Treatment of multiple uterine fibroids. About methods of treating multiple uterine fibroids Treatment of multiple fibroids

The detection of 2 or more fibroids in different parts of the uterine wall is considered to be a prognostically unfavorable variant of the disease. Multiple uterine fibroids may be a reason for surgery, especially if the size of the tumor rapidly increases or if there is uterine bleeding. Timely diagnosis and drug treatment will help preserve the reproductive organ, but the likelihood of having the uterus removed will still remain.

Multiple fibroids - what is it?

Nodules in the muscle wall of the female reproductive organ can be single or multiple. Multiple fibroids are more than 2 benign myomatous nodes that are found in any part of the uterus. Pathology is one of the common variants of the course of the disease, but with small nodes, the woman will not always have complaints and symptoms. The first manifestations of multiple fibroids occur with the rapid growth of one of the nodes or with a general significant increase in the size of the uterus. If the pathology is asymptomatic, the doctor can identify the problem during an annual preventive examination.

Node location options

With fibroids, multiple nodes are most often found in the thickness of the uterine wall. The following localizations of fibroids are distinguished:

interstitial fibroids (in the wall of the uterus);
broad-based subserous fibroids;
intramural fibroids with centripetal growth;
isthmus.
submucosal and subserous fibroids on a thin stalk;
intraligamentary fibroids (interligamentous).

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The main symptoms of multiple fibroids

Many small interstitial nodules extremely rarely present with symptoms, and, in the vast majority of cases, become an incidental finding during ultrasound scanning. Multiple large fibroids always manifest themselves with the following symptoms:

pain syndrome (with the total size of the uterus more than 12 weeks of pregnancy, a painless course of the disease is very rare);
heavy menstruation, turning into bleeding and spotting during the intermenstrual period;
lack of desired conception;
inability to safely carry a fetus to term (miscarriage or premature birth);
problems with the bladder (difficulty urinating due to compression by a knot);
difficulties with defecation (constipation) caused by the pressure of the node on the rectum;
pain in the lower back similar to radiculitis (compression of the nodes of the radicular nerves in the sacral area);
varicose veins of the small pelvis.

Most often, 1–2 symptoms predominate, which is associated with the location and size of specific fibroids. In each specific case, the manifestations of the disease are individual - if fibroids are suspected, the doctor will refer you for examination.

Diagnostic methods

The basis of a quick and effective examination is transvaginal ultrasound scanning. The ultrasound doctor will detect all myomatous nodes measuring 5 mm or more on the monitor screen. If necessary and according to indications, the following studies are carried out:

Doppler ultrasound to assess blood flow in the uterine nodes;
MRI with contrast;
hysteroscopy;
laparoscopy;
aspiration of the endometrium to exclude oncopathology;
colposcopy.

Carrying out a standard examination scheme helps to make an accurate diagnosis and choose the optimal method of treatment for multiple uterine fibroids.

Treatment tactics for multiple fibroids

The choice of treatment tactics for multiple uterine fibroids is influenced by the following factors:

woman's age;
potential desire to conceive and bear a baby in the near future;
presence of symptoms - bleeding and severe pain;
overall size of the uterus;
suspicion of cancer.

With multiple uterine fibroids, treatment depends on the symptoms - when a woman cannot be relieved of the problem with medications, the doctor will suggest surgical intervention. The most commonly used types of operations are:

embolization of uterine vessels to reduce the size of nodes;
laparoscopy with removal of the subserous node;
hysteroresectoscopy for submucosal localization;
conservative myomectomy of a large node;
hysterectomy (subtotal or total) if it is impossible to use organ-preserving techniques.

Drug treatments are ineffective, and traditional methods are unacceptable: multiple uterine fibroids are optimally treated with surgical methods. Medicines are used at the stage of preoperative preparation, when it is necessary to reduce the size of fibroids. With minimal suspicion of malignant degeneration, one should not waste time on medications - confirmation of this fear is an indication for hysterectomy.

Treating
doctors

Our center employs the most experienced and qualified personnel in the region

Attentive
and experienced staff

Zhumanova Ekaterina Nikolaevna

Head of the Center for Gynecology, Reproductive and Aesthetic Medicine, Candidate of Medical Sciences, doctor of the highest category, Associate Professor of the Department of Regenerative Medicine and Biomedical Technologies of Moscow State Medical University named after A.I. Evdokimova, board member of the Association of Aesthetic Gynecologists ASEG.

Graduated from the Moscow Medical Academy named after I.M. Sechenova, has a diploma with honors, completed clinical residency at the Clinic of Obstetrics and Gynecology named after. V.F. Snegirev MMA named after. THEM. Sechenov.
Until 2009, she worked at the Clinic of Obstetrics and Gynecology as an assistant at the Department of Obstetrics and Gynecology No. 1 of the MMA named after. THEM. Sechenov.
From 2009 to 2017 she worked at the Federal State Institution “Treatment and Rehabilitation Center” of the Ministry of Health of the Russian Federation
Since 2017, he has been working at the Center for Gynecology, Reproductive and Aesthetic Medicine of Medsi Group of Companies JSC.
She defended her dissertation for the degree of Candidate of Medical Sciences on the topic: “Opportunistic bacterial infections and pregnancy”

Myshenkova Svetlana Aleksandrovna

Obstetrician-gynecologist, candidate of medical sciences, doctor of the highest category

In 2001 she graduated from the Moscow State Medical and Dental University (MGMSU)
In 2003, she completed a course of study in the specialty “obstetrics and gynecology” at the Scientific Center for Obstetrics, Gynecology and Perinatology of the Russian Academy of Medical Sciences
He has a certificate in endoscopic surgery, a certificate in ultrasound diagnostics of pathologies of pregnancy, fetus, newborn, in ultrasound diagnostics in gynecology, a certificate of a specialist in the field of laser medicine. He successfully applies all the knowledge acquired during theoretical classes in his daily practice.
She has published more than 40 works on the treatment of uterine fibroids, including in the journals “Medical Bulletin” and “Problems of Reproduction”. He is a co-author of methodological recommendations for students and doctors.

Kolgaeva Dagmara Isaevna

Head of pelvic floor surgery. Member of the scientific committee of the association for aesthetic gynecology.

Graduated from the First Moscow State Medical University named after. THEM. Sechenov, has a diploma with honors
She completed clinical residency in the specialty “obstetrics and gynecology” at the Department of Obstetrics and Gynecology No. 1 of the First Moscow State Medical University. THEM. Sechenov
Has certificates: obstetrician-gynecologist, specialist in laser medicine, specialist in intimate contouring
The dissertation is devoted to the surgical treatment of genital prolapse complicated by enterocele
The sphere of practical interests of Dagmara Isaevna Kolgaeva includes:
conservative and surgical methods of treating prolapse of the walls of the vagina, uterus, urinary incontinence, including the use of high-tech modern laser equipment

Maksimov Artem Igorevich

Obstetrician-gynecologist of the highest category

Graduated from Ryazan State Medical University named after academician I.P. Pavlova with a degree in general medicine
Completed clinical residency in the specialty “obstetrics and gynecology” at the Department of Obstetrics and Gynecology Clinic named after. V.F. Snegirev MMA named after. THEM. Sechenov
Proficient in a full range of surgical interventions for gynecological diseases, including laparoscopic, open and vaginal access
The scope of practical interests includes: laparoscopic minimally invasive surgical interventions, including single-puncture access; laparoscopic operations for uterine fibroids (myomectomy, hysterectomy), adenomyosis, widespread infiltrative endometriosis

Pritula Irina Alexandrovna

Obstetrician-gynecologist

Graduated from the First Moscow State Medical University named after. THEM. Sechenov.
She completed clinical residency in the specialty “obstetrics and gynecology” at the Department of Obstetrics and Gynecology No. 1 of the First Moscow State Medical University. THEM. Sechenov.
She is certified as an obstetrician-gynecologist.
Possesses the skills of surgical treatment of gynecological diseases on an outpatient basis.
He is a regular participant in scientific and practical conferences on obstetrics and gynecology.
The scope of practical skills includes minimally invasive surgery (hysteroscopy, laser polypectomy, hysteroresectoscopy) - Diagnosis and treatment of intrauterine pathology, cervical pathology

Muravlev Alexey Ivanovich

Obstetrician-gynecologist, gynecological oncologist

In 2013 he graduated from the First Moscow State Medical University named after. THEM. Sechenov.
From 2013 to 2015, he completed clinical residency in the specialty “Obstetrics and Gynecology” at the Department of Obstetrics and Gynecology No. 1 of the First Moscow State Medical University named after. THEM. Sechenov.
In 2016, he underwent professional retraining at the State Budgetary Institution of Healthcare of the Moscow Region MONIKI named after. M.F. Vladimirsky, specializing in Oncology.
From 2015 to 2017, he worked at the Federal State Institution “Treatment and Rehabilitation Center” of the Ministry of Health of the Russian Federation.
Since 2017, he has been working at the Center for Gynecology, Reproductive and Aesthetic Medicine of Medsi Group of Companies JSC.

