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1-Subperitoneal node on the leg
2-Interstitial node
3-Node with centripetal growth
4-Submucosal node
5-Subperitoneal node
6 neck knot
7-Born submucosal node on the leg

Fibroma, or fibromyoma of the uterus, is a single or multiple accumulation of benign formations. Seals, as a rule, develop from the muscular layer of the endometrium, some nodes are directed inside the wall of the organ, others - into the cavity.

Fibromyomas do not transform into malignant nodes, but due to their size they can hide tumors of a different nature. Fibroma often remains in its original position or progresses slowly. A sharp jump in tumor growth is associated with a number of provoking causes. The latter include - inflammatory processes of the genital organs and manipulations on the uterus (in particular, curettage).

According to statistics, a woman encounters this type of neoplasm after 35 years. There is a scientifically substantiated fact that fibromas can independently decrease and disappear during menopause, but in 10% of patients during this period an increase in the tumor was recorded.

Symptoms and signs of fibroids

The danger of fibromyoma lies in its asymptomatic course. Only 20% of patients report symptoms of the disease. The clinical picture can be varied, depending on the location, size, nature of the fibroma and concomitant pathologies of the pelvic organs.

The first signs characteristic of fibroids are:

• violation of the menstrual cycle, which in some patients is expressed by heavy bleeding, and in others - by spotting.
• with abundant blood loss, the patient notes pain in the lower abdomen, which radiates to the lumbar region.

Remote signs of the presence of fibroids are:

• heaviness in the genital area;
• pain in the lumbosacral region;
• frequent urination;
• pain during intercourse;
• an increase in the volume of the abdomen;
• problems with conception and childbearing.

Seals on the walls of the uterus of a single nature, as a rule, do not prevent the onset of pregnancy. The nodular form of fibroma is of great danger. The tumor in this case is large, touches nearby organs and disrupts their functioning.

Treatment of uterine fibroids

Fibromyoma is diagnosed through a gynecological examination and transvaginal ultrasound. As an additional study, diagnostic curettage and biopsy with histology of pathologically altered tissues are also used.

Treatment of patients with a diagnosis of fibromyoma is handled by a gynecologist. Observation by an endocrinologist is also possible.

Conservative (drug) treatment

The goal of therapy is to prevent the growth of fibromatous nodes, prevent surgical intervention and preserve the reproductive function of a woman. Indications for drug treatment are:

• young age;
• small size of neoplasms;
• slow growth or no progression;
• localization of nodes in the intermuscular layer;
• absence of severe bleeding and pain syndrome;

Conservative therapy includes:

1. Hormone therapy:

• oral contraceptives - slow down the growth of fibroids (in the presence of seals no more than 2 cm). The course of treatment is from 3 months;
• the establishment of an intrauterine device with the progestogen hormone levonorgestrel. The latter is regularly released into the uterine cavity and prevents the growth of the neoplasm;
• androgen derivatives (danazol, gestrinone) - is prescribed to suppress the synthesis of steroids in the ovaries and reduce fibroids in size. The course of treatment is continuous - at least 8 months;
• gestagens (utrogestan, duphaston) - are prescribed for fibroid tumors to normalize the growth of the endometrium (with other types of fibroids, it has a minimal effect). The course of treatment - up to 8 months;
• analogues of gonadotropin-releasing hormone - reduce blood flow to uterine fibroids, thereby reducing its size. After discontinuation, the fibroma returns to its original parameters. That is why these drugs are used shortly before surgery to completely remove the reduced tumor.

1. Treatment with non-steroidal anti-inflammatory drugs (NSAIDs).
2. Vitamin therapy.
3. Lifestyle change- balanced nutrition, physical activity regimen, normalization of sleep, regular sex life, quitting smoking and alcoholic beverages.

In some cases, conservative therapy provokes the appearance of side effects, which are expressed in menstrual dysfunction, irritability and nervousness, as well as chronic fatigue and lack of sleep.

Surgery for fibroids

Surgical methods of treatment should be used for the following indications:

• pronounced clinical signs of the disease;
• the presence of uterine bleeding, provoking anemia;
• the large size of the tumor, its dynamic growth;
• the location of the fibromyoma in the submucosa;
• complication in the form of torsion of the leg, hemorrhage or necrosis;
• the presence of endometriosis.

The choice of surgery depends on 2 factors:

1. If the patient is planning a pregnancy in the future, then the following are used:

• myomectomy (laparoscopic, laparotomic or vaginal method) - an organ-preserving operation, during which fibroids are enucleated;
• hysteroscopic myomectomy.

