Uterine fibroids: symptoms and treatment
Myoma of the uterus is a benign neoplasm that occurs in women of childbearing age (most often from 30 to 45 years). At the same time, the muscular fibers of the uterus are randomly enlarged, and a knot braided with densely altered vessels is formed. The peculiarity of the tumor is that it is hormone dependent — its development and growth depends on the level of sex hormones in the female body.
Myoma of the uterus — one of the most common gynecological pathology, occurs in about 25% of women of reproductive age, 3% of them are found during a preventive examination. This tumor occurs in elderly and young nulliparous women, after childbirth, gynecological operations and even in pregnancy and menopause.
Causes of uterine fibroids
There are such reasons for the uterine myoma:
- Hormonal disorders — a sharp decrease or increase in the level of progesterone or estrogens, which clinically manifest themselves with different menstrual irregularities.
- Irregular sexual activity, especially after 25 years. As a result of sexual dissatisfaction, the blood flow in the small pelvis changes, stagnation predominates.
- Inflammatory processes of genital organs of a chronic nature.
- Mechanical factors: traumatic births, induced abortions, consequences of gynecological surgeries, diagnostic curettage
- Genetic predisposition — the risk of this pathology in women whose grandmothers and mothers had uterine fibroids increases.
- Late childbirth.
- A sedentary lifestyle.
- Concomitant pathology — endocrine diseases (obesity, pathological processes of the thyroid gland, metabolic disorders, diabetes mellitus), arterial hypertension
There are such variants of uterine fibroids flow :
- localization — submucosal, intermuscular, subperitoneal and intermediate variants
- by location — body, bottom, cervix and isthmus of the uterus
- Sizes are large, medium and small;
- the nature of growth — true and false
- Morpho-histochemical features (proliferating and simple).
Symptoms of uterine fibroids
In the early stages of uterine fibroids most often has an asymptomatic course. Then the disease manifests itself by such symptoms:
- Menorrhagia is an increase in menstrual flow. Abundant bleeding is dangerous because after a while, anemia may result. More abundant bleeding suggests that the muscles of the uterus are reduced worse, in this case, necessarily need medical attention. In addition, a woman may experience metrorrhagia — acyclic uterine bleeding. Bleeding in this case is not a tumor, but the mucous membrane of the uterus, irritated by the tumor.
- Pain syndrome can be of a different nature. As a rule, pain is localized in the lower back or lower abdomen. Pain can also be sudden if blood circulation is disturbed in the myomatous node. Myoma of a large size, but slowly increasing, is manifested by drawing painful sensations during menstrual bleeding. The cramping character of the pain indicates that the tumor grows in the uterine mucosa. Pain in uterine myoma in the early stages of the disease occurs rarely, in most cases, pain shows that a certain time has passed since the onset of the illness.
- Violation of the operation of nearby organs, primarily the rectum and bladder. They may experience a feeling of depression if the tumor grows in their direction. Therefore, chronic constipation and micturition can occur. If there are such signs, it is necessary to address not only to the gastroenterologist and urologist, but also to the gynecologist so that he can exclude myoma of the uterus.
- As a result of heavy bleeding, anemia can occur — a decrease in the blood of red blood cells and hemoglobin. Anemia is accompanied by dizziness, headache, weakness and pallor of the skin.
- Pain in the heart area — if the tumor increases, myocardial tone decreases. In severe cases, venous pressure may increase. In this case, it is necessary to visit a cardiologist.
- Infertility — in the case of the submucosal location of the myoma, there is a violation of the patency of the uterine tube and this prevents the passage of spermatozoa.
Every third woman with multiple fibroids has complications during labor. There is evidence that myomone with the onset of menopause may decrease, as a result of which its symptoms disappear.
Depending on the localization of the myomatous node, its dimensions are dominated by those or other symptoms of the disease.
Myoma of the uterus with an arrangement of the node under the mucous membrane (submucous location) is manifested by various disorders of the menstrual cycle, abundant and prolonged menstruation, uterine bleeding, which often leads to anemia. Pain syndrome for such fibroids is not typical, but if the myomatous node from the submucosal layer falls into the uterine cavity, cramping, very intense pain occurs. Very often submucous myoma can cause miscarriage or infertility.