Mishukova Elena Igorevna

Obstetrician-gynecologist

Doctor Mishukova Elena Igorevna graduated with honors from the Chita State Medical Academy with a degree in general medicine. She completed clinical internship and residency in the specialty “obstetrics and gynecology” at the Department of Obstetrics and Gynecology No. 1 of the First Moscow State Medical University. THEM. Sechenov.
Mishukova Elena Igorevna has a full range of surgical interventions for gynecological diseases, including laparoscopic, open and vaginal access. He is a specialist in providing emergency gynecological care for diseases such as ectopic pregnancy, ovarian apoplexy, necrosis of myomatous nodes, acute salpingoophoritis, etc.
Mishukova Elena Igorevna is an annual participant in Russian and international congresses and scientific and practical conferences on obstetrics and gynecology.

Rumyantseva Yana Sergeevna

Obstetrician-gynecologist of the first qualification category.

Graduated from the Moscow Medical Academy named after. THEM. Sechenov with a degree in general medicine. She completed clinical residency in the specialty “obstetrics and gynecology” at the Department of Obstetrics and Gynecology No. 1 of the First Moscow State Medical University named after. THEM. Sechenov.
The dissertation is devoted to the topic of organ-preserving treatment of adenomyosis using FUS ablation. He has a certificate as an obstetrician-gynecologist and a certificate in ultrasound diagnostics. Proficient in the full range of surgical interventions in gynecology: laparoscopic, open and vaginal approaches. He is a specialist in providing emergency gynecological care for diseases such as ectopic pregnancy, ovarian apoplexy, necrosis of myomatous nodes, acute salpingoophoritis, etc.
Author of a number of published works, co-author of a methodological guide for doctors on organ-preserving treatment of adenomyosis using FUS ablation. Participant of scientific and practical conferences on obstetrics and gynecology.

Gushchina Marina Yurievna

Gynecologist-endocrinologist, head of outpatient care. Obstetrician-gynecologist, reproductive specialist. Ultrasound diagnostics doctor.

Gushchina Marina Yurievna graduated from Saratov State Medical University. V.I. Razumovsky, has a diploma with honors. She was awarded a diploma from the Saratov Regional Duma for excellent achievements in studies and scientific activities, recognized as the best graduate of Saratov State Medical University named after. V. I. Razumovsky.
She completed a clinical internship in the specialty “obstetrics and gynecology” at the Department of Obstetrics and Gynecology No. 1 of the First Moscow State Medical University. THEM. Sechenov.
He is certified as an obstetrician-gynecologist; ultrasound diagnostics doctor, specialist in laser medicine, colposcopy, endocrinological gynecology. She has repeatedly completed advanced training courses in “Reproductive Medicine and Surgery” and “Ultrasonic Diagnostics in Obstetrics and Gynecology.”
The dissertation work is devoted to new approaches to differential diagnosis and management tactics for patients with chronic cervicitis and early stages of HPV-associated diseases.
Proficient in the full range of minor surgical interventions in gynecology, performed both on an outpatient basis (radiocoagulation and laser coagulation of erosions, hysterosalpingography) and in a hospital setting (hysteroscopy, cervical biopsy, cervical conization, etc.)
Gushchina Marina Yurievna has more than 20 scientific published works, is a regular participant in scientific and practical conferences, congresses and conventions on obstetrics and gynecology.

Malysheva Yana Romanovna

Obstetrician-gynecologist, gynecologist for children and adolescents

Graduated from the Russian National Research Medical University. N.I. Pirogov, has a diploma with honors. She completed clinical residency in the specialty “obstetrics and gynecology” at the Department of Obstetrics and Gynecology No. 1 of the Faculty of Medicine of the First Moscow State Medical University. THEM. Sechenov.
She completed clinical residency in the specialty “Ultrasound Diagnostics” at the Research Institute of Emergency Medicine named after. N.V. Sklifosovsky
Has a Certificate from the FMF Fetal Medicine Foundation confirming compliance with international requirements for 1st trimester screening, 2018. (FMF)

Proficient in ultrasound examination techniques:

Abdominal organs
Kidney, retroperitoneum
Bladder
Thyroid gland
Mammary glands
Soft tissues and lymph nodes
Pelvic organs in women
Pelvic organs in men
Vessels of the upper and lower extremities
Vessels of the brachiocephalic trunk
In the 1st, 2nd, 3rd trimester of pregnancy with Doppler ultrasound, including 3D and 4D ultrasound

Kruglova Victoria Petrovna

Obstetrician-gynecologist, gynecologist for children and adolescents.

Victoria Petrovna Kruglova graduated from the Federal State Autonomous Educational Institution of Higher Education "Russian Peoples' Friendship University" (RUDN).
She completed clinical residency in the specialty “Obstetrics and Gynecology” on the basis of the department of the Federal State Budgetary Educational Institution of Additional Professional Education “Institute for Advanced Training of the Federal Medical and Biological Agency.”
He has certificates: obstetrician-gynecologist, specialist in the field of colposcopy, non-operative and operative gynecology of children and adolescents.

Baranovskaya Yulia Petrovna

Ultrasound diagnostics doctor, obstetrician-gynecologist, candidate of medical sciences

Graduated from the Ivanovo State Medical Academy with a degree in general medicine.
She completed an internship at the Ivanovo State Medical Academy, a clinical residency at the Ivanovo Research Institute named after. V.N. Gorodkova.
In 2013, she defended her thesis on the topic “Clinical and immunological factors in the formation of placental insufficiency” and was awarded the academic degree “Candidate of Medical Sciences.”
Author of 8 articles
Has certificates: ultrasound diagnostics doctor, obstetrician-gynecologist.

Nosaeva Inna Vladimirovna

Obstetrician-gynecologist

Graduated from Saratov State Medical University named after V.I. Razumovsky
Completed an internship at the Tambov Regional Clinical Hospital, specializing in obstetrics and gynecology.
He is certified as an obstetrician-gynecologist; ultrasound diagnostics doctor; specialist in the field of colposcopy and treatment of cervical pathology, endocrinological gynecology.
Repeatedly took advanced training courses in the specialty “obstetrics and gynecology”, “Ultrasonic diagnostics in obstetrics and gynecology”, “Fundamentals of endoscopy in gynecology”
Proficient in the full range of surgical interventions on the pelvic organs, performed by laparotomy, laparoscopic and vaginal approaches.

Myoma is a benign tumor that grows from connective tissue on the walls or in the uterine cavity. The incidence rate by age 35 is 35-45% among the entire female population. The peak incidence occurs in the age group of 35-50 years.

Uterine fibroids can range in size from a small nodule to a tumor weighing about a kilogram, when it is easily identified by palpation of the abdomen. Signs of the disease may not appear immediately. The more advanced it is, the more difficult the treatment and the greater the likelihood of complications.

Let's take a closer look at what kind of disease this is, what its characteristic signs and symptoms are, and what is prescribed as treatment for a woman.

Myoma: what kind of disease is it?

Uterine fibroids (fibromyoma, leiomyoma) are the most common benign tumor of the uterus, hormonal-dependent (develops with an increased content of female sex hormones estrogen).

