;
• localization;
• growth rate;
• severity of the clinic;
• complications.

If the formation is stable in size, there is no menorrhagia, no pain, and reproductive function is preserved, then dynamic monitoring with a gynecological examination every year is recommended. In other situations, a method of surgical, conservative or combined correction is selected.

Medicines are prescribed when the size of the tumor does not exceed 3 centimeters, menorrhagia is moderate, and the growth of nodes is slow. Patients are prescribed drugs that inhibit the production of sex hormones in order to eliminate the main provocateur of tumor formation - hormonal-mediated growth stimulation.

Additionally, symptomatic medications are prescribed. Conservative correction of patients in the premenopausal period is especially effective. Most often, drug treatment involves prescribing the following drugs:

• Inhibiting the production of gonadotropic hormones. These are antigonadotropins, agonists of gonadotropic releasing hormones. Their use helps to stabilize the size of the nodes, or reduce their size, and reduce blood loss during menstruation.
• Oral or intrauterine hormonal contraceptives. Prescribed to patients of reproductive age in order to stabilize the effect that was achieved during the suppression of the secretion of gonadotropic hormones.
• Hemostatic and uterine contraction agents. Necessary to reduce blood loss during menstruation.
• General strengthening. Used to improve well-being. Includes iron supplements, vitamins and minerals.

Combined treatment is the most acceptable option for women who want to preserve reproductive function in the presence of a single node or multiple nodes with a size of 50 mm or more with a clinical appearance and a slight growth rate.

The prescription of drugs that inhibit the secretion of gonadotropic hormones is carried out before and after conservative myomectomy. Prescribing them before intervention helps to reduce the size of tumors, reduce blood loss, reduce the duration of surgical correction and the recovery period.

Surgical

Surgical treatment is prescribed in cases where the fibroid is large in size - from 12 weeks, has a tendency to intensive growth (grows by 4-5 or more weeks annually, especially during menopause and menopause), is accompanied by an increase in pain, anemia and progression of complications. The course of the pathology and the patient’s reproductive plans determine the choice of one of the types of surgery:

• Organ-preserving. The nodes are removed by transcervical myomectomy (hysteroresectoscopy) using mechanical, electrosurgical, and laser instruments. Removal by FUS ablation (focused ultrasound) and cryomyolysis is also possible. Embolization of the uterine arteries is necessary to limit the nutrition of the neoplasm and stimulate its resorption.
• Radical. In case of unfavorable course of the pathology, the following are recommended: transvaginal, laparotomy, laparoscopic uterine defundation, subtotal or total hysterectomy.

Forecast

Early diagnosis and corrective measures make the prognosis of submucosal tumors favorable. During the menopausal period, the tumor regresses. The effectiveness of embolization reaches 50%. Organ-preserving operations help restore reproductive function.

The duration of the postoperative period is 7-24 days, which is determined by the volume of intervention and the type of access. The duration of follow-up after hysterectomy is 5 years. After removal of fibroids, lifelong monitoring of the patient is necessary due to the likelihood of recurrence.

Preventive measures include: rational use of contraceptives, minimization of invasive procedures, timely treatment of pathologies in which hyperestrogenemia is detected.

Women often turn to a gynecologist with complaints about prolonged menstruation. This disorder may indicate many malfunctions. One of them is the submucosal node. Timely detection of pathology allows it to be cured without any complications. Therefore, every woman should know what symptoms she manifests.

Brief description of the problem

A submucosal node (or submucosal fibroid) is a benign neoplasm localized under the mucous membrane of the reproductive organ and partially protruding into its cavity. This pathology is considered one of the most common in gynecology. Recently, it has been increasingly diagnosed among young women, which is very alarming to doctors.

Reasons for the development of pathology

The exact causes of the disease have not yet been established. However, numerous clinical studies have made it possible to identify a number of factors, the combination of which increases the likelihood of the development of a submucosal node. These include:

• changes in hormonal levels;
• excess body weight;
• long-term physical activity;
• inflammatory diseases;
• repeated abortions;
• taking oral contraception;
• genetic predisposition.

Even a qualified doctor cannot always accurately determine what exactly triggered the pathological process. At the same time, it is important to take into account all possible factors. For example, hormonal imbalance is often a consequence of polycystic ovary syndrome. This pathology is considered extremely unfavorable for a woman’s reproductive health.

Excess body weight also leads to hormonal imbalances. Sometimes a submucosal node is observed in the history of women over 30 years of age who have not given birth before this time. Determining the cause of the pathology allows you to predict its outcome.

The first signs of a violation

In approximately 50% of cases, the development of the pathological process is asymptomatic. In other women, at the initial stage of tumor formation, hyperpolymenorrhea is observed - heavy and prolonged menstruation. The appearance of this symptom is due to an increase in the size of the submucosal node. As a result, the myometrium cannot fully contract, and the endometrium begins to partially be rejected. In the future, the body will try to independently normalize the functioning of the reproductive system. Unfortunately, efforts do not always end in positive results.

Very often, with hyperpolymenorrhea, separation of mucous secretion is observed. The entire period of menstruation is accompanied by severe pain. Many women complain of increased discomfort when sitting.

