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Uterine fibroids: every woman needs to know
Medical studies conducted in Russia have demonstrated an increase in the incidence of uterine myoma in women over 30 years old by almost three times in the last few decades. It is noteworthy that the disease is mostly asymptomatic. Therefore, when a woman first hears a diagnosis, then for her, it sounds more than unexpected. And often the misconception about the disease in advance scares the patient, forcing seriously worry about their health. Women with this diagnosis need more information about what they can and cannot do. What contraindications exist when uterine fibroids are detected.
- Что такое миома матки 1 What is uterine fibroids
- Классификация и разновидности 2 Classification and varieties
- Симптомы и признаки 3 Symptoms and signs
- Диагностика и дифференциальная диагностика 4 Diagnosis and differential diagnosis
- Что можно и чего нельзя делать при обнаружении опухоли 5 What you can and cannot do when a tumor is detected
- Лечение без операции 6 Treatment without surgery
- Если таблетки не помогли: виды хирургии 7 If the pills did not help: types of surgery
- Миома матки и беременность 8 Uterine fibroids and pregnancy
- Возможно ли забеременеть после удаления миомы и через какой срок 8.1 Is it possible to get pregnant after the removal of fibroids and after what period
- Осложнения и последствия лечения 9 Complications and effects of treatment
- Профилактика 10 Prevention
- Видео про болезнь 11 Video about the disease
- Отзывы о лечении: 12 Treatment reviews:
What is uterine fibroids
Uterine fibroids (synonyms: leiomyoma, fibromyoma) is a round-shaped benign tumor that grows in the muscle layer of the uterus. Although fibroids consist of the same smooth muscle fibers as the walls of the organ (myometrium), it is much denser than the normal myometrium.
The disease code according to the international classification of diseases of the 10th revision (ICD-10), which was developed by the World Health Organization, consists of the Latin letter and the number D25 and stands for uterine leiomyoma.
Fibromyomas can vary greatly in size, shape, and location. Some of them are measured in millimeters and so small that even the doctor does not see them with the naked eye. Others grow to abnormal dimensions, sometimes reaching several kilograms. But the size of the majority of myomas is measured in centimeters; nevertheless, they are capable of influencing the shape of the uterus. Leiomyomas often appear in women of childbearing age - from 30 to 40 years, but can occur at different periods of a woman’s life.
Myomas rarely turn into malignant tumors, their presence does not mean that a woman is more likely to get cancer.
Until now, doctors do not know the exact causes of myomatosis, but clinical studies and practical experience indicate the influence of such factors:
- Genetic anomalies. Tumor cells exhibit changes in genes compared to healthy muscle tissue.
- The effect of hormones. Estrogen and progesterone, two hormones that stimulate the growth of the uterine lining (sealing the uterus) every month during the second half of the female cycle as preparation for pregnancy, presumably affect tumor growth. Fibroid smooth muscle cells have a higher number of estrogen and progesterone sensitive receptors than healthy uterine muscle cells. In support of this theory, it is known that benign tumors tend to shrink after menopause due to a decrease in the production of hormones.
- Other growth factors. Substances involved in the body's tissue metabolism, such as insulin-like growth factor, can provoke an increase in fibroma.
Doctors believe that leiomyomas develop from stem cells in the myometrium. One cell divides repeatedly, resulting in a hard, rubbery mass that is different from normal tissue.
The nature of the growth of formations is variable - it can be both slow and impetuous. Sometimes an increase in nodes is absent in principle. Some fibromyomas pass through growth spurts, while others can contract spontaneously. Many tumors that were diagnosed during pregnancy are reduced or resolved after delivery, as the uterus returns to normal size.
In addition to the reproductive age of a woman, there are few known risk factors for the onset of the disease. Fibroids may be affected by:
- Heredity. If the female line of the patient (mother or sister) had tumors, then she was initially an increased risk of their development.
- Race. Miomatosis is more common in dark-skinned women than in other racial groups. In addition, they have fibroids formed at a younger age, and there is probably a tendency to multiple or large formations.