Myoma certainly has signs of a tumor, but it also differs from it, so it is more correct to correlate it with tumor-like formations. Despite its benign nature, fibroids can cause a lot of trouble, including uterine bleeding and complications during pregnancy, so treatment must be approached responsibly.

The occurrence of uterine fibroids usually occurs in her body, but in rare cases it can also occur in the cervix. Fibroids that develop in muscle tissue are considered typical, while those that form in the neck or ligaments are considered an atypical form of the disease.

The myomatous node begins its development from a growth zone located around a thin-walled blood vessel. In size, such growth can range from several millimeters to several centimeters; most often in women, multiple fibroids occur when several tumors form at once.

Causes

Myoma ranks 2nd in the structure of gynecological diseases. Its frequency in reproductive age averages 16%-20% of cases, and in premenopausal age it reaches 30-35%.

Myoma appears as a result of mutation of a single cell. Its further division and development of the tumor is influenced by changes in hormonal levels in the body, a violation of the ratio of estrogen and progesterone. When the production of female sex hormones decreases, the tumor may disappear on its own.

The following reasons lead to uterine fibroids:

Hormonal disorders are a sharp decrease or increase in the level of estrogens, which are clinically manifested by various menstrual disorders.
Irregularity of sexual activity, especially after 25 years. As a result of sexual dissatisfaction, blood flow in the pelvis changes, and stagnation prevails.
Disturbance in the production of sex hormones in ovarian diseases
Prolonged stress, heavy physical work
The presence of chronic infectious diseases, such as chronic pyelonephritis, chronic tonsillitis, etc.
Diseases of the endocrine glands: thyroid, adrenal glands, etc.
Disorders of fat metabolism in the body (obesity).
Mechanical damage, difficult childbirth with ruptures, abortions, complications after surgery, consequences of curettage.
Hereditary factor. The risk of developing fibroids increases significantly in those women whose grandmothers and mothers had such a tumor.

It has been proven that women who have given birth are less likely to develop nodes. Often this tumor can appear during pregnancy. Especially if the first pregnancy is late.

Classification

I have several classifications of such formations. According to the number of nodes, uterine fibroids can be of the following types:

Single;
Multiple.

According to the sizes there are:

Large;
Average;
Small myomatous neoplasms.

Depending on the size of the myomatous nodes, which are compared with the duration of pregnancy, there are

small fibroids (5-6 weeks),
medium (7-11 weeks),
large sizes (over 12 weeks).

Depending on the size and location of the nodes, there are 3 types of uterine fibroids:

leiomyoma - consist of smooth muscle tissue;
fibroma - consists of connective tissue;
fibroids - consists of connective and muscle tissue.

Based on their location relative to the muscle layer – the myometrium – fibroids are classified as follows:

Interstitial uterine fibroids

It is located in the center of the myometrium, i.e. muscular layer of the uterus. It is characterized by large sizes. It is completely located in the thickness of the muscular layer of the uterine wall (occurs in 60% of all cases of the disease).

Submucosal fibroid

What it is? Submucosal or submucosal - grows in the direction of the endometrium. If such a node is partially (more than 1/3) located in the myometrium, it is called intermuscular with centripetal growth (towards the uterine cavity). It may also have a stem or a wide base. Pedicled fibroids can sometimes “fall out” of the cervical canal, becoming twisted and infected.

Subserosal

Subperitoneal (or subserous) - the node is located under the mucous membrane of the outer layer of the uterus, near the peritoneum. Subserous fibroids are divided into the following types:

"Type 0". A knot on a wide base is 0-A, a knot on a leg is 0-B.
"Type 1". Most of the node is located in the serous membrane.
"Type 2". Most of the tumor is located in the thickness of the myometrium.

Stages

There are three stages of fibroid morphogenesis:

Formation of the rudiment (active growth zone) in the myometrium.
Growth of an undifferentiated tumor.
Growth and maturation of a tumor with differentiated elements.

The rate of development of myomatous nodes depends on many factors:

The presence of chronic gynecological pathologies;
Long-term use of hormonal contraceptives;
Having had a large number of abortions in the past;
Prolonged ultraviolet irradiation;
Absence of childbirth and lactation in women after 30.

With the rapid growth of a myomatous tumor, a woman observes menorrhagic changes (excessive bleeding during menstruation), anemic signs, and hyperplastic tissue changes occur in the uterus.

An increase in tumor size does not always occur unambiguously, so the following is distinguished:

Simple. Slowly growing and asymptomatic uterine fibroids of small size, often single. Often simple fibroids are diagnosed accidentally.
Proliferating. It grows quickly and provokes clinical manifestations. Diagnosed as multiple uterine fibroids or single large ones.

It is usually recommended to treat fibroid nodes in young women, especially if the tumors are bothersome or interfere with pregnancy. Depending on the location of the node and its size, the doctor may first prescribe conservative therapy - taking medications, and if there is no effect, surgery.

The first signs in a woman

A fibroid can only be recognized when it has reached a sufficiently large size. As uterine fibroids grow, the first signs may appear:

The appearance of sharp pain of a cramping nature not associated with menstruation in the lower abdomen;
long, heavy and irregular menstruation;
constipation;
bleeding;
frequent urination;
heaviness and constant pain in the lower abdomen;
bleeding during sexual intercourse;
lower back pain;
abdominal enlargement not associated with significant weight gain;
frequent miscarriages.

All these signs may be present with other gynecological problems. Therefore, they are not enough to make a diagnosis. The presence of a tumor can only be confirmed by a thorough examination and ultrasound.

Symptoms of uterine fibroids

Often, uterine fibroids do not give any symptoms and are found during a routine examination by a gynecologist. Or it happens that the symptoms are quite smoothed out and are often perceived as a variant of the norm.

The growth of uterine fibroids is accompanied by the appearance of symptoms, the most common of which are:

Pain during the intermenstrual period, varying in duration, arising in the lower abdomen, sometimes extending to the lumbar region, upper abdomen or legs;
Menorrhagia is an increase in menstrual flow. Heavy bleeding is dangerous because after some time it can result. More heavy bleeding indicates that the muscles of the uterus are contracting less well, in which case medical attention is required.
Pelvic organ dysfunction, which are manifested by frequent urge to urinate and constipation. These symptoms occur when the nodes are subserosal, cervical or interligamentous, as well as when the tumor volume is large.
Feeling of heaviness increases, the presence of something foreign in the stomach. Sexual intercourse becomes painful (if the nodes are located on the vaginal side). The belly grows, as during pregnancy. A sprain increases the nagging pain in the abdomen.
Miscarriage, infertility - occur in 30% of women with multiple fibroids.

In the photo below, you can see the fibroid from different sides:

It is impossible to independently determine whether you have the disease. If the above symptoms and signs of uterine fibroids appear, you should definitely undergo an examination by a gynecologist. These signs can also be accompanied by more dangerous diseases, such as uterine or ovarian cancer, endometriosis.

	Symptoms in a woman
For submucosal	manifested by various menstrual cycle disorders, heavy and prolonged menstruation, uterine bleeding, which often results in anemia. Pain syndrome is not typical for such fibroids, but if the myomatous node falls from the submucosal layer into the uterine cavity, cramping, very intense pain occurs.
With intramural	appears in the middle layer of muscle tissue of the uterus and is accompanied by cycle disturbances and pain in the pelvic area
For subserous	It often occurs without symptoms, so the pain is minor and appears rarely: pain in the lower back, back pain, as well as urination problems and constipation.

Complications

Uterine fibroids pose a danger to a woman’s health in terms of the development of complications of the disease. With regular monitoring by a gynecologist and careful attention to her health, a woman can significantly reduce the risk of complications.

Complications of uterine fibroids:

necrosis of myomatous node;
birth of a submucosal node;
posthemorrhagic anemia;
tumor malignancy;
infertility;
miscarriage;
postpartum hemorrhage;
hyperplastic processes of the endometrium.