If the submucosal node is small, there is no pain between menstruation. As the tumor grows, a disproportionate increase in abdominal volume may be observed. The twisting of its legs is accompanied by a sharp rise in temperature. With such an acute course of the pathological process, it is necessary to urgently call a team of medical workers. Neglecting your own health is dangerous for the development of infertility.

Is pregnancy possible?

Many women who have learned about their diagnosis have a question: “we have discovered a submucosal node in the uterus - should we operate or not?” In most cases, you can hear a positive answer, because neoplasm is one of the causes of infertility. The thing is that the progression of the pathological process leads to hormonal changes and, in addition, the node can block the exit from the fallopian tubes. This negatively affects the movement of the egg to the implantation site, and as a result, an ectopic pregnancy is diagnosed.

Every woman of childbearing age should understand that treatment of this pathology is necessary. It should start as early as possible. This is the only way to hope for a favorable outcome - pregnancy.

Diagnostic methods

If symptoms of the disease appear, you should immediately contact a gynecologist. Diagnosis of a neoplasm is carried out in several stages. First, the doctor conducts an examination. He can easily determine the deformation and enlargement of the uterine body, which is characteristic of this pathology. Then they move on to instrumental diagnostic methods to identify the type of tumor. The examination includes the following procedures:

• Ultrasound (transabdominal/transvaginal);
• hysteroscopy.

The last two diagnostic options are considered the most informative. Using MRI, you can determine the presence of a neoplasm at the initial stages of its development and visualize the slightest changes in the tissues of the reproductive organ. Hysteroscopy allows you to take material for subsequent laboratory testing. Sometimes this method is used to remove the submucosal node.

Basic principles of therapy

Treatment of the pathological process consists of two stages. First, with the help of hormonal agents or surgical intervention, the neoplasm is affected. Then the woman is prescribed measures to restore reproductive function. The choice of a specific treatment regimen depends on the size of the node. If it is detected early, preference is given to conservative methods.

Hormone therapy

If a woman is diagnosed with a small submucosal node, treatment begins with hormonal drugs. Their use usually leads to regression of the tumor, but sometimes the opposite effect can be observed. Therefore, such therapy takes place cyclically, when taking medications is alternated with their withdrawal. This approach reduces the risk of relapse.

Of the wide variety of hormonal drugs today, doctors give preference to combined drugs or pure gestagens. The first category includes “Yarina” and “Zhanine”, and the second category includes “Duphaston”, “Utrozhestan”. The treatment regimen is selected individually and depends on the stage of development of the submucosal node in the uterus.

Treatment with combined oral contraceptives is prescribed from the first day of menstruation. It is advisable to take the tablet at approximately the same time every day. After completing the course (21 pills), take a break for seven days, then start a new pack. During this week's period, a menstrual-like reaction occurs.

Pure gestagens are prescribed one tablet twice a day. They should be taken from days 5 to 25 of the cycle, so the course of treatment is also 21 days. Afterwards there is a week break. Then treatment is resumed with a new package of pills.

Surgery

If the nascent submucosal node is of a significant size, and hormonal treatment is ineffective, surgical intervention is required. The following surgical procedures are currently used:

• Laparoscopy (removal of the tumor through small incisions on the abdominal wall).
• (introduction of special solutions to block the vessels supplying the node).
• Hysteroresectoscopy (the tumor is removed using a hysteroscope).
• FUS ablation (treatment using ultrasound waves).
• Hysterectomy type).

In most cases, patients are prescribed hysteroresectoscopy of the submucosal node. This is considered the best option for those women who want to restore reproductive health and take on the role of a mother in the future.

The most radical method of treatment is hysterectomy. During the intervention, the surgeon completely removes the uterus, which leads to irreversible infertility. Such an operation is resorted to only in extreme cases, when rapid growth of the node is observed.

Help from traditional medicine

Many representatives of the fair sex, having learned about their diagnosis, are in no hurry to begin treatment. They prefer to resort to traditional medicine even when gynecologists warn them about possible complications. Doctors allow the option of unconventional treatment for submucosal nodes, but only as an addition to the main therapy.

Traditional healers suggest fighting pathology with the help of various decoctions and douching. Burdock infusion has the most positive reviews. To prepare it, you need to pour 5 g of dry raw material into 500 ml of boiling water and let it brew for eight hours. Take 100 ml before meals.

Similar infusions can also be prepared using carrot tops, aloe or calendula. It should be noted that before starting treatment, you should definitely consult your doctor. Sometimes folk recipes do more harm than good.

Restoring reproductive health

After removal of the submucosal node, you can begin to plan a pregnancy, but before that you need to undergo an examination. Based on its results, the doctor will be able to tell whether ovulation is occurring or not. When the phenomenon of anovulation is observed, the woman is prescribed special drugs to stimulate it. The effectiveness of the treatment is assessed using ultrasound. If growth occurs and then ruptures, the therapy is considered effective.

In this case, we can say that the probability of pregnancy is high. The woman is prescribed progestin medications to maintain the luteal phase. After successfully conceiving a child, these drugs will contribute to the normal development of pregnancy.