- External factors:
- the onset of menstruation at an early age (up to 10 years);
- use of contraceptive drugs;
- vitamin D deficiency;
- the prevalence in the diet of red meat on the background of a small amount of green vegetables, fruits and dairy products;
- drinking alcohol, including beer.
It is believed that the presence of these predisposing factors increases the risk of developing fibroids.
In general, these tumors are quite common and occur in about 70–80% of all women by the time they reach 50 years of age. Most of the time, tumors do not cause symptoms or problems, and women do not feel their presence.
Classification and varieties
Types of myomas are classified based on their location in the uterus. The two most common types of leiomyoma are most commonly found: interstitial and subserous. The remaining species are rare.
- Interstitial (intermuscular) - the most common type (50-60% of all cases), when the nodes are located inside the myometrium.
- Subserous - ranks second in frequency of occurrence (from 25 to 35% of cases). New growths are located on the outer side of the uterus, leaving the abdominal cavity. They may have a stem-like base, a so-called knot on the stem.
- Submucous (submucosa) is a rare species (the frequency of diagnosis is about 13%), when the nodes are located under the inner mucous membrane of the uterus. Sometimes they seem to "hang" on a thin leg, dropping into the neck or vagina.
- Intraligamentary fibroids - a tumor grows into ligaments that fix female reproductive organs.
- Cervical fibroids are rarely diagnosed (no more than 5% of cases) when the growths grow in the vaginal part of the cervix. The peculiarity of this type is painful symptoms even with small sizes of nodes, impaired reproductive function, compression of surrounding organs and tissues.
Although uterine fibroids are usually not dangerous, they can cause discomfort and lead to complications, such as anemia (from large blood loss).
Symptoms and signs
Asymptomatic fibroids occur in half of all cases of the disease. When signs are still present, their location, size and number of nodes may influence their intensity. The most common symptoms of myomatosis are:
- Severe (painful) menstrual bleeding.
- Prolonged periods of more than a week.
- Feeling of pressure or pain in the pelvis.
- Frequent urination.
- The difficulty of emptying the bladder.
- Pain in the back or legs.
Occasionally, a tumor may cause acute pain. This happens when it “outgrows” its own blood supply and begins to die.
Signs indicating a woman to seek medical attention:
- Persistent pain in the pelvis.
- Excessively heavy, prolonged or painful menstruation.
- Blood smears or bleeding between periods.
- Difficulty in emptying the bladder.
Urgent medical intervention requires a situation where there is a strong vaginal bleeding or acute sudden pain in the pelvis.
Diagnostics and differential diagnostics
Myomatosis is often found by chance during a routine gynecological examination. The doctor palpatorno examines irregularities in the form of the uterus, indicating the presence of fibroids. Clarifying diagnostics, as a rule, is carried out with the help of such studies:
- Ultrasound (ultrasound) - examination, during which the doctor or nurse moves the ultrasound device (transducer) along the patient's stomach. Sometimes transvaginal ultrasound is necessary when an intravaginal sensor is used to obtain the desired image.
- Laboratory tests. For abnormal menstrual bleeding, the gynecologist will also prescribe blood tests:
- detailed - to determine if there is anemia due to chronic blood loss;
- clotting - to eliminate this cause of bleeding;
- for thyroid hormones - in order to differentiate thyroid problems.
If traditional ultrasound does not provide sufficient information, other imaging tests are prescribed, these include:
- Magnetic resonance imaging (MRI). This imaging method will show the size and location of the nodes, it can be used to determine different types of tumors and select the appropriate treatment.
- Ultrasonic hysterosonography, also called saline infusion sonography, the doctor uses sterile saline to expand the uterine cavity, which makes it easier to obtain images of submucosal myomas and endometrium.
- Hysterosalpingography is an x-ray method when a dye is used to isolate the uterus and fallopian tubes on x-rays. The method is also recommended for infertility of unknown etiology. In addition to identifying fibroids, it helps determine if the fallopian tubes are in good order.
