Myoma of the uterus
Myoma of the uterus is a hormone-dependent tumor-like benign formation (node), arising from the smooth muscle structures of the uterine wall. Myoma of the uterus certainly has signs of a tumor, but also differs from that, so it is more appropriate to relate it to tumor-like formations. Significant characteristics of uterine fibroids are its good quality, hormone dependence and the ability to self regress.
The "favorite" age of myoma is 20-40 years. A rare pathology of uterine fibroids can not be called, recently it is diagnosed in 30% of patients with gynecological pathology. To the statement of some specialists that the uterine myoma is "younger" and has become more common, one should not treat with unconditional consent. It is possible that such statistics are associated not only with a true increase in the incidence, but also with a change in the mentality of patients: women have become more attentive to their body, undergo preventive examinations. Also, an increase in the number of uterine myomas detected is influenced by new, more accurate, diagnostic equipment, which makes it possible to detect small asymptomatic tumors in the uterine wall.
To have a correct idea of the uterine myoma, you should know about its structure. The uterus is intended for the realization of a single and very important function - procreation. Its structure allows you to increase during pregnancy many times, to hold the fruit for many months and push it out when it is fully formed.
The most powerful and thick middle layer of the uterine wall is the myometrium. It forms three layers of smooth muscle fibers, which intertwine and form spiral turns. To strengthen the muscular frame of the uterus and to ensure its greater extensibility and elasticity in the myometrium, fibers of connective tissue and elastic elements are weaved.
From inside the uterine cavity lining the mucous membrane - the endometrium. This is where the monthly processes of growth and subsequent rejection occur with the participation of ovarian hormones - estrogens and progesterone.
External strong serous membrane of the uterine wall, perimeter, protects the uterus from external influences.
Myoma of the body of the uterus arises inside the myometrium in the form of nodal formation. Myomatous nodes are either single or multiple, small or large. More often in the uterus, there are several nodes of different sizes, and sometimes localization, then it is called the uterine myoma of the uterus.
The localization of myoma is not limited to myometrium, since the nodes can grow over the boundaries of the muscular wall, growing into other uterine layers. In rare cases, the myoma becomes atypical in the tissues of the cervix, between the wide uterine ligaments and even behind the peritoneum.
The causes of uterine fibroids continue to be studied and refined. The only reliable sign of uterine fibroids is its close connection with hormonal dysfunction, when the amount of estrogen increases. Like any dyshormonal process, myoma can decrease symmetrically with a decrease in the amount of estrogens, and in menopause, when estrogens are practically absent, it often disappears.
The clinical manifestations of uterine fibroids do not have clear criteria. The disease often does not have any subjective manifestations and is diagnosed accidentally. The severity of symptoms in uterine myomas affects the size and number of nodes, their location and the presence of a concomitant adverse background.
Relatively unfavorable situation is considered a combination of uterine myoma and pregnancy. The presence of large nodal formations in myometrium alters the strength and contractility of the muscle layer, which is fraught with complications in bearing and childbirth. Myoma of small uterus well "gets along" with pregnancy and does not threaten it.
Diagnosis of uterine fibroids does not cause difficulties. It begins with a routine examination and ends with instrumental methods of examination.
Despite the word "swelling" in the definition of fibroids, therapeutic tactics are not limited to surgical methods. Small, uncomplicated myomas with favorable localization respond well to conservative therapy. Complicated uterine fibroids are less common, especially in recent years, when diagnostic methods have become more sophisticated, and patients undergo regular screening, which allows timely diagnosis of the presence of myoma nodes and prevent negative consequences.
A patient who received a conclusion about the presence of fibroids in the uterus should not be frightened. With proper medical treatment with this education, you can live a lifetime or completely get rid of it, since treatment of uterine fibroids without surgery is possible.
Several terms are used to designate uterine fibroids, which can sometimes "confuse" patients. In fact, the name of the myoma changes according to its internal cellular structure. If it is formed predominantly by muscle fibers, it is said about the myoma. When it contains a significant number of connective tissue elements, it is called fibromyoma . As a matter of fact of an important clinical value the structure of a myoma does not have, as any its histological kind is diagnosed and treated equally.