1. If the patient does not plan pregnancy in the future, then radical methods are used:

• hysterectomy is the complete removal of an organ.

Separately, 2 more methods of surgical operation are distinguished:

1. Uterine artery embolization is an effective technique with minimal complications. Manipulation is aimed at blocking the blood supply to the tumor nodes and, as a result, stopping their growth.
2. FUS (ultrasound ablation) - evaporation of the tumor using high-frequency ultrasound. The operation is performed under MRI control.

Possible postoperative complications are bleeding, adhesions, infection and the formation of synechia inside the uterine cavity.

The probability of fibromyoma degeneration into a malignant neoplasm is minimal and amounts to only 1%.

Manifestations of fibroids will depend on the size of the nodes, the characteristics of their localization, the duration of the course of the disease, and other factors. Most often, the signs of the disease are pain, bleeding, anemia caused by prolonged blood loss, pain symptom, symptoms of compression of neighboring organs, an increase in the abdomen in size, pain during intercourse, a feeling of fullness in the stomach, flatulence. Menstruation with fibromyoma is abundant and prolonged, bleeding is not uncommon, not associated with menstruation.

Pain in fibroids is usually caused by tension of the ligamentous apparatus of the uterus, stretching of the abdominal wall, pressure of a growing tumor on other organs. Violations of the work of nearby organs often occur when fibroids are localized close to the cervix. The growing tumor puts pressure on the bladder and causes urination disorders (incontinence, frequent urination). A retrocervical fibroid puts pressure on the rectum and causes bowel problems (such as constipation). With the onset of menopause, the neoplasm decreases in size. However, according to medical statistics, in 2% of cases, uterine fibromyoma degenerates into a malignant tumor.

Types of fibromyomas, the reasons for their appearance

There are several types of fibroids. The submucosa appears inside the uterine cavity, under its membrane. It causes severe pain and spasms. Subserous fibromyoma develops on the outer lining of the uterus. Interstitial is formed on the walls of the uterus and rapidly increases in size. Interligamentous fibromyoma is localized in the environment of the ligaments that support the uterus in the abdominal cavity. The stalked one develops from the subserous form when a leg grows in it. Such formations can twist and cause severe pain. Making a diagnosis with an increase in the size of the uterus does not cause difficulties during a routine gynecological examination. In order to clarify the number and location of nodes, additional studies are used: ultrasound, hysteroscopy, laparoscopy.

Factors contributing to the development of fibroids include progesterone deficiency, increased levels of estrogen hormones, disruption of the synthesis and conversion of sex hormones, and changes in the sensitivity of the myometrium (uterine body) to them. The hereditary factor also plays a role. The cause of the development of fibromyoma can be an abortion, chronic inflammatory diseases of the genital organs. The likelihood of developing this disease increases in women who postpone pregnancy to a later age.

- a benign tumor, manifested by the appearance of nodules and seals in the body of the uterus, which can grow in all directions: inward, outward or directly in the thickness of the uterine body.

Experts say that uterine myoma is a benign formation, which has practically no chance of developing into a malignant one. However, fibromyoma creates significant discomfort in a woman's daily life, and therefore every second woman who is admitted to the department of operative gynecology is forced to undergo a planned operation to remove the fibromyoma. This pathology develops in every fourth woman over thirty and in every third woman who is on the verge of menopause.

Causes. To date, the exact causes of uterine fibroids have not been fully elucidated, but experts say that failures in the hypothalamus-pituitary-ovaries-uterus system play an important role in the development of this pathology. Despite the fact that there is very little data in this area, many doctors agree with the hypothesis that the root cause of the pathology is the level of the hormone estrogen in the blood of a woman, which increases almost three times from the onset of puberty to the onset of menopause.

Genetic predisposition can also play a big role. It has been proven that in families where cases of polycystic ovaries or fibromyomas have been observed, the risks of developing these pathologies are significantly increased due to the increased susceptibility of hormones.

Symptoms

There are three main types:

• . subserous nodes. They develop under the outer shell of the uterine wall and grow outward, giving the uterus a knotty shape. As a rule, subserous nodes do not cause menstrual disorders, but can cause pain in the pelvis, back and put pressure on nearby organs (intestines, bladder, pelvic vessels), causing a breakdown in their function. A subserous fibroid may be pedunculated (peduncular fibromyoma), making it difficult to distinguish from an ovary.
• . Intramural fibromatous nodes. They develop in the depth of the muscular wall of the uterus and grow inward, causing an increase in the size of the uterus. This type of uterine fibroid is the most common. Intramural fibromatous nodes can cause profuse uterine bleeding, manifest as pelvic pain and pain in the spine, as well as a feeling of general pressure on the internal organs.
• . Submucous fibromatous nodes develop inside the uterine cavity, under its mucous membrane. This is the least common type of uterine fibroids, however, and they are the most severe. Even a very small submucosal nodule can cause life-threatening bleeding.