- Hysteroscopy is a study with the help of a small illuminating telescope - a hysteroscope, which is inserted through the cervix. For a more effective assessment, the doctor introduces saline into the uterus, expanding its cavity.
What can and cannot be done when a tumor is detected
Myomatosis is a diagnosis that is most often given to young and active women in all spheres of life. In this connection, patients have legitimate questions, is it necessary to limit yourself in any kind of activity or leisure, for example, in sports, sex or exposure to the sun? Do these factors affect the further development of nodes, and if so, positively or negatively?
First of all, women should be aware of the importance of regular exercise. Abdominal, or visceral fat is associated with an increase in the production of estrogen. Increasing the level of these hormones can trigger the growth of nodes in the uterus. Exercise helps burn fat, eliminating obesity and reducing weight. A positive factor is that physical exertion helps the liver to dissipate excessive estrogen and improve hormonal balance. Sports exercise is an important factor in controlling the benign uterus and alleviating pain, because sport strengthens strength and promotes the release of endorphins, which increase the feeling of well-being.
Before embarking on any exercise, it is important to first enlist the support of the attending physician. The important point is the choice of exercises. Experts recommend to stay on low and medium intensity cardiovascular disease. Such activities are considered suitable:
- Walking is a great exercise — not too tense and extremely effective. You need to start slowly and carefully. Over time, you should gradually increase the distance and speed (pace). Walking can be alternated with jogging starting at 30 seconds.
- Swimming and aqua aerobics are cardio exercises in “weightlessness”, when water takes up most of the body weight, making movements more pleasant and gentle, but no less effective. Since you have to additionally overcome the resistance of water.
- Yoga - there are certain yoga poses that help relieve pain in the uterus and reduce congestion. Begin classes should be as careful as possible, after informing the instructor about your disease.
- Power loads are a form of physical activity aimed at improving muscle fitness. Exercise helps to strengthen muscles and tissues, gradually increasing the ability to resist through the use of free weights, exercise equipment or weight of your own body. As a result, the strength, aerobic endurance and skeletal muscles will strengthen, and also the weight will gradually go away, which will immediately reflect on the state of health and quality of life.
But not all physical activity is equally beneficial. It should be borne in mind that it is important to avoid exercises that have a direct effect on the lower abdomen or excessively increase intra-abdominal pressure. Sudden jerks can irritate and make fibroids painful. For example, the rotation of the hoop at the waist and the swing of the press - these are the types of exercises that necessarily exclude, in order not to get instead of wellness - the opposite effect.
It is known that fibroids are found in the uterus, not in the vagina. By themselves, they are not a contraindication to sexual intercourse. But their size and location can cause discomfort during sex. Large nodes sometimes create a feeling of pressure that interferes with sexual enjoyment. If the formations are located in the cervix or near it, they can cause not only pain, but also bleeding during sexual penetration, and this, in turn, constantly provokes a stressful situation. It is unlikely that someone will desire sex, if intercourse is painful. In addition, fibromyomas can create an imbalance between two important female hormones, estrogen and progesterone. This hormonal imbalance is also able to reduce libido.
Even very small fibroids can affect the estrogen / progesterone ratio. Decreased sexual desire can be an early sign of myomatosis.
In this case, it is necessary to contact a gynecologist with a problem, who will conduct the necessary examination and select treatment options. The disease is usually treated without serious surgical interventions, and the effect of tumors on the sex life of a woman can be successfully eliminated.
With this diagnosis, it is necessary to avoid warming up the pelvic region, including mechanical, with the use of massage oils and creams. Massage is a procedure with a warming effect, activating blood flow in the area of its implementation. Therefore, it is safe to massage any part of the body, except for the waist, lower abdomen and buttocks. In these places, rubbing and other manipulations with uterine myoma are completely unacceptable. Gynecological massage is also contraindicated.