Prognosis for recovery

Treatment of a tumor by any of the methods listed in this article provides a positive result. However, today there is no such technique that could guarantee the patient’s recovery. Each treatment option has its own advantages and contraindications, disadvantages, and possible complications. Therefore, it is impossible to say for sure which treatment method is most preferable for the diagnosis of “submucosal node in the uterus.”

Whether to operate or not, prescribe hormonal drugs or limit yourself to wait-and-see tactics - all these issues are decided by the doctor. In doing so, he must take into account the woman’s condition, the severity of the pathological process and a number of related factors. It is worth noting that the chances of recovery are very high, but much depends on the patient herself. Some women manage to maintain reproductive function after surgery. They successfully carry the child to term and give birth.

Why is a submucosal node in the uterus dangerous?

Lack of timely treatment of the pathology or poor quality therapy can lead to the development of complications. Among them, the most dangerous are the following:

1. Uncontrolled bleeding. Often the discharge becomes so profuse that the patient is diagnosed with iron deficiency anemia. With this disorder, the woman experiences weakness, headaches, and the skin becomes characteristically pale.
2. The appearance of myomatous formation. This disorder is usually caused by intense physical activity. Its first symptom is severe cramping pain that ends in heavy bleeding.
3. Malnutrition of the submucosal node. The cause of this disorder is considered to be torsion of the pedicle of the neoplasm. As a result, tissue death occurs, which requires emergency surgery.

Another unpleasant complication of the pathological process is infertility. This is discussed in more detail a little higher in the article.

Prevention measures

The main way to prevent any gynecological disease, including submucosal node, is regular visits to the gynecologist. This means that you need to see this specialist at least once a year. Timely identification of the problem is the key to a speedy recovery.

In addition, it is necessary to avoid factors that provoke the disease. These include frequent abortions, long-term use of oral contraception, and lack of lactation up to 30 years. Excluding these factors allows you to minimize the risk of pathologies such as uterine fibroids and submucosal node.

Submucosal uterine fibroids in medicine are also called submucosal fibroids, since they develop under the endometrium. The neoplasm is benign and may partially extend into the organ cavity. This type of uterine fibroid is characterized by a rapid increase in size, severe symptoms and frequent cases of transition to a malignant form.

Submucous uterine fibroids are a fairly common disease and account for about 30% of the total number of uterine tumors. The disease is mainly registered in women of reproductive age. According to experts, the disease most often develops against the background of hormonal imbalances.

Nodes form on the smooth muscle tissue of the uterus. There are:

• thin-pedunculated submucosal leiomyoma of the uterus;
• sessile submucosal leiomyoma.

The main reasons for the appearance of pathology are:

Symptoms

Unlike other types of uterine fibroids, submucous fibroids grow very quickly, and the symptoms are always severe. The main features include:

An interstitially localized tumor growing inside the cavity and a rapidly growing submucous node increase the severity of menstrual bleeding, which is explained by an increase in the volume of the inner surface of the uterus and a failure of the contractility of the uterine muscle.

Severe pain occurs as a result of the node on the leg moving towards the neck. The reproductive organ tries to push out the node, considering it a foreign body in the cavity, but due to the vascular pedicle, this fails. As a result of contractions, pain appears. Sometimes such cramping pains lead to inversion of the uterus.

The submucosal node receives sufficient nutrition, due to which it quickly increases in size. According to research by specialists, nodes can increase several times in 2 months, causing bleeding and pain.

Complications

If the disease is not treated promptly, it will progress and cause a number of serious complications, including:

Bleeding

The main and characteristic sign of submucosal uterine fibroids is bleeding, heavy and prolonged menstruation. As a result of such cycles and inter-cycle bleeding, as well as blood loss due to complications caused by the neglect of the pathology, anemia with all its symptoms can develop. The woman begins to complain of headache, increased fatigue, and weakness. When hemoglobin levels drop below 90 g/liter, the heart and brain begin to suffer.

Diagnostics

Submycotic nodes are divided into several types:

The diagnosis can be confirmed by palpation. It is not difficult for a specialist to detect a dense submucosal node. If a mirror is used during examination, a whitish compaction with a vascular picture is recorded. Dense submucous nodes are found in the uterus, which can increase to large sizes. If the blood circulation of the submucosal nodes in the uterus is disrupted, the tumors become painful.

Laboratory research methods

A general blood test is prescribed. Important indicators of the approval of submucosal fibroids are a reduced level of hemoglobin, a decrease in the color index and the percentage of red blood cells. Moderate leukocytosis and acceleration of the erythrocyte sedimentation rate are also recorded.

Swabs are taken from the vagina and cervix to determine concomitant diseases.

Separate curettage of the mucous membrane of the cervical canal and the uterine cavity is performed. This examination allows us to determine the degree of endometrial growth and the presence of estrogen-dependent fibroids. The results help determine the need to use progestin hormonal drugs before and after surgery.

Instrumental research methods

The effectiveness of treatment for submucous uterine fibroids depends on correct diagnosis and complete information about the location of the tumor and its condition. They use a number of instrumental methods to obtain an accurate and true picture.