The development of fibroids in most cases is characterized by the occurrence of multiple nodules of very different sizes - from one to thirty centimeters, and in some cases more. A rare phenomenon occurs when, due to the growth of nodes, the uterus increases to the size of a five-month pregnancy, and, characteristically, the woman looks pregnant. One by one, the nodes are extremely rare, most often there are several of them, and they can be located in different layers of the uterine wall.

If the nodules grow slowly, then the disease may not manifest itself for years, despite the large size of the formation at the time of its discovery. Usually, women go to the doctor when they find bleeding outside of their period, pain in the lower abdomen and anemia associated with it, as well as bladder anxiety, etc.

If the course of the disease is longer, then ovarian dysfunction may be detected up to the impossibility of ovulation or pathology of the corpus luteum function, and this entails an even greater hormonal imbalance. This imbalance can become a stimulus in the formation of cystic ovarian lesions and endometrial hyperplasia.

If the tumor grows rapidly, then the symptoms are more pronounced, because such patients are treated only one to two years after the onset of fibroids. As a rule, the course of this disease becomes much easier after menopause, as the amount of the female sex hormone estrogen becomes less. Despite this, if a woman is still taking synthetic sex hormones during menopause, tumor growth may continue.

Fibroma and pregnancy. There are frequent cases of normal pregnancy, despite the presence of fibromyoma, often it is found on ultrasound along with the diagnosis of pregnancy. In this situation, it is required to determine the size and location of the nodules, as well as the rate of their growth. If the doctor is sure that they will not interfere with the normal course of pregnancy and labor, then the woman will be able to give birth to healthy offspring. However, if concerns still arise, the use of a caesarean section is recommended, or, in extreme cases, termination of pregnancy or premature birth.

Diagnostics. Fibromyoma is initially detected on examination by a gynecologist.The diagnosis is confirmed by ultrasound. This is a painless procedure that allows specialists to see the size, shape and structure of the uterus.In some cases, a transvaginal ultrasound may be necessary. In this case, the transducer is inserted into the vagina, which allows the inside of the uterus to be seen more clearly. The slight discomfort associated with this procedure pays off with its high information content.

Uterine fibroids can also be confirmed using computed tomography (CT) and magnetic resonance imaging (MRI). These are also painless diagnostic procedures that provide accurate information about the number and location of fibromatous nodes.

Hysteroscopy is a diagnostic method that allows you to confirm the presence of small submucous nodes that are difficult to distinguish using the above methods. A long, thin, probe-like instrument is inserted through the vagina and cervix into the uterus, after which the doctor can examine the inside of the uterus and take tissue samples. This procedure, which causes some discomfort, is performed by a gynecologist in a clinic or hospital under local anesthesia.

Treatment. Surgical and conservative techniques are used. Surgery

Initially, unconditional indications for surgical treatment should be identified:

• submucosal localization of fibroids
• large size of the node (the total value corresponds to the uterus of 14 weeks of gestation)
• uterine bleeding accompanied by chronic anemia
• rapid tumor growth
• acute malnutrition of fibroids (torsion of the legs of the subserous node, tumor death)
• combination of uterine fibroids with endometrial hyperplasia, ovarian tumor
• compression of the ureter, bladder, rectum
• the presence of a node in the area of ​​the tubal angle of the uterus, which is the cause of infertility
• cervical and cervical isthmus localization
• non-regressing and growing uterine fibroids in postmenopausal age.

The volume of surgical intervention is largely determined by the age of the patient.

Up to 40 years of age, if there are indications for surgical treatment, if technical capabilities allow, a conservative myomectomy is performed. It is especially advisable to remove medium-sized myoma nodes (in diameter from 2 to 5 cm), until their intensive increase in size has occurred. The preferred technique is laparoscopic. Relapses with conservative myomectomy for uterine myoma occur in 15-37% of cases.

After 40 years and postmenopausal age, in the presence of surgical indications, an operation is necessary to remove the myomatous uterus, because. if the myoma did not regress in the first 2 years of postmenopause, its further existence is accompanied by the risk of oncology (adenocarcinoma, sarcoma).