In order to avoid complications, you should begin treating fibroids in a timely manner (immediately after detection). Surgical intervention is rarely required and is more often associated with existing complications of the disease.

Fibroids and pregnancy

Uterine fibroids are found in 8% of pregnant women undergoing pregnancy monitoring. For most women, during pregnancy the size remains unchanged or decreases.

Danger:

development of fetoplacental insufficiency (changes in the structural and functional properties of the placenta, which can lead to impaired fetal development);
threat of miscarriage at various stages.

Most often, women with uterine fibroids are offered to give birth by cesarean section due to the risk of various complications, such as:

untimely discharge of amniotic fluid (this occurs due to increased tone of the muscular layer of the uterus or improper positioning of the fetus);
risk of heavy postpartum bleeding;
risk of premature placental abruption (most often this occurs if the fibroid is located behind the placenta).

During a cesarean section, a woman may have the tumor removed immediately so that she can plan another pregnancy in the future.

Diagnostics

The first signs of fibroids are very similar to the symptoms of other gynecological pathologies. Therefore, to make a correct diagnosis, it is necessary to conduct a series of laboratory instrumental studies. Only a correct and timely diagnosis can guarantee successful treatment and a speedy recovery.

Diagnostics include:

Gynecological examination. It is carried out on a gynecological chair using the necessary instruments. The size of the uterine body, the location of the ovaries, the shape and mobility of the cervix, etc. are taken into account;
Ultrasound of the pelvic organs using a vaginal probe. For better visualization, the study is performed with a full bladder. The method is highly informative and allows you to identify the size of the tumor and its shape;
Laparoscopy - used only when myoma cannot be distinguished from an ovarian tumor;
Hysteroscopy is an examination of the cavity and walls of the uterus using an optical hysterocope. Hysteroscopy is performed for both diagnostic and therapeutic purposes: identification and removal of uterine fibroids in certain locations.
Biopsy. In some cases, during hysteroscopy or laparoscopy, a small sample of tissue is taken, which is then examined in more detail under a microscope.
Diagnostic curettage of the uterine cavity: indicated for all identified uterine fibroids in order to establish endometrial pathology and exclude uterine cancer.

How to treat uterine fibroids?

How to treat uterine fibroids? The main goal of treating fibroids is to eliminate the cause of the disease and the harmful effects of the tumor on the surrounding tissue of the uterus, reduce its size, and stop growth. Both medical and surgical methods are used.

As a rule, treatment tactics are chosen depending on the size, location and clinical and morphological variant of the tumor, the hormonal status of the patient, the state of her reproductive systems, etc. Some experts believe that there is no need to rush into surgery, but it is wiser to monitor the woman’s health before the onset of menopause.

Unfortunately, conservative treatment of fibroids 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);
asymptomatic course;
the patient’s desire to preserve the uterus and, accordingly, reproductive function;
inertial or subserous arrangement of nodes having an exceptionally wide base.

With a confirmed diagnosis of uterine fibroids, the following groups of drugs are used:

Combined oral contraceptives containing desogestrel and ethinyl estradiol. These medications help suppress and alleviate the first symptoms of fibroids in women. However, drugs in this group do not always help to reduce tumors, so they are used only when the size of the node does not exceed 1.5 cm.
Androgen derivatives: Danazol, Gestrinone. The action of this group is based on the fact that androgens suppress the synthesis of ovarian steroid hormones. As a result, the size of the tumor decreases. Use for up to 8 months continuously.
Antiprogestogens. Helps stop tumor growth. Treatment can last up to six months. The most famous drug in this group is Mifepristone;
Antigonadotropins (Gestrinone)– prevent an increase in the size of uterine fibroids, but do not help reduce existing sizes.

FUS ablation. One of the modern ways to combat fibroids. In this case, the tumor is destroyed by ultrasound under the control of a magnetic resonance imaging scanner.

A woman receiving conservative treatment for uterine fibroids should be examined at least once every 6 months.

A set of recommendations has been developed for such patients:

It is strictly forbidden to lift heavy objects, which can lead to prolapse of the uterine body and other complications;
Stress that negatively affects hormonal levels is unacceptable;
Increase the consumption of fruits, berries, herbs, vegetables, as well as fish and seafood;
Walk more often (this helps improve blood flow);
Avoid sports that place stress on the abdominal muscles (you can do free swimming and yoga);
It is also worth noting that patients with diagnosed fibroids should avoid exposure to heat. This means that you need to give up long sunbathing, visiting the bathhouse, sauna and solarium, as well as hot showers.
Undergo restorative treatment with vitamins 4 times a year (select the complex together with your doctor).

Surgical treatment: surgery

Mandatory indications for invasive therapy are:

the size of the tumor is more than 12 weeks and it puts pressure on nearby organs;
myomatous formations provoke heavy uterine bleeding;
there is an acceleration in the growth of fibroids (by 4 weeks in less than a year);
necrotic changes in the tumor;
twisting of the pedicle of the subserous node;
nascent submucosal myoma (emergency laparotomy is indicated);
combination of myomatous nodes with.

There are different options for surgical treatment of uterine fibroids. Among them, three main areas can be distinguished:

removal of the entire uterus and nodes;
removal of myomatous nodes while preserving the uterus;
surgical disruption of blood circulation in fibroids, which leads to their destruction.

Depending on the type of fibroid, its location, and size, the doctor chooses the type of surgery to remove the fibroid. Myomectomy today is performed in 3 ways:

Laparoscopy - through small holes in the abdomen
During hysteroscopy, a special instrument is inserted into the uterus through the vagina.
Strip surgery through an incision in the lower abdomen is performed very rarely.

Rehabilitation after surgery

Rehabilitation of the female body depends on a variety of factors:

For example, if the operation was performed using an open method, then the recovery process is slower.
The patient is offered to limit physical activity, not forgetting that measured walking can only be beneficial and will contribute to accelerated healing.

Maintaining proper nutrition

There is no special diet, you just need to stick to a healthy diet.

First of all, it is a varied and balanced diet that meets a woman’s energy needs, including vitamins and microelements.
Food is taken 5 times a day; overeating and long breaks between meals are not allowed.
A healthy diet involves eliminating frying and using baking, stewing or boiling when preparing dishes.

Allowed products for fibroids

Prohibited Products

The basis of the diet should be the following products:

vegetable oil – sunflower, flaxseed, rosehip, corn, etc.;
any fruits, herbs, vegetables, berries;
dark varieties of bread, with the addition of coarse flour and bran;
cereals, legumes;
fish products, mainly sea fish;
fermented milk products (fresh);
nuts, seeds, seeds;
high-quality varieties of green and black tea, herbal tea;
compote or jelly based on berries or fruits.

Undesirable foods should be excluded from the diet:

margarine, oil mixtures (spreads), limited butter;
fatty meat, lard;
sausages, smoked products;
hard cheese with a high percentage of fat, processed cheese, sausage cheese;
baked goods and baked goods made from white flour;
sweets, including cakes, ice cream, cream pies.

Folk remedies

Before you start using folk remedies for fibroids, be sure to consult with your doctor.

Tampons with burdock root juice are applied topically. Add honey, sea buckthorn and St. John's wort oil, mumiyo to the juice and mix thoroughly. The tampon is placed overnight for 21 days.
Sea buckthorn berry oil. To do this, make cotton swabs, soak them in oil and place them in the morning and evening. The course lasts 2 weeks. It can be repeated if necessary.
Take 4 tsp. flax seeds, pour half a liter of boiling water and simmer over low heat for 10 minutes. At this time, stir the broth. When it cools down, drink half a glass, 4 times a day. The course lasts 15 days, then take a break for 15 days, and repeat the course.
Tincture of walnut partitions. You can buy it ready-made at the pharmacy and use it according to the instructions, or you can prepare it yourself: pour 30 grams of partitions with vodka (1 glass) and leave in a dark place for 3-4 weeks. Take 30 drops 30 minutes before meals with a glass of water. The course is 1 month, 2 weeks break and can be repeated.
Prepare an infusion of several flowers by brewing them with a glass of boiling water for 10 minutes. You need to drink it in the morning before breakfast, for a long time. The duration of admission is determined by the herbalist. Calendula infusions are used for douching. This plant can be used internally in the form of a pharmaceutical tincture.
Finely chopped boron uterus grass(50 g) pour 500 ml of vodka. Leave for ten days in a dark place, shaking regularly. The first ten days take the infusion one teaspoon once a day, the next ten days - one tablespoon. Then take a break for ten days and repeat the treatment.
Using tampons gives good results, soaked in medicinal liquids. Shilajit should be diluted with water in a ratio of 2.5:10. Soak a cotton pad in the prepared solution and place it in the vagina. At the same time, mumiyo should be taken orally at a dose of 0.4 g. Therapy should last 10 days, after which a break of 1 week must be taken. Afterwards you can repeat the course.