Recently, due to the use of high-precision diagnostic equipment, the term " fibroids of the uterus " has often been used. This is the presence of premalignant changes in the uterine wall, that is, the initial stage of the formation of uterine fibroids, which is not always transformed into the actual myoma.
Causes of uterine fibroids
The hormonal nature of uterine myoma is recognized as the most reliable, it is confirmed by numerous clinical cases of simultaneous diagnosis of the presence of fibroids and hormonal dysfunction. When the hormonal balance exists throughout the cycle, against the background of a continuous increase in FSH and LH and persistent anovulation, the amount of estrogen remains consistently high, and the concentration of progesterone becomes lower. This means that most of the causes of hormonal disorders can also become a source of uterine fibroids.
The proper hormonal balance in the body is maintained through the complex interaction of brain structures, ovaries, uterus, immune and endocrine systems. Therefore, the mechanisms of the development of myoma can be conditionally classified into:
- Central ones. Associated with dysfunction of the cerebral cortex, that is, the "pituitary-hypothalamus" system. Expressed stresses, vascular disorders, neurological disorders and acute infections can deform the normal function of the organs controlling the ovaries, causing hormonal failures.
- Ovary. Myoma of the uterus body is not formed with short-term changes in normal ovarian function, however, prolonged ovarian dysfunction against the background of infectious inflammation, cystic enlargement leads to persistent anovulation followed by hyperestrogenia.
- Uterine. In order for the uterus to "recognize" hormones, special endings (receptors) are located in the endometrium, capable of perceiving them. Damage to receptors that perceive progesterone leads to an excessive effect of estrogens on the uterus. Such abnormalities can be triggered by abortion or diagnostic manipulations in the uterine cavity, chronic inflammation ( endometritis ), or hypoplasia (underdevelopment) of the uterus.
There is a possibility of uterine myoma after abortion, incorrectly performed hysteroscopy, traumatic removal of the intrauterine device, diagnostic scraping, biopsy and similar traumatic events. Trauma of the uterine wall leads to local disruption of nutrition of surrounding tissues, inflammation and reduction of local immunity.
Among pregnant uterine fibroids is diagnosed infrequently (0.5 - 6%). In the first two months of fetal development, the ratio of hormones changes and structural changes occur in the uterus in the form of an endometrial overgrowth. All this provokes the growth of myoma nodes.
The problem of utilization of excess estrogen is laid on the liver. In severe hepatic pathologies, when there is a violation of this function, hyperestrogenism may develop.
A reliable participation of heredity in the formation of uterine myoma is confirmed. In a family history of patients with fibroids, hormone-dependent gynecological pathologies associated with hyperestgenia are often present.
Despite the close relationship of uterine fibroids with dyshormonal disorders, it does not occur in every patient with hormonal dysfunction. Therefore, the search for other mechanisms for the development of nodes in myometrium, especially their combination, continues.
Symptoms and signs of uterine myoma
It is impossible to name the exact symptoms indicating the presence of fibroids in the uterus. The clinical picture is formed under the influence of many factors and conditions. Contrary to popular belief about the decisive importance of the size and number of myomatous nodes in the clinical picture, the primary factor is their localization.
Initially, all nodes appear in the myometrium and pass through several stages:
1. Formation. Near the small vessels of the myometrium appears a focus of increased growth of muscle elements.
2. Maturation. A "glomerulus" of small size (not exceeding 3 cm) is formed from muscle bundles going in different directions. Gradually, the node becomes denser and increases, and around it a peculiar capsule appears from the elements of the surrounding tissue. At this stage, intensive growth of uterine fibroids occurs.
3. "Aging" of the node. There is no active growth of fibroids, but there are dystrophic disorders within the site.
The increase in the size of the tumor is not always unambiguous, so it stands out:
- Simple uterine myoma. Slowly growing and malosimptomnaya myoma of small uterus, more often single. Often, simple fibroids are diagnosed accidentally.
- Proliferating uterine myoma. It grows rapidly, provokes clinical manifestations. It is diagnosed as multiple uterine myoma or single large uterine myoma.
The type of nodal growth in diagnosis of myomas is very important, since the size of the uterine myoma for surgery is one of the primary criteria.