Conservative treatment

Conservative treatment, carried out immediately after the detection of small and medium-sized myomatous nodes, in some cases makes it possible to slow down the further growth of the tumor, prevent operations to remove the uterus, and preserve the ability to give birth to a child.

Indications for conservative treatment:

• young age of the patient
• small size of the myomatous uterus (up to 10-12 weeks of pregnancy)
• intermuscular location of myomatous nodes
• relatively slow growth of fibroids
• no deformation of the uterine cavity.

Conservative treatment consists in the normalization of systemic disorders characteristic of patients with uterine fibroids, among them:

• chronic anemia,
• inflammatory processes of the uterus and appendages,
• violation of the blood filling of the pelvic organs with a predominance of venous stasis and a decrease in arterial blood supply,
• violation of the functional state of the nervous system and vegetative balance.

Methods for correcting systemic disorders include the following:

• compliance (normalization of sleep, rational nutrition, physical activity, rejection of bad habits, control of body weight);
• normalization of sexual life;
• periodic intake of vitamins and microelements in the winter-spring period;
• anemia treatment;
• neurotropic effects, if the patient shows features of a disharmonious personality.

If a pregnancy occurs, not even planned, it is necessary to preserve it, because. postpartum reduction of the uterus, breastfeeding a child for at least 4-6 months contribute to a change in the composition of fibroids, its transition to a simple one and, in some cases, the cessation of its further development.

To prevent the inevitable removal of the uterus during tumor growth, the preservation and maintenance of reproductive function up to 40 years is of great importance.

The effectiveness of hormonal therapy varies greatly depending on the nature of hormonal disorders, the presence and density of receptors in the myomatous nodes and myometrium. In fibromas, where connective tissue prevails, as well as in large nodes, hormone receptors are usually absent. Therefore, hormonal therapy in these patients is not very effective.

Nevertheless, it is used in the correction of a disturbed menstrual cycle. For this purpose, progesterone and its derivatives (dydrogesterone, cyproterone acetate), as well as androgen derivatives, 19-norsteroids (levonorgestrel, norethisterone acetate) are used. The latter are undesirable at a young age, with obesity, diabetes, cardiovascular diseases.

The most promising drugs in the treatment of patients with uterine fibroids are antigonadotropins (gestrinone, danazol), which have antiestrogen and antiprogesterone effects, causing temporary amenorrhea, as well as gonadotropin-releasing hormone agonists (triptorelin, goserelin, buserelin), which cause a state of reversible hypogonadism.

The following antigonadotropins are registered in Russia:

Depo-goserelin 3.6 mg s.c.; triptorelin 3.75 mg i/m and s/c; leuprorelin 3.75 mg IM The drug is a ready-made kit with various routes of administration. Treatment begins on the 2nd-4th day of the menstrual cycle: 1 injection every 28 days.
Endonasal spray - 0.2% solution of buserelin acetate 0.9 mg per day. Treatment begins on day 1-2 of the menstrual cycle: 0.15 mg in each nasal passage 3 times a day at regular intervals.

Preparation for surgical intervention with the help of antigonadotropins in the presence of uterine fibroids allows for sparing organ-preserving operations using endoscopic techniques.

To date, several strategies for long-term antigonadotropin therapy have been described to avoid significant side effects while maintaining high clinical efficacy:

Add-back mode - a combination of antigonadotropins with small doses of estradiol.
On-off mode - therapy with antigonadotropins intermittent courses (three-month therapy with a three-month break up to 2 years).
Drow-back - the use of high doses of antigonadotropins for 8 weeks with the transition to lower doses of the drug for 18 weeks.

The likely response to treatment can be predicted in most cases 4 weeks after the first injection.

The drugs are well tolerated, do not have antigenic properties, do not accumulate, do not affect the blood lipid spectrum. Side effects: hot flashes, sweating, vaginal dryness, headache, depression, nervousness, libido changes, seborrhea, peripheral edema, poor prospective memory, decreased bone density.

Termination of therapy leads to the restoration of a normal menstrual cycle and estrogen status approximately 60-100 days after discontinuation of the drug and the rapid re-growth of uterine fibroids to its original size (during the first 3-4 menstrual cycles) with all clinical symptoms (although some authors note that these symptoms are less pronounced).

Tumor diseases of the genital organs are widely used in gynecology. And one of the most common formations is uterine fibromyoma. This benign tumor is detected in every sixth woman of reproductive age. Therefore, it is extremely important to its timely diagnosis and subsequent active treatment.