Forecast

With timely detection and proper treatment of uterine fibroids, the further prognosis is favorable. After organ-conserving operations, women in the reproductive period are likely to become pregnant. However, the rapid growth of uterine fibroids may require radical surgery to exclude reproductive function, even in young women.

Prevention

The main preventive measures are as follows:

proper nutrition with a predominance of fresh vegetables and fruits;
taking vitamins and microelements that contribute to the normal synthesis of sex hormones;
active lifestyle, playing sports;
regular sexual intercourse;
annual preventive examinations with a gynecologist with ultrasound.

We found out what uterine fibroids are and what treatment is most effective. Remember, when visiting a doctor regularly, if a tumor occurs, it will be found at the very beginning, while its size is small and the woman does not even suspect the presence of fibroids. Timely detection of a tumor will allow it to be cured without the use of surgery and preserve the ability to bear children.

– the presence of two or more myomatous nodes of different sizes, types of growth and localization. Clinical manifestations and their severity depend on the size and location of the fibroids. Heavy and prolonged menstruation may occur; sensations of heaviness, pressure and pain in the lower abdomen, problems with conception and pregnancy. A gynecological examination, pelvic ultrasound, HSG, hysteroscopy, and laparoscopy help to detect multiple uterine fibroids. Taking into account many factors (number, size, location of nodes, age and reproductive plans of the patient), the choice can be made in favor of conservative therapy or surgical treatment (myomectomy, hysterectomy).

General information

Multiple (multi-nodular) uterine fibroids (leiomyoma, fibromyoma) - several benign tumor growths emanating from the myometrium. Multiple uterine fibroids are detected in 80% of patients with this pathology. In recent decades, the age of women with myomatosis has become younger - if previously the disease was mainly diagnosed in late reproductive and premenopausal ages (40-50 years), today fibroids are increasingly detected in patients 30-35 years old.

At the same time, nodes of different sizes can occur: small - up to 2 cm, medium - up to 6 cm, large - more than 6 cm in diameter. Myomatous nodes can have the same or different localization (in the body or cervix) and direction of growth (subserous, submucosal, interstitial, interligamentous uterine fibroids). In some cases, multiple uterine fibroids are detected, growing in a “node within a node” type. In 95% of all observations, the nodes are located in the body of the uterus, less often in the area of the cervix and ligamentous apparatus. Quite often, multiple uterine fibroids cause disruption of menstrual and reproductive functions, so its treatment and prevention are the most important tasks of clinical gynecology.

Causes of multiple uterine fibroids

According to most researchers, uterine fibroids occur due to dysregulation of the growth of myometrial smooth muscle cells. This process can be initiated by ischemia caused by arterial spasm during menstruation, endometriosis, inflammatory diseases (metritis, metroendometritis), hormonal imbalance, damage to the myometrium during gynecological manipulations (abortions, separate diagnostic curettages), long-term use of the IUD. These damaged smooth muscle cells become the rudiments of future myomatous nodes.

In the initial stage, the growth of uterine fibroids occurs under the influence of changes in the concentration of sex hormones during the menstrual cycle, but later, due to the inclusion of autocrine-paracrine regulatory mechanisms, the growth of nodes becomes relatively autonomous, independent of the general hormonal background. The increase in the size of the node occurs both due to an increase in the proportion of connective tissue in its structure, and due to the local production of estrogens.

Factors that stimulate the growth of multiple uterine fibroids may include hereditary predisposition, stress, endocrine and metabolic disorders (hypothyroidism, obesity), prolonged sexual abstinence, and sexual dissatisfaction. An important role in the pathogenesis of the disease is played by an imbalance between estrogen and progesterone in the female body, which is greatly facilitated by the absence of pregnancies and childbirth, and repeated artificial termination of pregnancy.

Symptoms of multiple uterine fibroids

Both single and multiple uterine fibroids have similar clinical manifestations, which depend mainly on the size and growth pattern of the nodes. Small fibroids, especially those with a subserous location, are often asymptomatic: menstruation comes regularly and on time, there is no abdominal pain. As a rule, asymptomatic multiple uterine fibroids are detected during a routine ultrasound of the pelvic organs.

Submucosal (submucosal) and interstitial (intramural) myomatous nodes are characterized by menorrhagia. Uterine bleeding of varying intensity can also occur during the intermenstrual period. Constant blood loss leads to the development of iron deficiency anemia. Menstruation is usually accompanied by severe pain. The growth of old and the appearance of new nodes with multiple uterine fibroids leads to the fact that aching pain in the pelvic area becomes constant. Large interstitial and subserous uterine fibroids can put strong pressure on neighboring organs (bladder, ureter, rectum), resulting in difficulty or frequent urination, chronic constipation, hydronephrosis.

With multiple uterine fibroids of any localization, transformation of the mucous layer of the uterus is observed: from glandular-cystic hyperplasia and polyposis to endometrial atrophy. If there is a malnutrition of one or more nodes (due to ischemia of interstitial fibroids, twisting of the legs of subserous fibroids), symptoms of an acute abdomen develop: sharp abdominal pain, nausea and vomiting, increased body temperature, tension in the muscles of the anterior abdominal wall.

Multiple uterine fibroids and pregnancy

The effect of multiple uterine fibroids on a woman’s ability to conceive, bear a child and give birth to a normal child is controversial. Some fibroids (subserous, small in size) may not have any significant effect on reproductive abilities. Moreover, during pregnancy, the myomatous nodes themselves can behave differently: slightly increase, decrease, or stabilize in size.

The inability to conceive with multiple uterine fibroids may be associated with the following factors: anovulation caused by hormonal imbalance; obstruction of the cervical canal or fallopian tubes, preventing fertilization; pathology of the endometrium, complicating implantation. As a rule, reproductive function is reduced in the presence of fibroids with submucosal and interstitial growth.

However, even if pregnancy has occurred, multiple uterine fibroids are a risk factor for its complicated course. First of all, due to increased myometrial tone, the likelihood of miscarriage in the early stages increases, and in the second and third trimester there is an increased risk of developing placental pathology (premature aging, abruption), bleeding, and premature birth. With large nodes that deform the uterine cavity, fetal malnutrition and the formation of various anatomical defects are possible. Immediately during and after childbirth, multiple uterine fibroids can cause weak labor, uterine atony and postpartum hemorrhage, and prolonged involution of the uterus.

Diagnosis of multiple uterine fibroids

Confirming the presence of multiple uterine fibroids is possible only with the help of instrumental imaging methods. A gynecological examination and analysis of complaints can only provide an approximate estimate of the size and type of growth of the nodes. With a two-handed examination, the gynecologist determines the enlargement of the uterus, its tuberous surface, and the presence of nodes of varying sizes and mobility.

The standard examination is supplemented by a combined gynecological ultrasound (TA+TV). During the study, the number, size, location and condition of multinodular fibroids are clarified. Color Doppler mapping and Doppler measurements allow us to obtain information about the nature of blood flow in myomatous nodes, which is important for the subsequent choice of treatment tactics. Significantly expands the capabilities of ultrasound in the diagnosis of submucosal fibroids. Ultrasound hysterosalpingoscopy, in which the uterine cavity is contrasted with liquid media.