Nodular uterine myoma can form at different depths of the muscular wall of the uterus. Depending on the localization of single or multiple nodes, fibroids are classified:
- interstitial (intramural), located in the muscular thickness (40%);
- submucous, protruding into the lumen of the uterus and deforming its cavity (5%);
- subserous, protruding from the outer wall of the uterus towards the peritoneum (55%).
Infrequently, the myoma has an interconnected arrangement when the node is located between the leaves of the wide uterine ligament. Atypical location of the myoma (cervix, retroperitoneal region) is extremely rare.
Multiple uterine fibroids do not appear overnight, the process of forming all nodes is slow and unequal for each of them. Therefore, the myomatous nodes can simultaneously be present in the uterus at different stages of development and different localization, and the clinical picture of the disease consists of symptoms provoked by each node separately. If, at the most typical, interstitial location of the fibroid in the uterus, another node is born, but already in the submucosa, a calm clinical picture can acquire features of an emergency situation.
Multiple uterine myoma with interstitial localization of small nodes can not disturb the patient for a long time.
Despite the variegated and ambiguous clinical picture of uterine fibroids, it is possible to isolate several of the most frequently observed symptoms in patients:
- Menstrual dysfunction. It often appears at the initial stage of tumor formation in the form of longer and more abundant periods ( hyperpolymenorrhea ). Such violations do not always lead the patient to the doctor, especially if they are not accompanied by other negative symptoms, do not disrupt the habitual life rhythm and are self-controlled by the use of haemostatic agents. Over time, menstrual irregularities become more pronounced: bleeding becomes acyclic, and blood loss reaches a significant extent, provoking anemia.
The nature of menstrual irregularities is influenced by the location of the myomatous nodes. Subfertous uterine fibroids do not affect the character of menstruation more often. Interstitial myoma of the uterus does not change the menstrual cycle, however, the intramuscularly large uterine myoma prevents the correct contraction of muscle tissue and provokes abundant menstruation.
The submucosal location of the myoma is considered to be the most unfavorable. Bulging into the uterine cavity, myoma greatly deforms, reduces the uterine tone and already in the initial stages of the formation provokes abundant bleeding, which eventually lose its cyclicity.
- Pain. Myoma of the uterus can be accompanied by pains of very different intensity and localization. Interstitial uterine myoma of large size with slow growth causes aching soft pains, and submucous nodes often cause strong cramping pain.
Irradiation of pain is associated with localization of myoma nodes. They can be projected onto the area of the bladder, lower back, and rectum. With circulatory disorders in the node with subsequent necrosis of its tissues, the pain is so pronounced that it resembles a clinic of acute surgical pathology ("acute abdomen").
- Violation of the function of neighboring organs. The nodes located in the uterus lead to an increase in its size. Therefore, the uterus begins to press on a nearby located bladder and rectum, causing their dysfunction.
Infertility . Myoma of the uterus refers to the potential cause of the development of primary and secondary infertility. It is associated not only with the existing hormonal changes, but also with a mechanical obstacle for normal conception and bearing, created by myoma nodes.
The presence of fibroids in the uterus can be suspected in the presence of the above complaints. When gynecological examination reveals an increase in the size of the uterus and changes in its density. Sometimes it is palpated "tuberous" due to the subsideous nodes located on the outside.
Essential diagnostic help is provided by ultrasound scanning. It determines the change in the size and density of the uterus, the presence of nodes and their localization, the state of the endometrium and the deformation of the uterine cavity.
Often, ultrasound and gynecological examination is enough to establish the correct diagnosis. However, if the study reveals a hyperplastic process in the endometrium, it becomes necessary to clarify the nature of the changes in the mucous layer. A diagnostic fractional scraping of the uterine cavity is carried out with subsequent laboratory study of the material obtained.
The list of diagnostic measures depends on the type of uterine myoma and its location. It is possible to use hysteroscopy, metrosalpingography (MSG) for a more detailed study of the state of the endometrium, as well as echography.