Causes and mechanisms

To understand the essence of the pathological process, it is necessary to familiarize yourself with its origin. The development of fibroids is mediated by general and local disorders. The main concept of the occurrence of a benign neoplasm is considered hormonal. Regulatory disorders in the hypothalamic-ovarian system give rise to proliferative processes in the uterus. In the muscle layer, hyperplasia and hypertrophy of the fibers are observed, but the cells do not lose their differentiation.

A key role in maintaining tumor growth is assigned to an increase in the concentration of estrogens - both absolute and relative. These substances are natural stimulators of cell growth. In addition, the metabolism of sex hormones changes in the tumor and the sensitivity of receptors to them increases. Of no small importance is cytokines and growth factors, immunological disorders and tissue hypoxia. It should also be remembered that the following conditions contribute to the development of fibroids:

• Infectious and inflammatory diseases.
• Disorders of the menstrual cycle.
• Endocrine-metabolic pathology.
• Invasive interventions, including abortions.
• genetic predisposition.
• Violations in the neuropsychic sphere.

All these factors must be taken into account when correcting the disease, because the basis of treatment, especially in the early stages, consists of eliminating the cause and mechanisms of fibromyoma development. Without this, it is difficult to talk about further recovery.

Classification

There are several classification criteria for such a diagnosis as uterine fibroids. The doctor must take into account the localization of the tumor, the direction of its growth, size, distribution and morphological structure. The pathological process in most cases develops in the body of the uterus, including the fundus, and only in some cases affects the cervix. The most important influence on the nature of the symptomatology is exerted by the direction of fibromyoma growth. Based on this, the following node options are distinguished:

1. Submucosal (in the submucosal layer).
2. Intramural (in the thickness of the myometrium).
3. Subserous (in the outer shell).

Fibromyomas can also be observed growing between the uterine ligaments (interligamentary). In turn, the size of the nodes varies over a very wide range: from clinically asymptomatic to those that are comparable to pregnancy for more than 12 weeks. Despite the fact that the tumor grows from the myometrium, it can have a different histological structure:

• Mostly muscular - leiomyoma.
• Mixed connective tissue-muscular - fibromyoma.
• Mostly connective tissue - fibroma.

And based on the growth rate and cellular changes, fibroids can be simple and proliferating. The first is called muscular hyperplasia, and the second is a true tumor with rapid development. In addition, the size of the intramural component in the structure of fibroids and the direction of its growth allow us to form another classification, according to which there are such types of pathological process:

• 0 - superficial nodes on the stem.
• I - having a wide base and penetrating into the wall of the uterus (less than half the thickness).
• II - more than 50% of the tumor volume is assigned to the intramural component.

In terms of prevalence, there is a single uterine fibromyoma, but most often it is necessary to ascertain multiple nodular formations. The foci are located randomly along the entire plane of the organ wall.

Each feature of the tumor, indicated in the classification, is necessary for the construction of a clinical diagnosis.

Symptoms

The clinical picture of pathology is very variable. With small sizes, the intramural and subserous tumor does not manifest itself at all. But submucosal foci, even small ones, can give certain symptoms, which increase as the fibromyoma grows. The most common signs include:

• Profuse and prolonged menstruation.
• Intermenstrual bleeding.
• Soreness in the lower abdomen.
• Problems with conceiving a child.

Submucosal nodes disrupt the functioning of the endometrium, which creates such a picture. Due to severe menometrorrhagia, a woman experiences chronic blood loss, which causes anemia. Characterized by general weakness and fatigue, pale skin and mucous membranes, changes in taste, dizziness, brittle hair and nails. Infertility is caused by both hormonal disorders and local disorders in the uterine wall (tumor nodes prevent normal implantation).

If a large uterine fibroid is diagnosed, the symptoms will include violations from neighboring organs. In women, urination becomes more frequent, constipation and chronic pelvic pain develop. Sometimes there is shortness of breath and tachycardia in the supine position - this is the so-called inferior vena cava syndrome, which appears due to compression of the vascular bundle.

As the tumor grows, the risk of complications increases: pedicle torsion and node necrosis. In both cases, signs of an "acute abdomen" develop, in particular, sharp pains, irritation of the peritoneum, reflex muscle tension, and deterioration in the general condition. This situation calls for an urgent response.

On gynecological examination, the picture also varies. Small submucosal and intramural nodes cannot be palpated. But external tumors manifest themselves in the form of moderately dense, rounded and inactive foci, which give the impression of a “lumpy uterus”. With large nodes, the organ increases significantly in size, and with complications, diffuse soreness appears.

