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One of the most urgent problems is such a gynecological disease as uterine fibroids.
However, there is no need to panic if you are diagnosed with this:
First, you should calm down and understand that fibroids are not a malignant neoplasm, and that there are reliable methods of treatment;
Secondly, it is important to undergo a thorough examination using hardware techniques. Then the diagnosis will either be refuted or confirmed for certain.
Here we look at the most important questions about uterine fibroids, talk about the likely causes of its occurrence, symptoms and methods of treatment.
Uterine fibroids – what is it?
Hysteromyoma – This is a disease of the female genital area, characterized by the formation and growth of a benign tumor in the myometrium – the muscular layer of the uterus. Most often, the problem of uterine fibroids is faced by women in the age group from 30 to 40 years and older. However, at present, fibroids are significantly “younger”, and cases of the disease in young women at the age of 20-25 are not uncommon.
Uterine fibroids is a tumor (formation, node) located inside the body of the uterus (in 95% of cases, less often in the cervix – 5%). Fibroids can develop from both muscle and connective tissue cells.
Obstetrician-gynecologists indicate the size of fibroids either in centimeters (the size of the node itself) or in weeks. The phrase “myoma 12 weeks” means an increase in the uterus with a myomatous node to the same size as with a period of 12 weeks of pregnancy.
By location relative to the muscle layer – myometrium – fibroids are classified as follows:
Intermuscular (or intramuscular, or interstitial, or intramural) – the node is located inside the myometrium;
Subperitoneal (or subserous) – the node is located under the mucous membrane of the outer layer of the uterus, near the peritoneum;
Submucosal (or submucosal) – the node is located under the internal mucous membrane of the uterus, in the cavity of the organ;
Interligamentous (or intraligamentary) – the node is located between the wide uterine ligaments.
There are fibroids on the leg, but their localization is exactly the same as we listed above.
Sometimes a diffuse form of fibroids is diagnosed, in which the node as such is absent, but diffuse growth of the myometrium occurs.
What is the difference between fibroids and uterine fibroids?
All types of fibroids are formed from two types of tissue: muscle and connective. The predominant composition of the tumor determines its belonging to the type of fibroids. If it is dominated by muscle fibers, then this is a fibroid. If connective fibers predominate, which are mixed with muscle fibers, then this is fibromyoma. And if the tumor consists entirely of connective tissue, then it is called a fibroma.
Symptoms of uterine fibroids
Symptoms of uterine fibroids depend on the age of the node, the age of the woman, the size and location of the tumor, the growth rate of the myoma node and the presence of other chronic diseases. Sometimes fibroids are almost asymptomatic and are detected only at the next medical examination.
The most common and characteristic symptoms of uterine fibroids:
Pain in the intermenstrual period, different in duration, occurring in the lower abdomen, sometimes radiating to the lumbar region, upper abdomen or legs;
Menstrual disorders. These can be changes in the duration of the cycle in the direction of reduction or increase, increased pain in menstruation, an increase in the volume of blood loss during menstruation (menstrual uterine bleeding), intermenstrual bleeding;
Problems in the reproductive sphere (possible development of infertility).
With the rapid growth of uterine fibroids or with a large size of the myomatous node, the volume of the abdomen can increase without adding body weight, as well as discomfort and constant aching and pulling pains in the lower abdomen, which intensify after physical exertion and emotional and psychological experiences.
With compression of nearby organs by the myomatous node, persistent constipation occurs, as well as frequent, sometimes painful urination.
When the leg of the myomatous node is twisted, necrosis (necrosis) of the body of the fibroid develops, and then the clinical picture of the “acute abdomen” is observed: sharp pains in the lower part of the peritoneum, palpitations, cold sticky sweat, fainting. This situation requires urgent surgical care.
Other symptoms of uterine fibroids can be expressed in violation of the functions of organs indirectly affected by the pathogenesis:
The development of anemia (with frequent bleeding);
Dizziness;
Frequent headache;
Pain behind the sternum;
Neuroses and neurosis-like states due to thoughts about the growth of a tumor, the danger of a disease.