Thermal overheating of the body in the abdomen should be excluded. This also applies to baths and saunas. It is not recommended even to receive hot baths, which can also harm. The same applies to prolonged exposure to the sun in the presence of fibroids: it is forbidden to sunbathe, including in the solarium. For the same reason, thermal physiotherapy is not possible.
There is no single best approach to the treatment of uterine myomas - there are many treatment options. If you have symptoms, talk with your doctor about options for alleviating the symptoms.
Treatment without surgery
Dynamic observation is the best medical tactic for those women whose symptoms of fibroids are absent or insignificant. Fibromyomas are not malignant. They rarely interfere with pregnancy, usually grow slowly or not at all and usually decrease after menopause when the level of reproductive hormones decreases. In general, the approach in each case is individual, based on a complex impact.
For drug therapy, medications that regulate the menstrual cycle are used, symptoms such as heavy menstrual bleeding and pelvic pressure are treated. They do not eliminate tumors, but can reduce them. For this purpose, apply:
- The sexual cycle blockers, or gonadotropin-releasing hormone agonists - Lupron (Lupron), Sinarel (Synarel), Lyukrin Depot, etc. These hormonal drugs treat fibromyoma, blocking the production of estrogen and progesterone, injecting the patient into a temporary postmenopausal state. As a result, menstruation stops and tumors shrink, anemia disappears. Sometimes they are prescribed to reduce the size of the nodes before the scheduled operation. Many women have significant flushes from blocker drugs, and long-term use can cause osteoporosis. Therefore, this group of drugs are usually used no more than three to six months. And the symptoms can return when medication is stopped.
- Progestin is a released intrauterine device, or an intrauterine hormonal system (HCV). HCV alleviates severe bleeding caused by fibroids, but does not directly reduce fibroids. Prevents pregnancy.
- TranECZAMIC ACID - LISTEDA. This non-hormonal medicine is taken to prevent excessive blood loss during heavy periods.
- Other medicines. The gynecologist may recommend other means. For example, oral contraceptives or progestins. They help control menstrual bleeding, but do not affect the size of the nodules.
- Non-steroidal anti-inflammatory drugs (NSAIDs), which are not hormonal agents, are effective for alleviating pain associated with fibroids, but do not reduce bleeding caused by the tumor.
The doctor may also recommend taking vitamins and iron for heavy menstrual bleeding and anemia.
Other non-invasive treatment
MRI-controlled focused ultrasound surgery (FUS - Focused ultrasound surgery) is a non-invasive treatment of uterine fibroids that does not require an incision and is done on an outpatient basis. During the procedure, the patient is inside an MRI scanner equipped with a high-power ultrasound transducer for treatment. On the computer screen, the doctor determines the exact location of uterine fibroids. The ultrasound transducer is sent to fibroids, heating and destroying small areas of nodular tissue.
Focused ultrasound surgery is one of the newest technologies. At the moment, scientists are still exploring its safety and effectiveness in the long term. But the data collected show positive results.
To date, there is no scientific evidence supporting the effectiveness of alternative therapies, such as dietary recommendations, magnetic therapy, herbal preparations, or homeopathy.
If the pills did not help: types of surgery
The absolute indications for surgical treatment are:
- fibroid size greater than the size of the uterus at 12-14 weeks of pregnancy;
- rapid growth of neoplasms (if the uterus enlarges a year before the size of a 4–5 week gestation).
Other cases of the need for surgery are discussed by the patient with the doctor individually.
Minimally invasive procedures
Some tumor-destroying procedures are performed through minimally invasive intervention - without any incisions. Local or general anesthesia is used.
- Uterine artery embolization. In the arteries supplying the blood, small particles of a special polymer or gelatin (embolic agents) are injected through a thin catheter, selectively blocking the blood flow to the myomas, causing them to wrinkle and die. This method is effective in node degeneration, when the tumor is naturally damaged from malnutrition. At the same time, the total blood supply to the uterus does not suffer, so a healthy myometrium has an extensive arterial network feeding the uterus, in addition to the main source, the uterine arteries.