It is often difficult to distinguish between subserous myomas and ovarian tumors without laparoscopy, which allows you to examine all the pelvic organs and detect any pathological changes. Sometimes patients call this method "uterine fibroids laparoscopy". This definition is not entirely correct, because laparoscopy involves an examination of the entire pelvic region, when not only the myoma is examined, but also the tissues and organs surrounding it. When talking about laparoscopy, not to list all the structures around it, use only the name of the method itself. Instead of the phrase "laparoscopy of uterine fibroids", it is more competent to say "laparoscopy".
For the correct tactics of subsequent treatment, the diagnosis of fibroids involves a search for the cause of its development, therefore, regardless of the characteristics of the tumor, the hormonal status of the patients is always examined, and an infection for genital infections is diagnosed.
Subserous myoma of the uterus
With subserous (subperitoneal) arrangement, the myomatous nodes begin to develop in myometrium on the border with the serous membrane, and then, as they increase, form protrusions toward the abdominal cavity. For the subserosal nodes, it is typical that the base of the muscular layer does not grow into the muscle layer, since they grow away from it. Therefore, they often have a more subtle base - the leg.
The subperitoneal nodes in half the cases do not provoke menstrual irregularities, while in the other half of the patients they are reduced to more ample menstrual disorders. The subserous uterine fibroids rarely reach large sizes, but in these rare cases it overstrains the peritoneum covering it from the outside, thereby provoking persistent aching pelvic pain. The most intense pain, similar to pain in an "acute abdomen," develops when the feeding of the subserus node is disturbed by the torsion of its pedicle.
More often the subserous nodes remain small, do not enlarge the uterus, progress slowly and asymptomatically, they are detected accidentally.
During the gynecological examination, a slightly enlarged dense womb with deformed contours is palpated. If the subserous node has a leg, palpation can determine its displacement relative to the uterine body. If there is a wide base, small nodes are not palpable, but their presence can be thought by determining the unevenness and asymmetry of the contours of the uterus.
A subserous uterine fibroids of large size can change the function of neighboring organs due to their compression. Located on the front of the uterine wall, the subserous node provokes bladder dysfunction, if it is localized on the posterior uterine wall, there are disruptions in the terminal section of the colon.
Ultrasound scanning is used to diagnose the subperitoneal fibroid, and laparoscopy helps distinguish the subserious node on the uterus from the ovarian tumor.
Submucous uterine myoma
The submucosal location of the myomatous nodes among other typical forms of localization is considered very unfavorable. The asymptomatic presence of the submucous node in the uterus is only possible for a short time, while the myoma is too small to be "seen" by the uterus. When the tumor becomes larger, the uterus perceives it as a kind of "foreign body" and begins to try to get rid of it, that is, push it out with the help of muscle contractions, which is always accompanied by pains that increase in the menstrual period.
The submucosal nodes protruding into the lumen of the uterus deform its cavity, which affects the character of menstrual bleeding. Monthly gradually become more abundant, and unsuccessful attempts of the uterine wall to reduce correctly, in order to push out the torn tissues, lead to increased pain. When the node reaches a large size and occupies the greater part of the uterine cavity, menstruation becomes acyclic or ceases altogether.
In the deformed myomatous node of the uterine cavity, the mechanisms of immune defense and the processes of correct renewal of the mucous layer are violated, which often provokes the attachment of an infectious inflammation. As a rule, in patients the fat metabolism is broken, reproductive problems arise.
Submucous uterine myoma, provoking prolonged and profuse bleeding, leads to anemia. Patients complain of rapid fatigue and weakness, nausea, dizziness and even fainting.
The intensity of pain and bleeding with submucous uterine myoma depends on its location and magnitude. Sometimes the uterine contractions become so intense that they resemble labor contractions and lead to the independent "birth" of the submucosal node, when it, like a fetus, leaves the uterine cavity, causing profuse bleeding. The patient's condition requires immediate hospitalization and surgical intervention.
Primary diagnosis of submucous uterine myoma is often limited to gynecological examination and ultrasonic scanning of the pelvic cavity. During the examination, it is possible to palpate the increase in the size of the uterus and change its density. If the myoma is small, the size of the uterus does not always exceed the norm.
Ultrasound - signs of submucosal fibroid are:
- deformation and expansion of the contours of the uterine cavity;
- Rounded or oval mid-echogenic formation in the uterus.