Additional diagnostics

Uterine fibromyoma should be confirmed with the help of additional diagnostics, because on the basis of clinical data one can only assume a tumor. And its characteristics will become known according to the results of instrumental studies:

• Ultrasound of the pelvis.
• Metrosalpingography.
• Hysteroscopy with biopsy.
• Diagnostic curettage.
• Histological analysis.

To establish the mechanisms of development of fibroids and predisposing factors for their occurrence, laboratory tests should also be carried out. The most important is a blood test for the hormonal spectrum (gonadotropins, estrogens, progesterone) and an immunogram. The attending physician may prescribe other studies necessary to identify concomitant disorders.

Methods of additional diagnostics allow obtaining reliable information about the nature of the tumor process in the uterus and the prerequisites for its development.

Treatment

Therapeutic measures are determined by how uterine fibromyoma behaves in a particular patient, depend on the size and number of tumor foci, clinical symptoms, and are also carried out taking into account the patient's age and her reproductive characteristics. Based on the diagnostic results, the doctor creates an individual program for each woman.

conservative correction

Until now, the question of the advisability of treating asymptomatic tumors remains open. Such patients are most often recommended to undergo ultrasound monitoring every six months, observing fibroids. If its size increases, then it will be necessary to carry out a therapeutic correction.

In the early stages, when the nodes are still small, drug treatment is actively used. Hormone therapy becomes the basis of conservative correction. Given the important role of regulatory disorders in the origin of the tumor, the following drugs are used to eliminate it:

1. Progestins (Norkolut, Duphaston).
2. Gonadotropin antagonists (Danoval).
3. Agonists of releasing hormones of the hypothalamus (Triptorelin).

In addition to systemic drugs, gynecologists also have local forms of hormonal drugs in their arsenal. We are talking about an intrauterine pharmacological system called Mirena. It contains the progestogen levonorgestrel, which has a local effect directly on the tumor nodes in the uterus. If the fibromyoma is accompanied by profuse menstruation and bleeding, then symptomatic correction is necessary with the help of hemostatics (Dicinon, Vikasol, aminocaproic acid).

Operation

Any pathological process, even of a benign nature, must be eliminated. If conservative correction does not help, and the tumor continues to develop, then it is necessary to involve surgeons in the treatment of uterine fibroids. Surgical intervention is indicated for large tumor sizes (more than 14 weeks), its rapid growth, submucosal localization, complications (pedicle torsion and necrosis), infertility and impaired function of adjacent organs.

Uterine fibromyoma is removed in various ways. Recently, preference has been given to organ-preserving operations, which allow a woman to become pregnant in the future. Such interventions include myomectomy or node enucleation (husking), hysteroscopic or laparoscopic resection. The choice of technique and approach is determined by the location of the tumor, its size and direction of growth. But in advanced cases, when the above methods are no longer effective, radical operations have to be performed:

• supravaginal amputation.
• Defundation (removal of the fundus of the uterus).
• Extirpation (hysterectomy).

Such interventions are more often performed in women of late reproductive and menopausal age, since they do not allow them to carry a child anymore. But low-traumatic techniques completely preserve menstrual and reproductive functions. After the operation, hormonal agents are often prescribed to normalize the regulatory processes of the female body.

Modern treatment of fibroids consists of drug correction and surgical interventions aimed at eliminating the tumor.

Folk methods

Some patients of traditional therapy prefer treatment with folk remedies.

Indeed, there are a number of natural components used to suppress the tumor process in the uterus and normalize menstrual function. But, unfortunately, they do not have proven efficacy and safety, which makes taking such drugs not entirely justified. In addition, the independent use of folk methods can result in serious consequences, ranging from allergic reactions to the progression of the disease.

Therefore, you should first consult with your doctor and not refuse the traditional therapy prescribed by him. And as an addition, you can try to be treated with such means:

1. Tinctures of propolis, Maryina root, walnuts, celandine.
2. Infusions of chamomile, St. John's wort, calendula, boron uterus.
3. A decoction of flaxseeds.
4. Aloe juice.

Any disease is easier to prevent than to cure. Therefore, it is important for women to undergo regular examinations by a gynecologist. Early detection of the tumor will allow you to get better results from conservative therapy. And the later stages, unfortunately, will be almost impossible to cure without surgery. But in any case, the doctor will try to do everything possible to restore the disturbed functions of the female body.

Not all women clearly understand what nodular uterine fibroids are and what complications appear in this case. The tumor is a serious diagnosis, but in some cases it has been in the uterus for years, and the patient does not even know about it. However, there are factors that begin to accelerate its development. Sometimes it is even possible to become pregnant in the presence of large multinodular uterine fibroids.