- Myolysis This is a laparoscopic procedure for the destruction of fibroids and the overlap of the vessels supplying them with:
- electric current;
- laser radiation;
- radio waves;
- liquid nitrogen (cryomiolysis).
- Laparoscopic (robotic) myomectomy. The procedure is relevant with a small number of nodes. During it, the surgeon removes the fibroids, leaving the uterus in place. For laparoscopy, use long thin instruments inserted through small holes in the abdomen. The doctor sees the patient's abdominal cavity on the screen, where the image is displayed using a miniature camera attached to one of the tools. Fibroids are removed through the same small incisions, breaking them into smaller pieces (morcellation), or one of the incisions is expanded to remove solid myomas. Robotic myomectomy gives the surgeon an increased three-dimensional view of the patient's uterus, which allows the procedure to be performed with higher accuracy, flexibility and dexterity than is available with other methods.
- Hysteroscopic myomectomy. The procedure is suitable for the removal of submucosal nodes. The surgeon removes fibroids using instruments inserted through the vagina and cervix.
- Ablation of the endometrium. The destruction of the inner mucous layer of the uterus (endometrium) with the help of a special tool inserted into the uterus through the vagina, and the physical effects of heat or cold, in the form of:
- hot inputs;
- weak electric current;
- liquid nitrogen;
- microwave energy.
Morcellation - the process of destruction of the fibroids into smaller pieces - can increase the risk of spreading a malignant tumor, if a previously not diagnosed oncological mass is frozen during myomectomy.
As a rule, endometrial ablation is effective in stopping abnormal bleeding. Submucosal fibroids can be removed during hysteroscopy before ablation of the endometrium, but the procedure does not help remove fibroids outside the uterine lining.
Variants of traditional surgical procedures include:
- Abdominal (abdominal) myomectomy - removal of fibroids through an open incision with preservation of the uterus. For multiple myomas, very large or deep-seated nodes, open surgery is necessary. In many cases, when it seems that the removal of the uterus is the only option, abdominal myomectomy is possible. However, postoperative scars can affect the future possibility of childbearing.
- Hysterectomy - removal of the uterus - remains the only proven way to permanently get rid of myomatosis. But hysterectomy is a serious operation that stops the ability to reproduce offspring. And if you simultaneously remove the ovaries, it will lead to menopause and the issue of hormone replacement therapy.
Uterine fibroids and pregnancy
Of course, a woman with uterine myoma is able to conceive and have children, and there are quite a few such cases, much depends on the localization of the nodes, their number. However, it is important to understand that myomatosis (especially submucosal) reduces the likelihood of conception and is often associated with infertility. The main reason for the appearance of difficulties lies not so much in the tumor itself, as in hormonal disorders leading to myomas.
With fairly large dimensions of fibroids during pregnancy, the risk of complications increases, such as:
- placental abruption and miscarriage in the early period;
- premature birth of a premature baby.
A scientific study of the influence of uterine fibroids on the prenatal development of a child has shown that this benign neoplasm often does not interfere with the healthy formation of the baby, and a woman can give birth naturally.
During childbirth, knots may grow, but this is not at all necessary. According to doctors, the growth of fibroids in this case is caused not so much by hormonal surges, as by activating the blood supply to the uterus, which is characteristic of pregnancy. As a result, doctors are sometimes forced to remove the uterus during a cesarean section. And often it is necessary to resort to artificial delivery in the presence of even small formations.
Many women with uterine myoma become pregnant and produce healthy babies. Often, during pregnancy, the fibroids are safely resolved or eliminated by caesarean section, so the woman says goodbye to this problem.
Is it possible to get pregnant after the removal of fibroids and after what period
Endometrial hysterectomy and ablation are the only two treatment options that are excluded for women who want to maintain their ability to become pregnant. The procedure of choice is usually myomectomy. However, all treatments have their pros and cons. It is necessary to discuss them in detail with your doctor.