Ultrasonic scanning allows to detect submucous myoma of the uterus, to specify its localization. Often, the data obtained is not sufficient to determine further tactics.
The most complete information about the tumor and its effect on surrounding structures is obtained by metrosalpingography (MSG). Another name is hysterosalpingography (GHA). In the presence of an X-ray, a contrast medium is injected into the uterine cavity and a series of images is performed, which clearly shows the "colored" uterine cavity and the lumen of the fallopian tubes filled with contrast. The submucosal nodes contrast well with the asymmetric uterine cavity, and the wrong filling of the fallopian tubes indicates their obstruction, which is especially important in patients with infertility.
Submucous uterine myoma on a narrow base resembles a polyp, in this situation it should be properly diagnosed. The most reliable data on pathological changes in the uterus is provided by hysteroscopy. It allows to see the entire surface of the uterine cavity, to find even the smallest submucous nodules, to assess the state of the endometrium (especially with hyperplastic changes). Submucosal nodes are visualized in the form of spherical whitish formations of regular shape, dense consistence, covered with a thin endometrium. Due to the overgrowth of the mucosa above the surface of the myoma, the enlarged blood vessels are well visualized. Hysteroscopy allows you to see the entire endometrium and detect areas of hyperplasia or inflammation. From "suspicious" sites, you can take material for a more detailed laboratory study.
Submucous uterine myomas are unpredictable and require compulsory treatment.
Uterine fibroids and pregnancy
Infertility accompanies uterine fibroids quite often. Each third patient who has primary infertility is diagnosed with myoma, and in every fifth infertile patient the myoma is its cause.
The most simple cause of infertility in uterine myomas is the formation of a mechanical obstacle to the development of pregnancy. Localizing in the corners of the uterus and blocking its communication with the canals of the fallopian tubes, the myomatous nodes not only prevent the fertilized egg from getting into the uterine cavity, they also can not "miss" the spermatozoa to the egg.
More often infertility is caused not by the myoma itself, but by the same reasons that it appeared, that is, hormonal disorders, when the change in the ratio of sex steroids leads to anovulation.
The presence of uterine fibroids, especially small and without complications, does not exclude the possibility of pregnancy. The scenario for the development of the clinical situation depends on many conditions, but more often the "critical" period is the first two months of pregnancy. It is during this period that important hormonal changes occur, aimed at maintaining the pregnancy and provoking the growth of myomatous nodes.
From the beginning of pregnancy in the uterine blood flow there are local hormonal changes, they provoke the transformation of cellular hyperplasia and hypertrophy, including in the myomatous nodes. As a result, an increase in their size is recorded during this period. However, two months after the onset of pregnancy and until the end of the pregnancy, the proliferation of tissue inside the nodes is completely blocked, and all subsequent changes in the volume of uterine myoma are associated with edema, destruction and necrosis.
Pregnancy and uterine fibroids may not interfere with each other at all. Often, myoma in pregnant women is asymptomatic. There is a direct dependence of the outcome of pregnancy and childbirth on the size and location of the myomatous nodes.
The most characteristic symptom of myoma in pregnant women are uterine bleeding of varying intensity and duration. Often they are accompanied by pain in the abdomen with irradiation in the lower back.
In the presence of any fibroids in the uterus, the blood supply and feeding of the uterine wall are disturbed, the ability of the myometrium to change correctly decreases. Therefore, the presence of fibroids in the pregnant uterus increases the risk of its premature interruption.
Even if the myomatous nodes do not threaten pregnancy, they can cause complications of labor.
Save pregnancy can only if the risk of complications is low. If the risk is high, the decision on the outcome of pregnancy is taken individually with the patient.
When the decision is made to keep the pregnancy , the uterus is "helped" by conservative methods: prescribe medications that reduce the tone of the uterus, antibiotics to eliminate the first signs of eating disorders in the myomium, haemostatic drugs and vitamins.
Pregnancy does not prevent surgical treatment of uterine fibroids. If the clinical situation requires the removal of the myomatous node, conservative myomectomy is performed - removal of the myoma.
In a difficult situation, when the fibroid threatens not only the fetus, but also the patient, abortion is carried out.