To clarify diagnostic information, it is possible to conduct hysterosalpingography, hysteroscopy (for submucous fibroids), and MRI of the pelvic organs. If it is necessary to exclude malignancy of multiple uterine fibroids, an RDV is performed with a histological examination of scrapings or an aspiration biopsy with cytology of the aspirate. Diagnostic laparoscopy is indicated mainly for the differential diagnosis of subserous fibroids with solid ovarian tumors and retroperitoneal neoplasms.

Treatment of multiple uterine fibroids

The decision on conservative or surgical treatment of multiple uterine fibroids is made taking into account many factors: the woman’s age, plans for pregnancy, the number and location of nodes, as well as their size, clinical manifestations, and impact on reproductive function.

Patients of reproductive age with small tumors may be prescribed treatment with low-dose combined oral contraceptives to slow their growth. The use of the Mirena intrauterine hormonal system has a positive therapeutic effect. The possibilities of using gonadotropin releasing hormone agonists (goserelin, triptorelin, buserelin) in the treatment of multiple uterine fibroids are limited due to a number of side effects. Firstly, their use causes temporary regression of fibroids, and after discontinuation of the drugs, the size of the nodes quickly increases again. Secondly, GnRHa causes a pharmacological menopause in a woman with all its inherent symptoms, so in young patients the course of treatment should not exceed three months. Antigonadotropins (danazol, gestrinone), antiestrogens (tamoxifen), gestagens (norethisterone, dydrogesterone) and progesterone antagonists (mifepristone), etc. can be prescribed individually.

Indications for surgical treatment of multiple uterine fibroids are uterine bleeding, rapid growth or large size of nodes, infertility and miscarriage, pain and anemic syndrome, compression of neighboring organs, malnutrition in the myomatous node. In women of reproductive age, preference is given to removing the nodes while preserving the uterus and, therefore, the possibility of pregnancy. In these cases, laparoscopic myomectomy, conservative myomectomy using laparotomic access, and hysteroresectoscopy of nodes can be performed. Organ-preserving methods of treating multiple uterine fibroids also include uterine artery embolization. In women who do not plan to have children, in perimenopausal age, with a combination of multiple uterine fibroids with adenomyosis, signs of fibroid malignancy, supravaginal amputation of the uterus or hysterectomy is performed - removal of the uterus along with the cervix.

Patients who are seen by a gynecologist for multiple uterine fibroids are recommended to undergo OMT ultrasound twice a year. You should limit your exposure to the sun, exclude visits to the solarium, baths and saunas, thermal procedures on the lumbar and abdominal area, massage of the lumbosacral spine, since these procedures can provoke the growth of nodes and aggravate the clinical manifestations of multiple uterine fibroids.

Even in the period of high technology and the most accurate diagnostics, a woman’s health is susceptible to a huge number of diseases, especially gynecological ones. One of the most common diseases of this kind is multiple uterine fibroids, which is diagnosed in 10–25% of women.

Multiple uterine fibroids are a common gynecological disease

Fibroids are a benign tumor that forms in the muscle layer of the body or cervix. Multiple fibroids are characterized by a different number of nodes (interweaving of smooth muscle fibers).

Scientific classification

Depending on the overall size of the nodes, multiple uterine fibroids are divided by scientists into the following types:

small fibroids (size no more than 20 mm);
medium (size less than 60 mm);
large (more than 60 mm in diameter).

An equally important factor is where exactly the fibroids are located. The presence of various symptoms, pain, danger to the woman, threat to her reproductive health, as well as the treatment method and the complexity of the operation depend on this.

Based on the location of the nodes, they are distinguished:

submucosal myoma (submucosal nodes) – located closer to the uterine cavity itself;
interstitial (intermuscular nodes) - located in the muscular layer of the uterine wall;
subserous (subperitoneal nodes) – the outer side of the uterus;
intraligamentary fibroid (interligamentous nodes);
cervical fibroid.

Placement of fibroids in the body of the uterus

Symptoms and prevention of the disease

The most typical symptoms that may indicate the presence of fibroids are heavy bleeding during the menstrual cycle, heavier and longer than usual; feeling of pressure and pain in the lower abdomen. As the disease progresses, the pain can become sharp and cutting. One of the rare symptoms is infertility.

Detection of the disease is possible even with a simple examination by a gynecologist, not to mention an ultrasound.

Therefore, every woman should monitor her condition - undergo routine examinations and not let the matter develop to large nodes, the treatment of which requires urgent surgery.

Like all diseases, multiple uterine fibroids do not exclude preventive measures. To prevent its occurrence, you need to monitor your hormonal levels, spend less time in the sun, avoid sudden changes in temperature, attend routine examinations, use contraceptives, in order not to have abortions later due to an unplanned pregnancy, and immediately undergo treatment rather than wait, until the disease goes away on its own.

Pressing pain in the lower abdomen may be a symptom of fibroids

Pregnancy with fibroids

Doctors speak of an unconditional connection between pregnancy and this disease. After all, the disease directly depends on the hormonal state of the woman, and bearing a child can aggravate the condition. Due to hormonal surges in the body, myomatous nodes accelerate growth, and the size will sharply move from medium to large, that is, over 6 cm. And an increase in their size can lead to late toxicosis; large fibroids can even cause miscarriages.

Multiple uterine fibroids are one of the most frequently detected pathologies that occur during pregnancy, and often require urgent treatment, due to the threat of obstruction of the development of the fetus and its gestation.

But under no circumstances should you panic. If the diameter of the fibroids is not large, then the course of pregnancy is generally not in danger. But each patient should consult with several specialists.

A year after fibroid removal, you can plan a pregnancy

Treatment of the disease

Several types of treatment are used. The use of one or another method is considered only individually, taking into account the size of the fibroid, its location, growth rate, and the woman’s age. After all, the stage that involves hormonal intervention (inducing artificial menopause) cannot be applied in the long term to women under 30 years of age.

After drug treatment has been carried out, which should have led to a reduction in the nodes, surgical intervention follows, all stages and subtleties of which the specialist determines by analyzing only a specific case. Now doctors have abandoned the previous method of complete removal of the uterus and always try to preserve the reproductive organ during surgery, so multiple uterine fibroids have ceased to frighten with unconditional infertility.

The type of surgery to remove fibroids is prescribed by the attending physician

The operation is performed in several ways: with access through the vagina, through an incision in the lower abdomen, through several small incisions and using a hysteroscope.

The most acceptable method now is embolization. The method involves blocking the blood vessel that goes to the node, thereby stopping its nutrition, and it significantly decreases in size (up to 65% per year).

Emergency intervention is used only due to acute symptoms, a threat to the woman’s health, or the large size of the nodes. Therefore, you should not immediately panic.

It is best to undergo treatment before planning a pregnancy, so that no complications arise later. After all, large nodes will later threaten the child’s health.

The main warning of all doctors is not to start self-therapy, not to rely on folk remedies and that the disease will go away on its own over time.

The scary thing is that in the modern world the disease is getting younger. And an increasing number of women under 30 are being affected. Therefore, everyone should take time to worry about their health. Especially if pregnancy is planned in the future.

vrachlady.ru

Development of multiple uterine fibroids: dynamics and treatment of pathology

Multiple uterine fibroids are a type of benign formation in the uterine muscle tissue, which is characterized by the development of several lesions at once. In general, the nature of the development of the considered form of myomatous lesion is characterized by a higher rate, compared to a single form, and an increased risk of developing into malignant forms in later stages.

The nature and dynamics of the development of pathology

In order to find out what it is - a multiple form of myomatous growth in the uterus, one should consider the dynamics of the development of the disease, the causes of its occurrence and its characteristic manifestations.

Multiple uterine fibroids develop against the background of hormonal imbalance, as well as possible foci of inflammation in the uterine cavity. The lesion is formed by a specific node in the myometrium, and at the initial stage it is represented by a small neoplasm.

In some clinical cases, multiple uterine fibroids are accompanied by the following symptoms:

specific painful manifestations localized in the groin and lower back;
menstrual irregularities;
an increase in the volume and intensity of menstrual bleeding;
anovulatory spotting;
difficulties conceiving a child, which can develop into infertility.