Echography (ultrasound) using a transabdominal probe

The method is quite affordable, non-invasive and convenient. The information content of ultrasound research is high. In the expanded uterine cavity, oval or round configurations of the formation with regular contours are determined.

If the examination reveals necrosis, the heterogeneity of the fibroid structure is determined. In older patients, there may be a zone of calcification in it.

Transabdominal sensors are used to examine formations of 10 cm or more.

The use of transvaginal convex sensors with high resolution makes it possible to detect submucosal leiomyomas measuring 3 mm.

In modern medicine, three-dimensional ultrasound examination is used, which has a great informative potential.

Hydrosonography. It is an ultrasound examination using a contrast solution. The examination allows you to accurately determine the size and location of the nodes, the degree of deformation of the inner wall of the reproductive organ. It is possible to carry out differential diagnosis with focal forms of adenomyosis and endometrial polyps (zones are distinguished by less echogenicity).

Ultrasound with Dopplerometry. During the examination, it is possible to monitor the characteristics of blood circulation in and around the myomatous formation, assess the degree of blood supply and deformation of the structure, and predict its further progression. The method helps in the correct choice of treatment tactics.

Hysteroscopy. The uterine cavity is examined on the screen by introducing an endoscopic device (hysteroscope) into the cavity of the optical system. The device has a 5-15x magnification, which makes it possible to detect even very small formations, determine the nature of their surface, consistency, and width of the base. The device allows you to see large-scale or small-point hemorrhages, dilated and elongated blood vessels under the injured layer of the mucous membrane.

Why is submucous fibroid dangerous?

According to statistics, submucosal fibroids are most often found in women under 40 years of age; the disease accounts for about 30% of all types of fibroids.

Occasionally, such a neoplasm develops near the cervix. Has a tendency to malignancy.

The submucous form of fibroids is also dangerous due to its rapid growth rate. Basically, drug treatment can stop the increase and progression of the disease.

Depending on the size of the nodes, surgical intervention is indicated for the purpose of absolute cure. Submucous fibroid nodes grow rapidly and are classified as benign tumors.

With and without blood flow. What is this?

With simple fibroids, a single peripheral blood flow is recorded, with proliferating fibroids, intense central and peripheral intratumor blood flow is recorded.

Symptoms of the disease become more pronounced as the size of the fibroids increases, which can cause malnutrition of the tumor as a result of interruptions in the blood supply. Lack of blood flow increases the risk of torsion of the pedicle of the myomatous node. The patient complains of nagging or sharp pain radiating to the lumbar region, legs, and perineum. Necrosis occurs, pain gradually intensifies, a symptom of peritoneal irritation and signs of an “acute abdomen” appear.

Treatment

To treat submucosal fibroids, conservative and surgical treatment is used. The choice of the required treatment method is made by the doctor based on diagnostic studies, depending on the size, condition, and location of the tumor.

In the initial stages of the disease, all efforts are directed toward getting rid of the nodes using medications, using certain drugs that stop the growth of the tumor. The indication for surgery is the large size of the tumor and the dynamics of its growth. If the patient is of reproductive age, conservative treatment is generally used in order to preserve the reproductive organ and the possibility of having children after treatment.

Conservative treatment

Applicable if certain indicators are available:

• small tumor size (up to 12 weeks);
• slow growth of education;
• desire to have children in the future.

The course of treatment is aimed at slowing the growth of submucosal nodes and preserving the woman’s reproductive function.

The conservative course includes hormonal drugs, most often antigonadotropins and agonists of gonadotropic releasing hormones.

A popular antigonadotropin drug is Gestrinone, the use of which prevents the increase in the size of nodes, while simultaneously reducing their size.

The effect of gonadotropic releasing hormone agonists is aimed at reducing the size of nodes, reducing pain, and preventing the occurrence of uterine bleeding.

Hormonal treatment is combined with symptomatic treatment.

Appointed:

• medicines that eliminate and prevent anemia;
• analgesics and sedatives;
• vitamin complexes.

Patients undergoing conservative treatment should undergo examination 2 times a year in order to monitor the dynamics of the development of the disease.

Modern medicine also uses the following as conservative methods:

1. Focused ultrasound ablation under MRI control. The essence of the method is the non-invasive destruction of leiomyoma using focused ultrasound waves;
2. Embolization of the uterine arteries. Embolization is carried out through a thin catheter, with the help of which special balls are introduced into the arteries - emboli, which have a certain size and are made of medical polymer. They selectively close the lumen of the arteries that supply myomatous nodes in the uterus.

Surgical treatment

The following types of surgical intervention are used:

Indicators for uterine amputation are also:

• a large node in combination with uterine prolapse or prolapse;
• rapid growth of tumors;
• suspicion of degeneration into cancer;
• severe anemia;
• the presence of a leg, which increases the likelihood of torsion;
• location of the tumor in the cervical area;
• compression of neighboring organs by the node;
• endometrial cancer.

The operation is performed under general anesthesia. Basically, only the uterus is removed, and the cervix and ovaries remain if they are not affected by the lesion.