Symptoms of uterine fibroids in the early stages
The first signs of uterine fibroids are usually observed when a woman has a myomatous node measuring 2-6 cm or more:
The appearance of sharp pains of a cramping nature not associated with menstruation in the lower abdomen;
Painful menstruation, although this was not the case before;
Increased menstrual bleeding;
The appearance of bleeding in the intermenstrual period;
Heavy bleeding between periods;
Lengthening or shortening of the menstrual cycle;
Inability to conceive a child.
Causes of uterine fibroids
Research in the field of medicine allows us to identify several possible causes of the development of uterine fibroids:
Genetic factor (hereditary predisposition);
Imbalance in the hormonal sphere;
Pathological growths of the endometrium (the inner lining of the uterus);
The consequences of multiple or frequent abortions and the use of intrauterine devices;
Infectious and inflammatory processes of the female genital area;
Chronic stress conditions;
Diabetes mellitus and other endocrine diseases, including obesity;
The presence of chronic diseases of various internal organs and body systems;
Hypodynamia;
Lack of regular sex life and sexual satisfaction.
Let’s look at some of the reasons in more detail.
Excess estrogen, lack of progesterone. Uterine fibroids are considered a hormone-dependent disease – the tumor is formed against the background of an imbalance in female sex hormones. Therefore, the development of fibroids is typical for women of childbearing age. Myoma does not occur in girls before the onset of the first menstruation and in women in the menopausal and postmenopausal period. Studies have shown that the occurrence, growth and development of a tumor is affected by an imbalance in the production of female sex hormones – estrogen and progesterone.
Violation of the menstrual cycle, in which the production of estrogen is increased, can lead to the development of uterine fibroids. Obesity exacerbates the risk of disease, because. adipose tissue also produces estrogen. An increase in the level of estrogen entails a violation of the ratio of hormones estrogen – progesterone in a woman’s body.
In addition to increased production of estrogen, metabolic disturbances in its synthesis and the balance of its fractions (estrone and estriol) are often observed in different phases of the menstrual cycle. Therefore, if myoma is suspected, it is important to conduct a study of the hormonal status.
The number of pregnancies, childbirth, abortions. An important factor in the examination is to find out the total number of pregnancies in a woman, as well as their outcomes – childbirth, miscarriage (abortion). Abortions and miscarriages increase the risk of developing fibroids. Pregnancies ending in childbirth, especially with subsequent breastfeeding, are reduced.
Traumatic, difficult childbirth, diagnostic curettage of the uterine cavity, frequent and multiple medical abortions (including “mini-abortions”) can be the root cause of the development of fibroids.
Woman’s nutrition. Improper nutrition also leads to a violation of the hormonal balance. The predominance of refined foods, trans fats in the diet, an insufficient amount of fiber can cause an increase in the formation of female sex hormones and their imbalance. An unhealthy diet also leads to obesity, which, as we have already indicated, is a risk factor for the development of fibroids (Learn more about what you can and cannot eat with uterine fibroids).
If a woman’s diet is balanced, contains a large amount of plant foods, seafood, complex carbohydrates (cereals), few fats and sugars, the risk of developing fibroids is significantly reduced. Outwardly, women who eat right look young and attractive, they are full of health, strength and energy.
Lack of orgasm during sexual intercourse. The fullness of a woman’s intimate life also affects the occurrence of uterine fibroids. Irregular or infrequent sexual intercourse, lack of orgasms leads to stagnation of venous blood in the small pelvis. A chronic condition of venous stasis can provoke hormonal instability and the occurrence of a tumor.
Diabetes mellitus and hypertension. The risk of developing fibroids is increased by diseases such as diabetes mellitus (impaired production of the hormone insulin) and hypertension. The risk increases if a woman becomes ill at a young age, before the age of 35.
Other possible causes of uterine fibroids:
Obesity of the “apple” type;
Oral contraception with hormonal drugs;
Injuries and diseases of the female genital area;
Prolonged exposure to the ultraviolet spectrum of direct sunlight and in solariums.
Why is uterine fibroids dangerous?