Treatment of uterine fibroids
Having received a conclusion about the presence of uterine fibroids, the patient often associates this diagnosis with organ loss and subsequent infertility. Many mistakes are associated with the treatment of myoma. In particular, many patients are convinced that the treatment of uterine fibroids without surgery is impossible, or are convinced of its inefficiency.
Meanwhile, fibroids knowingly correlate with a tumor-like disease, because she, having signs of a tumor, is significantly different from that. The most favorable for patients difference from a true tumor is the ability to undergo reverse development, decrease in size and even completely disappear. If after careful examination it turns out that an unfavorable scenario of uterine fibroids development can be eliminated without surgery, an individual therapy plan is drawn up, aimed at the cause of myoma development and its consequences.
Unfortunately, conservative treatment with myomas is effective only under certain conditions, namely:
- relatively small size of the node (the size of the uterus does not exceed a 12-week pregnancy);
- Malosymptomatic flow;
- the desire of the patient to preserve the uterus and, accordingly, the reproductive function;
- inertial or subserosic arrangement of nodes having an exceptionally wide base.
If the myoma is accompanied by a serious non-gynecological pathology, which is a contraindication to the operation, conservative treatment is the forced choice.
As the leading diagnostic criterion in choosing a method of treatment is the rate of increase in the size of the uterus for the year. If it exceeds four weeks, fibroids are considered fast-growing and resort to surgical treatment.
Conservative therapy for uterine fibroids has several purposes:
- stop the growth of existing and the formation of new nodes;
- reduce the size of the tumor;
- prevent complications.
Often, medical treatment is performed before or after surgery. But in this case it is part of the combined treatment of fibroids and pursues other purposes, since it can not independently eliminate uterine fibroids, but it can reduce its size and prevent the development of complications or relapses.
Even if it is possible to rid the uterus of myoma completely, without eliminating the cause, the tumor can "return". To relapse did not happen, it is necessary to eliminate the prerequisites for its development. Therefore, the basis of conservative treatment is hormone therapy.
There is no universal scheme with a specific list of hormonal means, as each patient has its own individual hormonal shift, and hormonal drugs must mimic a normal hormonal balance.
The duration of hormonal treatment is determined individually, but, as a rule, it does not last less than six months. With the saved menstrual cycle, it is advisable to use gestagens (Norethisterone, Dufaston, Utrozestan, Progesterone and the like).
In the last ten years on the Russian market there is an intrauterine spiral "Mirena" containing heroin levonorgestrel. It is emitted daily into the uterus and stabilizes the correct quantitative ratio of hormones. The spiral is introduced for five years. In addition to the therapeutic spiral has a contraceptive effect.
From the acyclic bleeding of young women, estrogen-progestational drugs can be relieved (Zhanin, Yarina, Non-Ovlon and analogues), and after the 45-year-old line the patients are taking androgens (Sustanon-250, Testosterone and the like) for premature termination of menstrual function.
Sometimes patients ask why, instead of the recommended medication, the pharmacy released them a drug with a different name. When choosing a hormone drug, you should pay attention not to its name, which is indicated on the package, but to the main active substance indicated in the instructions. Differently named hormones often have one composition.
In parallel with hormonal therapy, general non-specific treatment is performed. It is aimed at all links of the pathological process of forming fibroids and helps to slow down the growth of the tumor. The medical complex includes:
- anti-anemia drugs;
- drugs that improve local blood flow;
plant-improving agents that improve liver function.
Once in three months, mandatory monitoring of the state of uterine fibroids and evaluation of the results of therapy.
Submucous location of myoma nodes does not imply drug treatment.
Myoma of the uterus
The size of the uterine myoma for surgery is not the only criterion. In the submucosal location, even small nodes often provoke significant bleeding, pain and anemia, and the "born" submucosal node requires urgent hospitalization.
In any clinical situation, if it is not an emergency, doctors seek to keep the uterus for young women, so removal of the uterus with a myomium is carried out only after excluding the possibility of other medical measures or in case of their ineffectiveness. Even if the operation is necessary, they prefer to remove the myoma itself, and not the whole uterus.