Dimensions for operation

Indications for surgery are:

• large tumor size (more than 12 weeks);
• its active growth. There is an increase in size by 2 times in 1.5 months;
• intense pain;
• heavy uterine bleeding.

Treatment with folk remedies

When submucosal fibroids do not reach large sizes and there are no indications for surgery, traditional methods of treatment are used in parallel with conservative therapy. Various plants and medicinal herbs are used, from which tinctures are prepared, baths and douches are made with the addition of decoctions from them, and it is also recommended to take home remedies internally.

Borovaya uterus.

You can buy boron uterus either in a pharmacy, in finished form (tincture), or prepare it at home. It is not recommended to use in combination with hormonal and contraceptive drugs, also during pregnancy, lactation and the monthly cycle.

Decoction

10 g of dry plant is poured into 200 ml of warm water and boiled over low heat for 5 minutes. Then leave for 3 hours. Take 1 tbsp. l. three times a day.

Tincture

50 g of the plant is poured with one 0.5 liter of vodka and left for 4 weeks. Take 40 drops three times a day before meals. The tincture is added to the water.

Red brush.

The tincture is obtained by adding 0.5 liters of vodka to 50 g of crushed herb. Infuse the mixture in a dark glass container for one month. The solution is shaken periodically. Take 3 times a day, before meals. Course - 30 days. If necessary, take a break for 10 days, then repeat use.

The tincture is also used for douching. 1 tsp. tinctures are diluted in 0.5 liters of boiled water, cooled to room temperature. The procedure is repeated morning and evening; the duration of douching should not exceed 15 minutes. Course – 7 days. Afterwards you need to take a break for a week and repeat the procedure.

Wintergreen.

A tincture from the plant is prepared from 50 g of dry crushed grass (its above-ground part), which is poured with 0.5 liters of vodka and infused for 10 days. Add 30 drops of tincture to water and take three times a day before meals.

An effective mixture is a tincture of wintergreen, hogweed and wintergreen. Take 50 g from each dried plant. The collection is poured into 1.5 liters of vodka and infused in a dark place for 2 weeks. Drink 1 tsp, 3 times a day.

Herbal decoction

10 g of celandine, St. John's wort, motherwort, nettle, valerian root, string, hawthorn, rose hips and mint are poured into 1 liter of boiling water and infused throughout the day. Take 1 tbsp twice a day. l.

Honey and oil tampons

In a deep bowl, mix tar, butter and honey (10 g of each). The tampon is soaked in the mixture and placed in the vagina overnight. On the second day, a tampon is made with camphor oil. Methods alternate for 25 days.

Hemp seeds

Boil hemp seeds and consume 3 times a cup of coffee for two weeks.

Peony roots

The crushed roots of the plant are placed in a container and poured with boiling water. Add 700 ml of water to 10 g of root powder. Leave covered for 30 minutes. Take three times a day, before meals.

Submucosal fibroids - is pregnancy possible?

It is not always possible to get pregnant with uterine fibroids, since the myomatous nodes compress the fallopian tubes, disrupting ovulation and preventing the fertilized egg from attaching to the uterus.

Another hindering factor that prevents you from getting pregnant is that the nodes increase the contractility of the uterus. The condition leads to miscarriage.

However, you can get pregnant with uterine fibroids. If the myomatous nodes are not large in size and changes in the cavity are not recorded, pregnancy may occur. The condition requires constant monitoring by doctors.

If there is fibroids on a thin stalk during pregnancy, there is a risk of its twisting, which can cause termination of pregnancy. Before conceiving a child, such nodes must be removed.

If studies confirm a tendency for the tumor to grow rapidly (the size doubles in six months), then planning a pregnancy with uterine fibroids is not recommended. In this case, there is a high risk of growth of submucous fibroids, which is fraught with malnutrition in the myomatous node, as well as with the risk of miscarriage. The condition requires surgical intervention.

Often, submucous fibroids and pregnancy are compatible. But the condition is quite dangerous in terms of the development of placental deficiency in the middle stages.

Is it possible to give birth with large sizes?

If the presence of large uterine fibroids is confirmed (exceeding 10 - 12 weeks), planning to conceive a child is not recommended, since there is a high risk of miscarriages and disruption of blood flow in the fibroid nodes during pregnancy. The condition leads to emergency surgery.

Pregnancy in the presence of large nodes is unlikely, since most such cases are accompanied by a disturbed structure of the endometrium, which is an obstacle to the attachment of the embryo.

If pregnancy has occurred and the tumor has grown to a large size during pregnancy, the woman is offered a caesarean section. When performing a caesarean section, nodes are rarely removed, as there is a risk of large blood loss after removal of the fibroids. The exception is tumors located along the suture, that is, tumors on the anterior wall. The presence of fibroids causes complications of childbirth:

• early placental abruption;
• bleeding caused by this;
• incomplete detachment of the placenta;
• weakness of labor.

After childbirth, the uterus contracts poorly, which often leads to blood loss during the postpartum period.