With regards to planning pregnancy after myomectomy, a lot depends on the nature of the tumor and the size of the scar. The recovery period after surgery lasts about a year and, most often, then you can plan a pregnancy. At the same time, constant monitoring of the condition of the scar and the correct choice of the method of labor is very important. Women who have undergone myomectomy are often shown cesarean section.
Complications and effects of treatment
After all procedures, except for hysterectomy, tiny tumors that were not detected by the doctor during the operation can further grow and cause a relapse of the disease. And also remains the likelihood of the development of new fibroids of various sizes and localization.
Unfortunately, there is no way to prevent the development of myomatosis. But some worldly habits, according to research, reduce the risk of tumors. To preventive measures include:
- low-sugar diet;
- regular exercise;
- eating fresh fruits and cruciferous vegetables, such as arugula, broccoli, cabbage (cauliflower and leafy), turnip greens.
Cruciferous vegetables are rich in beta-carotene, folic acid, vitamins C, E and K and other minerals, as well as dietary fiber.
Video about the disease
Hello girls! In June 2011, I had an ultrasound scan of multiple uterine myoma (sub-serous and interstitial nodes). The doctor diagnosed infertility and sent for surgery. Total nodes were 6 pcs. The largest is about 5 cm. Two is about 3 cm., The rest is about 2 cm. My husband and I didn’t have children, we decided on them only when I was 31 years old, and I, as a smart one, decided to check everything myself and my husband, and only then begin the work of conception. :-) 🙂 so I checked it. Of course, having learned about such a diagnosis, I was shocked. Moreover, they immediately told me that it’s not a fact that after such a myomectomy I can become pregnant and give birth. I will not say how I was thinking and studied the Internet ... but in October 2012 I had my little daughter in parallel, I had a cesarean with myomectomy and removed 5 nodes, one of which by that time reached 6 cm and 4 pieces about 3 see each. I want to say that my pregnancy proceeded without any problems, even the tone was never. True, my gynecologist Martynova Nina Karlovna (head of the miscarriage department) assigned me to save three times. Exterminate a good adequate doctor and he will help you.
Girls, I have long been convinced that state medicine is not interested in our treatment. I was 34 years old, my husband and I had an 8-year-old son, but I wanted another child. I noticed that I had a very heavy menstruation, I realized that I had to go to the doctor. And the doctor said that you can no longer dream of children, they say you have a “hindrance, you need to cut everything down by the root”. It did not suit me, I am a fighting woman, I began to look for information about alternative methods of treatment. Stumbled upon EMA. Read, evaluated and decided on the operation. It is said that uterine artery embolization is a crippling procedure. Girls, do not believe it! After the operation, I feel great, and our son got a pretty little sister Anya.
I found my fibroids in a little over 30 years. Also, of course, at first small, was observed. Myoma gradually grew, grew to 7–8 weeks of gestation, it also seemed to be tolerable. No treatment was offered. As for oral contraceptives - I took them for two years, of course there was no use for anything. And two years later, I was found the second myoma - a huge, 10 cm, grew over these one and a half years, that I was not a doctor. As a result, two fibroids, the uterus is increased to 18 weeks of pregnancy. Strong bleeding, hemoglobin nezky, big belly ... The result - an operation to remove the uterus, but I was 44 years old, have a child, was not going to give birth. My advice to you is to have children if you are planning, then it can be very problematic. I know girls who have been treating these fibroids for years, spend a lot of money, everything is useless. But now, already three years, I do not enjoy life - no problems, bleeding, pain, anxiety. Only advantages, well-being is excellent. The appendages are in place, so the hormones are fine. In an intimate life there is no difference. I tell you all this quite seriously. Myoma is such a thing, I do not know anyone who would cure it, just a divorce for money.
Although fibromyoma is a benign tumor, it can cause a number of serious symptoms and disorders depending on the size, location and proximity to other pelvic organs. Today, both surgical and conservative treatment options are available, which makes it possible to prevent a decline in the quality of life of patients.