The subzero arrangement of the myoma can have an asymptomatic course for a long time. But with the enlargement of the knot, there is discomfort in the lower abdomen and constant, unexpressed, drawing pains. In the event that the feeding of the large-sized subserous node is disrupted, a clinic of the «acute abdomen» may arise and it is wrong to assume the presence of diseases of the abdominal cavity organs, such patients are mistakenly hospitalized in a surgical hospital. With such nodes, bleeding does not occur.
Interstitial-subserous (mixed) myomatous nodes are very difficult to diagnose, they may not be recognized for a long time. Reaching large sizes (10-30 cm in diameter), they can manifest in the initial stages of unexpressed discomfort in the lower abdomen. The pressure increases with an increase in the size of fibroids and the first signs show signs of damage to neighboring organs. Due to constant pressure on the rectum, defecation processes are disrupted. The compression of the ureter and bladder not only leads to impaired urination, but also to kidney damage (pyelonephritis, hydronephrosis) and ureter (hydroureter) on the side of the lesion, to manifestations of the compression syndrome of the inferior vena cava (when lying, abdominal pain and shortness of breath occur).
Thus, uterine fibroids have characteristic features:
- is the most common tumor in premenopausal women (46-55 years) and late childbearing age (35-45 years)
- can grow, regress and even completely disappear into menopause (both artificial and natural)
- can save its size for a long time or grow in size very quickly or slowly («growth spurt»)
- a variety of clinical options (symptomatic and asymptomatic).
How is pregnancy with uterine myoma?
In most cases, with small-sized myomatous nodes, problems do not arise in the early stages of pregnancy. Difficulties are possible if the formation of the placenta occurs close to the myoma. The tumor produces substances that help reduce uterine muscle fibers, and pregnancy is interrupted.
In the second and third trimesters there is a risk of premature birth. This is due to the fact that for the growing fetus because of the myomatous nodes in the uterus there is less and less space, and this affects the development and growth of the fetus. Often, as a result of squeezing a large tumor in the fetus, deformity of the bones of the skull or torticollis may develop. In addition, uterine fibroids affect the placental circulation, as a result of which the fetus suffers from a deficiency of nutrients and oxygen.
If the uterine myoma and pregnancy have successfully combined all nine months, labor can be complicated as a result of an incorrect presentation of the fetus. That is why, in this case, a caesarean section is shown, in which a tumor can be removed.
With a small size of fibroids, its location in the thickness of the muscles of the uterus or sub-serous, the absence of its rapid growth shows conservative treatment. Appointed drugs of these groups:
- Androgen derivatives — interfere with the synthesis of ovarian hormones, preventing tumor growth in the future (gestrinone)
- gonadotropin hormone agonists — reduce the size of myoma and its symptoms (zoladex, buserelin); With their long use may develop menopause;
- Gestans — are able to stop the growth of the endometrium, without affecting the myoma itself (norkolut, utrozhestan); Their reception is indicated for hyperplasia in the inner uterine layer and small fibroids.
Surgical treatment is indicated for large uterine fibroids (more than 12 weeks), heavy bleeding, severe pain, a tendency to rapid tumor growth, infertility and miscarriage.
In modern gynecology, these types of surgical treatment are used:
- Laparoscopic myomectomy — it is carried out through a small incision in the anterior abdominal wall using a laparoscope.
- Embolization of the uterine arteries — embol, inserted into the vessels, blocks the lumen of the arteries feeding the node. This method of treatment is indicated for those women who plan to conceive a child.
- Hysteroscopic myomectomy — is performed with submucosal tumor localization, while internal nodes are removed
- Physis ablation — one of the new methods, is to use focused ultrasound waves. With this method, it is possible to reduce the size of myoma nodes. FUS ablation is not recommended for multiple neoplasms.
- Gistrectomy — the uterus is removed completely. It is performed with tumors in the ovaries, large sizes of fibroids, unwillingness of the woman in the future to have children.
A gynecologist chooses a method of treatment, considering the woman’s age, the location and size of the fibroids, the rate of her growth, the desire of a woman in the future to have children.