Heavy menstrual bleeding can also lead to the development of anemia, general conditions of apathy and increased anxiety.

A woman who has been diagnosed with myomatous pathology may experience attacks of instant weakness, nausea, and dizziness.

In uterine pathologies, fibroids are often a concomitant disease. An important factor in studying the dynamics of the development of this pathology is timely comprehensive diagnosis and identification of possible concomitant diseases, as well as the clinical prognosis of their parallel progress.

Forms of the disease

Before treating a myomatous lesion, it is necessary to establish the form of its development and make a medical prognosis for its further clinical behavior.

Depending on the number of neoplasms, the pathology can be single or multiple (when at least 2 nodules develop).

In addition, according to the type of location relative to the uterine walls, there are:

intraligamentary myoma (localization of formation - the main ligament of the uterine layers);
intramural (develops in the muscular layers of the uterine walls);
submucous type (forms under the endometrial layer and grows inside the uterine cavity);
subserous type (the node is located outside the uterine walls, under the connective tissue).

It is best to treat the first two types of myomatous pathology in the early stages, when the size of the tumors is still small. The other two types may require surgical intervention because they are quite difficult to diagnose and are less common in clinical practice.

Diagnosis and treatment

Multiple uterine fibroids are diagnosed using special laboratory research methods:

diagnostic laparoscopy;
hysteroscopy.

The accuracy of diagnosis using ultrasound is quite high. Ultrasound can detect the presence of nodules up to 5 millimeters in diameter. This, in turn, contributes to faster and more effective treatment and reduces the likelihood of relapse.

Multiple uterine fibroids in the early stages of development can be treated conservatively. However, due to its difficult diagnosis and detection in late phases, much more often doctors recommend a surgical route to eliminate the pathology.

Myomatous lesions of the uterus of small sizes are treated using a range of medications aimed at inhibiting the growth and development of fibroids and its further atrophy.

However, if the uterine fibroids are multiple and have reached significant proportions, it will be much more effective and safer to resort to surgical removal of the pathological growth. For the purpose of surgical removal of fibroids, the traditional curettage method is used,

using a modern device - a hysteroscope, equipped with a miniature video camera.

With its help, the surgeon can more effectively calculate all manipulations and control the entire procedure. After cleansing the uterine tissue from pathological growth, the area where the lesion was localized is cauterized using antiseptics or electric current.

After the operation, the resulting material is sent for histological examination in order to identify cells that have transformed into malignant forms.

It is worth noting that uterine fibroids tend to recur, and the return of the disease can be avoided only by carefully following all medical recommendations regarding the period of rehabilitation and recovery.

Rehabilitation and preventive measures

Large multinodular uterine fibroids require particularly careful treatment based on preliminary therapy, surgical intervention and rehabilitation treatment measures. Comprehensive and well-designed prevention is also of great importance to reduce the likelihood of recurrent manifestations.

In particular, an important factor in the patient’s recovery after treatment of multiple uterine fibroids and removal of foci of myomatous lesions is a properly selected diet rich in vitamins and nutrients.

Vegetables and fruits should predominate, but the consumption of meat products should be reduced to a minimum.

The psycho-emotional state of the recovering patient is also important. It is recommended to eliminate as many stress factors as possible from everyday life, stabilize emotional tone, and get rid of the feeling of depression.

Multiple uterine fibroids are quite dangerous because they are associated with an increased likelihood of relapses and progression to malignant pathologies. Therefore, treatment of multinodular uterine fibroids and comprehensive recovery after the disease must begin as early as possible.

womanhealth.guru

Multiple uterine fibroids

Multiple uterine fibroids are a tumor-like disease that occurs in the muscular layer of the uterus (myometrium) and is characterized by the appearance of two or more myomatous nodes.

The severity of the disease lies in the fact that the nodes in the thickness of the uterus have a different shape, structure, origin, and therefore each specific node will require an individual diagnostic approach and, accordingly, treatment.

The disease often debuts at the age of 32 - 33 years. During late reproductive age and early menopause, the growth of multiple fibroids increases. According to WHO, multiple uterine fibroids account for 24 - 26% of all cases of tumor processes of the reproductive system.

The prognosis for the disease is unfavorable. In most cases, with this pathology, the uterus is removed, which deprives a woman of having children during the reproductive period, and in more advanced forms of the disease can lead to death.

The severity of the pathological process in the uterus can be determined by the following criteria:

Localization of nodes, which depends on their location in the thickness of the myometrium.
The woman's age.
Node size.
The rate of growth of fibroids.

Causes of the disease

The cause of multiple uterine fibroids are mutations of 2 or more smooth muscle cells in the thickness of the myometrium and their subsequent uncontrolled and relatively rapid division.

These disorders in a woman’s body occur due to hormonal imbalance. It has been proven that the development and growth of multiple fibroids is influenced by high levels of estrogen in the blood. And another, less studied factor is heredity.

We can distinguish a risk group - women who may be more predisposed to developing the disease:

a history of 2 or more abortions;
late first birth - 35 years or more;
women who are overweight or obese;
women who have endocrinological disorders in the pancreas (diabetes mellitus), thyroid gland (hypothyroidism) or pituitary gland (brain tumor, consequence of TBI (traumatic brain injury));
women suffering from frequent inflammatory diseases of the reproductive system, as well as those with a history of benign or malignant ovarian tumors.

Classification

By size they are distinguished:

Multiple small uterine fibroids - the diameter of such nodes does not exceed 20 mm, and the overall size of the uterus is characteristic of the 8th week of pregnancy.
Multiple medium-sized uterine fibroids - the diameter of the nodes is from 20 mm to 6 cm, the total size of the uterus does not exceed the 12th week of pregnancy.
Multiple large uterine fibroids - the diameter of the nodes exceeds 6 cm, the total size of the uterus corresponds to 13 or more weeks of pregnancy.

Depending on the location of the nodes in the thickness of the myometrium, the following are distinguished:

Submucosal nodes located at the border of the muscular layer and the endometrium (inner lining of the uterus).
Intermuscular nodes located in the middle of the myometrium.
Abdominal ligaments located between the myometrium and perimeter (outer or serous lining of the uterus).

The classification of multiple uterine fibroids is only conditional, as it can combine several points at once.

Symptoms

headache;
dizziness;
memory and attention impairment;
general weakness;
decreased appetite;
nausea;
drowsiness;
irritability;
depression;
pale skin;
increased heart rate;
pain in the lower abdomen, intensifying before the onset of menstruation or during physical activity;
heavy and prolonged bleeding during menstruation;
bleeding from the vagina between menstrual cycles;
difficulty urinating;
frequent urge to urinate;
constipation;
swelling of the lower extremities.

Diagnostics

Examination by a gynecologist. The examination consists of collecting complaints, interviewing the patient and conducting an internal gynecological examination in the speculum. With multiple uterine fibroids of medium and large size, the doctor can palpate the nodes on the surface of the uterus through the anterior abdominal wall.
In the case of a large submucosal node “born”, which grows into the thickness of the uterus and descends through the cervix into the vagina, the gynecologist will determine it during an internal gynecological examination.
After the first stage of diagnosing the disease, additional examination methods are prescribed, which include laboratory and instrumental tests.
Lab tests. A breakdown of the results of a general blood and urine test (normal values of indicators and changes in nodular uterine fibroids) is given in the tables below. A general blood test will indicate the degree of anemia during bleeding caused by a general disease. Table 1. General blood test
Table 2. General urine analysis

Instrumental methods:

An ultrasound of the uterus can be used to identify the number of myomatous nodes and determine their size and shape. This examination method is quite informative, fast and relatively cheap.
MRI (magnetic resonance imaging) of the uterus allows you to identify the structure, shape, number and size of fibroid nodes, as well as determine their blood supply and the presence of complications that have arisen during the course of the disease. The method is more informative in comparison with ultrasound diagnostics, but more expensive. An MRI is mandatory for this disease.
Hysteroscopy is an examination of the vaginal cavity and uterus with a special device - a hysteroscope, which consists of a fiber optic tube and a light source. This examination method is used after ultrasound or MRI, in the presence of submucosal myomatous nodes.
Diagnostic laparoscopy is an examination of the pelvic cavity using an endoscope - an optical fiber tube that has a camera that displays an image on a monitor screen and a light source. This method is the most accurate, but invasive (penetrating into the body). The study is resorted to in case of doubt after ultrasound and MRI or in the presence of complications.