Description and types of pathology

A fibroid nodule is formed from muscle ligaments and tissue. It is a smooth and dense neoplasm of a round shape. The growth may be single. It is possible to develop several nodules at the same time (multiple nodular tumor). The nodes have a thick base or are attached to the wall of the uterus with a thin stem. They are located closer to the inner surface (submucosa), under the serous (outer) membrane, or in the middle of the muscle layer.

Given the location, the following types of nodular uterine fibroids are distinguished:

• submucosal (submucosal) develops in the uterine cavity;
• interstitial (intramural) develops in the depth of the muscle layer (myometrium);
• subserous develops under the serous membrane, grows towards the abdominal cavity.

The progression of the tumor leads to an increase in the abdomen, as during pregnancy. A strong increase in fibroids corresponds to the growth of the abdomen, which corresponds to a certain week of pregnancy. Therefore, for convenience, the increase in the tumor is estimated both in weeks and in millimeters.

Causes of neoplasm

The main reason for the appearance of fibroids is considered a hormonal disorder in the body. This neoplasm is estrogen-dependent, that is, the development and occurrence are due to an excess of estrogen in the body.

The reasons for the appearance of hormonal imbalance can be endocrine pathologies, the use of hormonal drugs in order to eliminate the violations of the cycle that occurs during menopause, as well as the treatment of infertility. Contraceptive drugs with a high amount of estrogens that activate ovulation also provoke the development of fibroids.

Violation of the hormonal balance also appears in infectious and inflammatory diseases of the genital organs. The presence of polyps, ovarian cysts, endometriosis also leads to an imbalance in the synthesis of sex hormones.

Other factors that contribute to the development of a nodular tumor are:

• uterine injuries that were obtained during gynecological treatment procedures, during an abortion or childbirth;
• heredity;
• depression;
• sedentary lifestyle.

Forms of the development of the disease

There are two forms of nodular uterine fibroids: proliferating and simple.. They differ from each other in the activity of development within the tumor of the vasculature.

simple tumor type

This form is the most common. The fibroid node consists of unevenly distributed cells of muscle and connective tissues. The number of nodes does not exceed four, their dimensions are insignificant - no more than 80 mm. After treatment, relapses, as a rule, are not observed. The neoplasm grows slowly because it has a low ability to divide cells.

A nodular tumor in this form usually appears in women aged 35-40 years. The cause of the tumor is most often inflammatory diseases of the pelvic organs. Very often, this neoplasm appears in women who have experienced severe psychological stress.

In certain cases, during the detection of growths, doctors use surveillance tactics, since the tumor does not increase and may even disappear on its own. For example, during menopause, when the content of estrogen in the blood of a healthy woman decreases very much, the tumor usually resolves over several years.

Proliferating type of growth

This variety most often includes small-nodular intramural fibroids that develop towards the uterine cavity. These neoplasms are tumors that contain a large number of voids, as well as vessels. As a rule, there are more than five nodes. Usually they increase rapidly (up to 90 mm or more), due to this, the shape of the uterus changes.

In addition to vascular enlargement, this condition is characterized by proliferation - the size of the tumor increases due to cell division. These neoplasms are diagnosed, as a rule, in women under the age of 20 or older than 40 years. Proliferating growths can increase rapidly during pregnancy.

The reason for the appearance of fibroids in this form is often a genetic disposition. Most often, there are comorbidities that lead to a change in the amount of hormones, such as ovarian cysts, mastopathy, endometriosis. Very often there are recurrences of a proliferating formation. One way or another, immediate treatment is required.

Possible complications of the disease

One of the dangerous side effects is the torsion of the thin pedicle of subserous fibroids. A complication of this condition is tissue necrosis of the neoplasm, which can lead to peritonitis.

If the nodular uterine fibroid, which has a thick base, begins to increase, then it compresses neighboring organs, making it difficult for them to work and disrupting blood circulation. For example, if the growth begins to compress the intestines, then its normal emptying is complicated. Patients develop constipation and, as a result, hemorrhoids. Squeezing the bladder can lead to the impossibility of complete urine output, the development of inflammation in the organs of the urinary system, the appearance of frequent urges.

Internal neoplasm overlaps the uterine cavity. The result of this may be infertility due to the impossibility of penetration into the tubes of spermatozoa. Various menstrual disorders appear.

Side effects during pregnancy

Most of all, this condition is dangerous when the fibroid begins to grow in size during pregnancy. Filling the uterine cavity, it often interferes with the development and growth of the fetus. Due to a violation of the strengthening of uterine contractions and blood circulation, the threat of miscarriage increases in it. The tumor does not allow the fetus to settle down normally, which in the future can complicate childbirth. Therefore, often with this pathology, a caesarean section is performed.