An advanced state of submucous uterine fibroids can lead to serious complications, even malignancy of the tumor. Periodic preventive examinations by a gynecologist, following the recommendations of specialists, will prevent the development of the disease, since the disease detected at the initial stage can be treated in a shorter period of time and irreversibly.

Any woman, upon hearing the diagnosis of uterine fibroids, will most likely become wary and afraid for her own health. Especially if we are talking about a woman of reproductive age who is planning to conceive a child. Let's consider what danger this diagnosis poses and how a submucous node of the uterus can affect the conception and bearing of a baby.

What is it

Uterine fibroids are a benign neoplasm that develops in its muscle layer. Despite the threatening name, fibroids almost never degenerate into cancer. It accounts for approximately 20-22% of all gynecological pathologies. The real numbers are much higher, since in some women it is asymptomatic and no one knows about its existence.

The following classification options for fibroids are distinguished:

1. According to the number of myomatous nodes:

• single;
• multiple.

1. According to the location of the node in relation to the myometrium:

• submucous fibroid. It grows towards the uterine cavity. It can descend into the uterus and even exit into the vagina, the so-called “birth” node;
• intermuscular. Located in the thickness of the muscular layer of the uterus;
• subserous. Grows towards the abdominal cavity.

1. By node location:

• body of the uterus. Occurs in 95% of cases.
• cervix. It happens rarely, but causes serious problems with conception.

Why is it developing?

There is no proven cause for the development of myomatous node. Among the contributing factors, pay attention to:

• genetic predisposition. Compounded heredity is an optional but common factor in the development of a benign tumor;
• hormonal imbalance. Excess significantly increases the risk of developing a myomatous node;
• overweight. Excess body weight leads to hormonal changes, an increase in the number and, as a result, contributes to the appearance of fibroids;
• inflammatory and traumatic damage to the uterus (after abortion, infectious diseases, etc.);
• physical inactivity and inactive lifestyle.

In some cases, fibroids appear even in the absence of the influence of these factors, so there is no clear reason for the development of this disease.

Clinical signs and symptoms

In some cases, the pathology does not manifest itself in any way and is detected only during a routine ultrasound scan by a gynecologist. In other situations, myomatous nodes of various locations manifest themselves with severe symptoms and significantly complicate the patient’s life. Thus, submucous uterine fibroids can manifest themselves:

1. Bleeding. Blood discharge occurs in the middle of the menstrual cycle. Such regular bleeding leads to the development of chronic anemia, which in the future can give the following symptoms: weakness, fatigue, pale skin, digestive problems, etc.
2. Prolonged heavy menstruation and cycle disruptions.
3. Pain in the abdomen, a feeling of pressure and fullness - all this can be associated with actively growing fibroids.
4. Violation of the function of neighboring organs. The rectum and bladder are adjacent to the uterus, so such nodes (especially subserous and intermuscular) can cause disruption in the functioning of these organs. A woman complains of frequent urination, problems with stool, etc.
5. Infertility. Myomatous node can cause problems both with conception and with bearing a child.
6. If the fibroid is located on a pedicle, then torsion of the pedicle of the node may occur. In these cases, symptoms of severe intoxication, severe pain and peritonitis develop.

Important! Not every fibroid presents with typical symptoms. Most of these neoplasms are detected incidentally during a pelvic ultrasound visit.

How to diagnose?

Ultrasound diagnostics helps determine the presence of single and multiple myomatous nodes. This study allows you to assess the number of formations, their size and location. On ultrasound, the myomatous node looks like a rounded lesion with reduced echogenicity.

In some cases, MRI and other research methods are used for detailed diagnosis. A specialist can identify some types of fibroids by touch during a gynecological examination.

Principles of treatment

The approach to treating the problem is chosen by the doctor, taking into account the size, number of nodes and the presence of symptoms. If the size of the tumor is small and the disease is asymptomatic, then some experts prefer a wait-and-see approach and monitor the development of the tumor over time. Others believe that even small fibroids should be treated conservatively.

Conservative treatment

Conservative therapy for fibroids is aimed at eliminating contributing factors: weight loss, treatment of sexually transmitted infections, stabilization of the psycho-emotional state, etc.

The following groups of drugs are used as drug therapy:

• gonadotropin-releasing hormone agonists. They help reduce the synthesis of estrogen, due to which the growth of the node stops and its size becomes smaller. The effect is expressed only while taking the medication, there are a number of severe side effects;
• oral contraceptives, synthetic progestogens. Currently, their role in the treatment of fibroids is being criticized. The conducted studies prove the absence of obvious changes in the size of fibroids;
• homeopathy and medicinal herbs. They are used to treat the disease, but their effectiveness has not been clinically proven.

Another group of drugs is not aimed at treating fibroids, but at eliminating developing complications such as pain, bleeding, etc. Painkillers and hemostatic drugs are used.

Important! In some cases, embolization of the uterine artery, which feeds the myomatous node, is performed. In such cases, tumor growth stops and it is replaced by connective tissue. Used for single fibroids with good blood supply.

FUS ablation

This treatment method is based on the action of high-focus ultrasound irradiation. Under the influence of such radiation, irreversible changes occur to the node, and it is destroyed under the influence of high temperature. At the same time, healthy cells remain undamaged.