Treatment of multiple fibroids

Treatment of multiple uterine fibroids, depending on the complexity of the course, can be conservative or surgical. Conservative (medicinal) methods combine the use of hormonal drugs, as well as vitamin therapy. Operative (surgical) methods are used for complicated forms of the disease, as well as for the growth of myomatous nodes. Common methods used include laparoscopy, embolization, myomectomy or hysterectomy.

Conservative treatment

If multiple small fibroids occur, expectant management is used, which involves undergoing an ultrasound examination of the uterus 2-3 times a year and, if mild or moderate anemia occurs, taking vitamins and iron supplements:

vitamins B1, B2 and B12 (neurorubin, neuromidin, milgama) intramuscularly 2.0 - 3.0 ml or orally 1 - 2 tablets per day (depending on the severity of anemia);
iron (totema, gynotardiferon, sorbifer) orally 1 - 2 times a day;
vitamin C 500 mg 2 times a day;
folic acid 1 capsule 3 times a day.

These medications are taken under the supervision of a general blood test every 7 to 10 days.

For small and medium-sized multiple uterine fibroids, which are characterized by rapid growth, drugs are prescribed that block their growth - gonadotropin releasing hormone antagonists (goserelin, leuprorelin, buserelin).

The dosage and frequency of taking these drugs are individual in each specific case and are decided by your attending physician.

Surgery

Surgical treatment of multiple uterine fibroids is divided into two types:

radical - removal of multiple fibroids throughout the entire uterus.
functional - removal of all uterine nodes while maintaining the integrity of the organ.

Indications for surgical treatment:

multiple large uterine fibroids;
severe anemia;
rapid growth of fibroids - an increase in height of more than 3 weeks in 1 year;
the presence of complications caused by this disease.

Methods of surgical treatment

Myomectomy is the removal of multiple fibroids, which is performed in an operating room under general anesthesia. This type of surgical intervention is performed only in the presence of intermuscular and abdominal myomatous nodes. The operation can be carried out in two ways:
Median laparotomy - an incision is made in the abdominal wall, the fibroid is brought out into the surgical field and excised, the surgical wound is sutured, and drainage is placed. The duration of hospitalization is 10 - 14 days.
Laparoscopy - 3-4 incisions are made in the lower abdomen, an endoscope, a camera and an electrocoagulator are inserted inside. Using an electrocoagulator, the fibroid is cut off and removed through one of the incisions. Postoperative wounds are sutured and drainage is placed. The duration of hospitalization is 5 - 7 days.
Hysterectomy is the complete removal of the uterus, which is performed in the operating room under general anesthesia. This method is used in almost 90% of cases when multiple uterine fibroids occur. Access and duration of hospitalization are indicated above.

Complications

necrosis of multiple uterine fibroids;
degeneration of fibroids into a malignant tumor;
infertility;
compression of the inferior vena cava by multiple fibroids, which manifests itself in increasing swelling of the entire surface of the lower extremities and the anterior abdominal wall, a decrease in blood pressure and pulse rate;
compression of the aorta by fibroids, which is manifested by fainting, shock, and the onset of coma;
compression of the ureters by fibroids, which is accompanied by anuria (lack of urine), vomiting and loss of consciousness.

Prevention

balanced diet;
fight against physical inactivity and excess weight;
compliance with the work and rest regime;
rejection of bad habits;
pregnancy planning;
undergoing annual examinations with a gynecologist;
sanitary educational work among the population.

Dimensions of uterine fibroids
Contraindications for uterine fibroids
Diagnosis of uterine fibroids

eva-health.ru

Multiple uterine fibroids

Unfortunately, today, many women are faced with various gynecological diseases. Uterine fibroids are also diagnosed very often.

Mostly women of reproductive age are affected. Myoma in the uterine cavity is a benign neoplasm. Such neoplasms can be localized both inside and outside the reproductive organ. Myoma nodes are formed due to the muscular layer of the uterine cavity. Myoma tumors can be single, when only one node is formed, and multiple, when several nodular formations are involved in the pathological process.

More often, doctors diagnose multiple fibroid tumors. The prognosis of the disease directly depends on its size, location, rate of growth and development.

Characteristic

Multiple uterine fibroids are a benign tumor. It is formed in the muscle tissue of the uterus, with a certain number of nodal formations.

The disease develops in a latent form; the patient may not be aware of the concomitant disease until the fibroid formations begin to actively progress in development. During this period, the woman may experience the first manifestations of the pathological process. This neoplasm can form in various sizes, shapes and quantities. If you study medical statistics, you can find out that multiple fibroids are diagnosed in almost 87% of patients, compared to other fibroids. With such tumor processes, it is imperative to carry out effective treatment. Otherwise, the nature of the neoplasm will develop into malignant. .

As practice shows, almost every woman seeks medical help only when the pathological process is already at an advanced stage.

Thus, in most cases, doctors are faced with the task of removing myoma formation already at the last stage of development.

Causes

Even thanks to modern medicine, experts still cannot determine the true causes of the appearance of fibroid tumors in the female body.

Many doctors are inclined to argue that certain factors contribute to damage to mature cells, and over time they begin to develop abnormally. Also, hormonal instability of the female body, namely increased estrogen levels, plays a large role in the formation of fibroid nodes. When estrogen exceeds normal levels, the body is stimulated to accelerate the development of increased concentrations of progesterone. Because of this, uterine cells grow uncontrollably and rapidly and provoke the formation of fibroid nodes. Provoking factors for the development of multiple fibroids can be:

a large number of instrumental interventions in the uterine cavity (abortions, curettage and various operations;
injury to the pelvic organs;
regular physical activity;
psycho-emotional disorders;
inflammatory processes;
genetic predisposition;
excess weight.

Also, provoking factors may include: untimely puberty, long-term use of oral hormonal contraceptives, substance metabolism, impaired metabolism, long-term use of the intravaginal device, including disorders of the endocrine system.

Symptoms

When the fibroid nodes reach a large size, the woman begins to notice the first manifestations of the pathological process.

The main symptoms include:

Cramping pain attacks during the menstrual cycle, however, if the tumor process is still at the stage of formation, then the pain syndrome can occur between periods;
The formation can put pressure on nearby organs and tissues and subsequently disrupt the blood supply;
heavy bleeding during menstruation;
The appearance of intermenstrual discharge;
increase in abdominal volume;
Frequent urge to urinate;
regular constipation;
Sensation of a foreign body in the lower abdomen.

In some cases, due to large nodes, compression begins in the inferior vena cava. This can cause tachycardic symptoms, difficulty breathing, etc.

However, in general, in each patient the formation of nodules occurs with individual symptoms, which depend on the volume and number of nodules, accompanying pathological processes, etc.

Varieties

Multiple myoma nodes can be interstitial, subserous and submucosal. Also, such formations are small, medium and large.

A large multiple neoplasm is a cluster of uterine formations with a diameter of about six centimeters. Such tumors are the most serious and cause critical condition in women. The average multiple fibroid is a cluster of two or three formations ranging in size from two to six centimeters. Small fibroids are multiple formations with a diameter of less than two centimeters.

Multiple fibroids can develop over a long period of time and with an uneven course. Therefore, it is very important to diagnose the formation of nodes at an early stage. Submucous multiple fibroids are localized under the mucous membrane of the uterine cavity. This type is characterized by the rapid growth of nodes and their increase in volume. Also, patients have pronounced manifestations of the pathological process. This picture makes it possible to diagnose the formation at an early stage, which has a positive effect on the outcome of the treatment. Interstitial and interstitial-subserous fibroids are localized directly in muscle tissue. These formations have different development patterns.

Doctors cannot determine the exact prognosis of the operation. It depends on the location of the node, its volume, etc.