Important: Women who are planning the birth of a child need to have a complete examination in order to identify and get rid of these neoplasms even before pregnancy.

The appearance of pathology during menopause

During menopause, the cause of the development of neoplasms can be hormonal disorders that appear as a result of gynecological diseases, as well as the appearance of scars after abortions or curettage. An increase in the content of estrogens, which contribute to the development of fibroids, also occurs due to an increase in a person's weight. In certain cases, at this time, due to a hormonal disorder, a tumor progresses, which appeared even before the onset of menopause.

In postmenopause, when the amount of estrogen is consistently low, new tumors do not appear. If at this moment a woman has pain, the lower abdomen increases and bloody discharge forms, then this indicates the development of a cancerous tumor.

First signs and symptoms

Tumor formations depend on the nature of concomitant diseases, size, location.

Nodular fibroids, which are located in the cavity and walls, lead to a violation of the structure of the mucosa and the destruction of blood vessels. Therefore, a characteristic feature is bleeding from the uterus. They are expressed in the form of a protracted menstrual cycle, as well as significant bleeding between them. Regular blood loss leads to the development of iron deficiency anemia. Significant blood loss is quite dangerous, can lead to death.

As a result of the appearance of anemia in a woman, the following symptoms occur:

• general weakness;
• drop in blood pressure;
• pallor of the skin;
• severe headache, nausea, dizziness;
• fainting;
• decrease in body temperature below 36.6 degrees;
• nausea in uterine myoma.

During an increase in the tumor, a woman develops pain in the lower abdomen, which is given to the back and legs. When twisting the legs of the neoplasm, a sharp pain in the abdomen is felt. An urgent operation is needed to remove the growth. If the tumor begins to affect the neighboring organs of the pelvis, then symptoms of a violation of their work appear (painful urination, constipation).

Basic diagnostic measures

During palpation and gynecological examination of the uterus, the specialist determines the presence of nodes,

their approximate size, localization, quantity. For accurate diagnosis of fibroids, methods such as abdominal x-ray, hysteroscopy, and ultrasound are used.

Ultrasound is performed by two methods: transvaginal (using a probe that is inserted into the vagina) and external (abdominal) method. At the same time, the structure of the tumor, location, exact dimensions are determined. It is believed that nodes more than 15-20 obstetric weeks should be removed. Tumors of 8-10 obstetric weeks are usually treated conservatively.

In certain cases, it can be difficult to distinguish ovarian tumors from fibroids. Then laparoscopy is performed - examination of the uterus using an optical device (endoscope), it is inserted through the abdominal wall.

To diagnose tumors with multiple nodes of complex localization, methods such as CT and MRI are also used.

Ways to treat the disease

Taking into account the nature of development, the size of the tumor, as well as the age of the patient, either conservative treatment is performed, or the neoplasm is removed surgically. We describe both methods of treatment.

Conservative therapy option

The main goal is to suppress the growth of minor tumors by reducing the amount of estrogens. The use of hormonal agents in certain cases leads to the disappearance of neoplasms.

Drugs that suppress the formation of estrogen are used. Among them are Norkolut (based on progesterone), Duphaston and Danazol (based on androgens). Birth control pills are used (for example, Janine), which suppress ovulation. To reduce the synthesis of pituitary hormones that stimulate the ovaries, Zoladex is used.

Methods of surgical removal

To get rid of a nodular tumor, minimally invasive intervention methods are often used, such as destruction of the fibroid by ultrasound, current, laser or its freezing, as well as embolization of the uterine arteries.

Taking into account the symptoms and size, only the tumor itself is removed (myomectomy is performed), and if it is multinodular and large, then the uterus itself (hysterectomy). This takes into account the age of the patient. If possible, they try to save even a small part of the cervix. Removal is carried out either through punctures or through an incision in the wall of the peritoneum.

Prevention and home treatment

It must be said that treatment during uterine fibroids must be prescribed only by a doctor after confirming the diagnosis. Treatment at home with the help of folk remedies can only harm, cause bleeding and provoke an increase in the tumor.

If a woman does not have allergies and the doctor does not mind, then potato juice or flaxseed decoction can be used as painkillers and anti-inflammatory drugs.

A woman is advised to follow a diet (do not eat starchy foods and sweets), try to lose weight, for which you need to be physically more active. Attentive attitude to one's health, as well as a proper lifestyle, can help minimize the risks of developing this pathology to a minimum, even during aggravated heredity and predisposition to fibroids.