The decision on operative treatment is accepted, if:
- the uterus exceeds the size of a 13-week pregnancy;
- the effect of the therapy is negative;
- the uterus grows too fast (more than four weeks per year);
- necrosis and destruction begin in the myomatous node;
- There is a subserous myoma;
- torsion of the myoma foot is diagnosed;
- a pronounced hyperplastic process is diagnosed;
- Myoma is located in the cervix.
Removal of fibroids (myomectomy) implies "hatching" the node while maintaining the uterus, respectively, menstrual function. It is spent to women of reproductive age if they are interested in pregnancy. However, the removal of fibroids does not guarantee its recurrence, if the causes of the disease are not eliminated. In order to prevent relapse after surgery, conservative etiotropic treatment is always performed.
Sometimes it is impossible to pick out the myomatous knot, but it is possible to remove not the whole uterus, but only its part, that is, resort to a semi-radical method - the deflation of the uterus, when the uterus only removes the bottom along with the nodes, and the remaining part of the uterus is able to menstruate.
A relatively new minimally invasive method of treatment is embolization of uterine arteries. In large uterine vessels, from which the myomatous nodes feed, embolus is introduced. He clogs the vessel, preventing the flow of blood to the myoma. Without blood supply in the nodes begin trophic disorders and necrosis.
FUS - ablation of uterine myoma using a locally focused ultrasonic wave refers to new techniques. It is called an "operation without surgery", since it is performed remotely without a single incision, and the fibroids are "evaporated" by ultrasound. Ablation of uterine fibroids is effective for single small (less than 3 cm) nodes. However, the method has extensive limitations and contraindications, is used infrequently, has no reliable statistics, and is not well understood.
Removal of the uterus (hysterectomy) is carried out after excluding the possibility of more sparing surgical interventions. In menopause and menopause, removal of the uterus with myomas is most justified.
Consequences of uterine fibroids
After the formation of fibroids, the scenario of further clinical events can not be predicted.
Myoma can be present in the uterus for many years, asymptomatically and independently disappear after the onset of menopause, while a small submucous myomatous node can lead to severe consequences and organ loss.
With uterine myoma is the most significant number of uterine bleeding and disorders of menstrual function. Patients with prolonged and profuse menstruation suffer from anemia. Prolonged anemia affects the functioning of the heart muscle, because it leads to hypoxia of the muscle cells.
Hormonal dysfunction, which provoked the appearance of fibroids, leads to the emergence of anovulatory cycles and infertility.
Some species of myomas are located in this way in the uterus, which, even with a small size of the myomatous node, disrupts the normal function of the bladder and large intestine. If the interconnection jam squeezes the ureter, a mechanical obstruction arises for a full-fledged urine outflow, which accumulates in the upper urinary tract and provokes the expansion of the cup-and-pelvic apparatus by the type of hydronephrosis . An anterior node also affects the urinary system, causing urinary incontinence. Violations of the normal act of defecation cause a backbone node.
Prolonged hyperestrogenia, accompanying uterine fibroids, can change the functioning of the liver. In parallel, there is a deformation of the metabolism.
Large fibroids, filling almost the entire uterine cavity, or cervical fibroids may prevent the correct outflow of menstrual blood, this leads to the formation of a closed uterine cavity, overflowing with blood - a hematometer. It is eliminated only surgically.
Hormonal dysfunction in uterine myomas affects not only the work of organs and systems, the nature of the menstrual cycle, it can affect the psychoemotional state of the patient. Neurological and even mental disorders lead to personal deformity. Patients are characterized by depression , hysteria or psychasthenia.
Undesirable combination of fibroids and pregnancy also sometimes leads to negative consequences. At any time in pregnant women with fibroids, there is a high risk of premature interruption, and a decrease in uterine tone due to the presence of nodes in the wall of the uterus provokes serious postpartum uterine bleeding. As a rule, pregnancy is not interrupted if the risk of complications is low or because the patient refuses to interrupt. With an adequate attitude to their health, women planning pregnancy, in advance pass the necessary examination. Diagnosed pre-pregnancy fibroids can and should be treated to reduce the risk of complications.
Severe effects of uterine fibroids are rare. As a rule, the disease is diagnosed and treated on time.