Those fibroids that contain a sufficient amount of connective tissue can be treated with this method, so before the procedure, the type of node is calculated using MRI.

This is a low-traumatic, organ-preserving method that has virtually no complications. May not be used in all cases.

Surgical treatment

In cases where the tumor reaches an impressive size, its symptoms worsen the patient’s condition or threaten his life, surgical intervention is performed. Myoma can be removed laparoscopically (access through the anterior abdominal wall) or hysteroscopically (through the uterine cavity).

If such removal is ineffective and there are other indications (multiple fibroids, massive bleeding), they resort to complete removal of the uterus (hysterectomy).

Uterine fibroids of various locations can prevent a woman from becoming a mother and cause a number of unpleasant complications. To exclude this pathology, you need to undergo a routine ultrasound and, if necessary, carry out appropriate treatment.

Myoma, or uterine leiomyoma, is one of the most common diseases of the genital organs in women of reproductive and premenopausal age. Of all gynecological operations performed for bleeding from the genital organs, 20% are due to bleeding caused by leiomyomas.

They are usually multiple, less often - single, and of considerable size. The nodes can be located in different parts of the uterus in the muscle layer - intramural, under the mucous membrane - submucous uterine fibroids, under the peritoneum - subserous, between the broad ligaments of the uterus - intraligamentary.

Types of submucosal fibroids and their clinical manifestations

They account for about 1/3 of all localizations of leiomyomas (in relation to the uterine layers). The causes and pathogenesis, risk factors for the occurrence and development of submucous fibroids are presumably the same as for similar formations in other localizations. However, due to good blood supply and high metabolic processes, the former are characterized by rapid growth.

They are considered the most unfavorable type of leiomyomas, since the frequency of their presence reaches 35%, and in cases of pregnancy, the probability of spontaneous abortion, miscarriage or premature birth, abnormal position of the fetus, premature placental abruption, and complications during childbirth is quite high. In addition, treatment of submucosal formations almost always requires the use of surgical methods.

Submucosal leiomyomas originate from the myometrium (the muscular layer of the wall), but their growth is directed under the mucous membrane, into the uterine cavity. During instrumental examination (hysteroscopy, ultrasound), they are defined as a section of the wall that “bulges” inward (to a greater or lesser extent). At the same time, its size, the size of the base, as well as the ratio of submucosal and intramuscular volumes are determined. The main classification is based on the volume of the node in relation to the myometrium:

1. Type 0 - these are nodes that are completely located in the uterine cavity and connected to its wall only by a stalk.
2. Type I - broad-based fibroids, less than 50% of which is located in the myometrium, in the wall (intramural)
3. Type II - formation, more than 50% of the volume of which is located intramural.

This classification makes it possible to correctly assess the clinical situation, decide on the choice of surgical method and decide on the need for preoperative preparation in the form of conservative treatment.

Clinical manifestations and diagnosis

The main provoking factors for the development of submucous fibroids:

• hereditary predisposition;
• chronic inflammatory processes with frequent relapses in the pelvic organs;
• gynecological instrumental procedures and operations accompanied by trauma to the mucous membrane and myometrium - diagnostic curettage, abortion.

The most common and main symptoms of submucosal fibroids, even of small volume, are:

1. Pathological uterine bleeding. They can manifest themselves as excessively heavy bleeding with blood clots during menstruation (menorrhagia), long and heavy menstruation with short intervals between them (hyperpolymenorrhea), non-cyclical bleeding not associated with menstruation (metrorrhagia). Such blood loss leads to secondary iron deficiency anemia, often accompanied by weakness, dizziness and headaches, fatigue, impaired cardiac function and myocardial dystrophy.
2. Painful menstruation (algomenorrhea).
3. Pain in the lower abdomen, which is sometimes cramping in nature.
4. Constant pelvic pain of variable intensity, pain in the lumbar region, becoming permanent as the node grows.
5. Liquid discharge with an unpleasant odor, sometimes brownish in color, which can appear when there is a malnutrition of the node and its necrosis.
6. Infertility, spontaneous abortions, miscarriage (spontaneous termination from the 22nd to 37th week).

Large submucosal fibroids, especially types “0” and “I”, are dangerous due to their “birth” and uterine inversion. During menstruation, the pharynx expands, in which, upon examination, the gynecologist can detect the lower pole of the node. In this case, pronounced cramping contractions and “pushing out” of the fibroids occur, similar to labor contractions and pushing. During the birth process, the node can drag the uterus along with it and turn it out. This complication is dangerous due to heavy bleeding and infection of the uterine cavity.

Diagnostic methods

Treatment of submucous uterine fibroids depends on the correct diagnosis, completeness of information about the location of the fibroids and its condition.

Echography (ultrasound) using a transabdominal sensor is the most accessible and convenient non-invasive diagnostic method. Information content is 93-96%. When examining the expanded uterine cavity, oval or round-shaped formations with regular contours and peripheral compaction like a capsule, characteristic of the processes of sclerosis and fibrosis, are determined. In the presence of necrosis, the heterogeneity of the fibroid structure is determined, and in older women it may contain zones of calcification.

Transabdominal sensors are most optimal for assessing formations of 10 cm or more. The use of transvaginal (vaginal) convex sensors with high resolution makes it possible to detect submucosal leiomyomas measuring 3-4 mm. Ultrasound three-dimensional (3D) examination has even greater informative capabilities.

Hydrosonography(ultrasound with the additional use of a contrast solution) makes it possible to more accurately determine the size and location of nodes, the degree of deformation of the inner wall of the uterus, as well as carry out differential diagnosis with focal forms of adenomyosis and endometrial polyps, which are characterized by less echogenicity.

Ultrasound with Dopplerometry- allows you to see the characteristics of blood flow in and around the myomatous formation, assess the degree of blood supply and changes in structure, and predict its further development. This greatly simplifies the choice of treatment tactics.

This is a visual or on-screen examination of the uterine cavity by introducing into it the optical system of an endoscopic device (hysteroscope). Devices with a 5-150-fold magnification have been developed that make it possible to diagnose even small nodes, determine the nature of their surface, consistency, width of the base, see extensive or small-point hemorrhages, dilated and elongated blood vessels under a thin layer of the mucous membrane, etc.

Separate curettage mucous membrane of the cervical canal and uterine cavity. It makes it possible to draw certain conclusions about the degree of proliferation (growth) of the endometrium and the presence of estrogen-dependent fibroids, which is associated with increased activity of estrogen- and progesterone-dependent receptors. This determines the need to use progestin hormonal drugs (combined oral contraceptives, GnRH agonists, mifepristone, etc.) before and after surgery.

Treatment of submucosal fibroids

Recently, conservative methods such as:

• focused ultrasound ablation under the control of magnetic resonance imaging (FUS-MRI ablation), which consists of non-invasive destruction of leiomyoma using focused ultrasound waves;
• embolization of the uterine arteries - their occlusion using polyvinyl alcohol in order to stop the blood supply to the myomatous nodes;
• the use of medications - analogues of gonadotropin-releasing hormone, mifepristone, etc.

However, these methods are used as independent methods in exceptional cases. They are mainly used to reduce the volume of the node and reduce the severity or completely eliminate the symptoms of fibroids in preparation for surgical treatment.

When a node is born in the vagina, it can simply be unscrewed and removed. In almost all other cases, the presence of submucosal leiomyoma is a direct indication for conservative myomectomy (for node size less than 17 mm) or for radical surgery. Surgical methods:

1. Myomectomy through the abdominal wall.
2. Transvaginal hysteroscopic myomectomy.
3. Two-stage myomectomy.
4. Radical subtotal or total hysterectomy, which consist of supravaginal amputation of the uterus (removal without the cervix) or its extirpation (complete removal), respectively.

Conservative simultaneous myomectomy through the abdominal wall consists of simultaneous removal of the tumor using a laparotomic approach (with an incision in the anterior abdominal wall) or through a laparoscopic technique, which is the most optimal and modern. In both cases, access to the neoplasm itself is provided by dissection of the myometrium followed by the formation of a scar in it. Despite the obvious advantages of the method as a whole and the possibility of removing relatively large tumors, its main disadvantage is the threat of uterine rupture during a subsequent pregnancy due to the presence of a scar in it.

Transvaginal simultaneous hysteroscopic myomectomy consists of removing submucous leiomyomas of “0” and “I” types with a slight intramural (in the muscle layer) component through the vagina using an optical hysteroscope device. It is impossible with multiple nodes of other localizations and in the presence of severe forms of adenomyosis. The operation can be performed in one of three ways:

1. Mechanical, which consists of cutting the capsule and twisting the formation. The procedure is characterized by a short duration (up to 15 minutes), does not require additional special equipment or a liquid medium that can lead to overload of the vascular bed. In addition, it eliminates the possibility of vascular damage and burns to adjacent areas, which can occur with the electrosurgical technique. However, despite the possibility of removing nodes of even significant size, the method is applicable only to “0” type fibroids and, less often, to “I” type mobile formations with a very small intramural volume.
2. Electrosurgical hysteroresectoscopy, which uses a hysteroresectoscope with special loops for cutting tissue and cylindrical or ball electrodes designed for coagulation of bleeding vessels at the bottom of the wound. The operation can be performed by evaporation (vaporization) or resection of fibroids. In the second case, it is excised and removed in parts. The most convenient localization of the tumor for this method is the fundus, lateral walls of the uterus and the mouth of the fallopian tubes.
3. Contact or non-contact laser method using a solid-state laser whose wavelength is 1064 nm.

Two-stage conservative myomectomy carried out in the presence of type II submucosal formations, the submucosal component of which is less than 50%. The essence of the method is to combine the laparoscopic method with electrosurgical or laser hysteroresectoscopy.

Principle of management of patients with submucous fibroids using hormonal therapy

Conservative myomectomy of submucosal nodes is an effective surgical treatment method that provides a favorable course of the postoperative period with a short hospital stay. In combination with targeted hormonal therapy, it helps restore the normal menstrual cycle, the ability to become pregnant and prevent relapses of the disease.