Uterine fibroids pose a danger to a woman’s health in terms of the development of complications of the disease. With regular monitoring by the attending gynecologist and careful attention to her health, a woman can significantly reduce the risk of complications.
Therefore, you should be aware of possible potential problems:
Massive uterine bleeding is dangerous both in itself as a threat to life and the development of anemia;
Torsion of the myomatous node on a thin stalk. It is fraught with the development of the picture of “acute abdomen”. Requires immediate operational assistance;
Necrosis of the myomatous node. necrosis of fibroid tissue. More often occurs with involution (reduction) of the uterus after childbirth, up to the 40th day. Immediate surgical assistance is also required;
Malignancy of the myomatous node – the degeneration of the tumor from benign to malignant. According to studies, it occurs in 1,5 – 3% of all cases, which does not detract from the risk of complications;
The birth of a myomatous node with submucosal myoma – occurs with an eversion of the uterus;
Violation of the reproductive activity of a woman – the development of an ectopic pregnancy, spontaneous miscarriages, premature and complicated births, infertility;
The development of purulent processes in the myomatous node and surrounding tissues. Inflammatory processes without medical attention can lead to severe septic complications.
Women diagnosed with uterine fibroids should be regularly observed by a gynecologist. At the slightest change in your state of health, you need to seek medical help to avoid all of these complications.
How to treat uterine fibroids?
There are two main treatments for uterine fibroids:
Conservative treatment – with the help of medications and non-invasive procedures.
Surgical treatment – through surgical intervention.
The choice of treatment method depends on the severity of the clinical symptoms of uterine fibroids, the size of the myomatous node, the age of the woman, and the intention to have children in the future.
The conservative method is based on the use of hormonal drugs orally and by injection, as well as symptomatic therapy (pain relief, treatment of anemia, reduction of blood loss, etc.).
Conservative therapy is effective only for curbing tumor growth. It is impossible to eliminate uterine fibroids conservatively. Therefore, a non-surgical method of treatment is used mainly in women in older childbearing age. At the same time, the growth of the tumor is restrained until the onset of the menopausal period. At this time, the probability of self-resorption of the tumor is high.
Basic principles of conservative therapy of fibroids
Non-surgical treatment of uterine fibroids is a set of measures, including adherence to an appropriate diet, the use of immunomodulators, herbal medicine, permitted physiotherapy procedures, and the use of hormonal drugs.
The course of treatment consists of the following stages:
Anti-inflammatory therapy of infectious processes in the gynecological sphere;
Activation of the immune system with special preparations;
Adjustment of diet and diet;
Normalization of the endocrine system;
Formation of an even psycho-emotional background;
Elimination of bleeding;
Treatment of anemia;
Bringing the menstrual cycle back to normal.
When is an operation to remove the uterus for fibroids indicated?
Indications for radical surgical treatment of uterine fibroids:
Tumor sizes from 12 weeks (bulky tumor compresses neighboring organs, blood vessels, interfering with their normal functioning);
Rapid growth of the myomatous node (from 4 weeks per year);
Myoma is the cause of massive bleeding;
Severe pain syndrome;
Torsion of the leg and necrotization of the myomatous node;
The birth of a submucosal myomatous node;
The combination of endometriosis and fibroids;
Suspicion of malignant fibroids.
Embolization of the uterine arteries – a modern unique method for the treatment of fibroids
The essence of the method is to block the blood flow through the arteries that feed the myomatous node. This non-invasive operation is performed in an X-ray operating room. A catheter is inserted into the femoral artery, through which a special embolizing (clogging artery) drug is passed. The operation is performed under local anesthesia and radiopaque control. For a woman, everything is painless.
In the future, without blood supply, the tumor decreases in size and completely disappears. There were no relapses after such treatment.
FUZ-ablation
MRI-guided FUS ablation of fibroids is a non-invasive treatment for uterine fibroids. The essence of the method: heating the cells of the myomatous node with the help of a directed ultrasonic pulse in order to kill them.
At the first stage of treatment, the doctor plans the whole process in the study using MRI. At the second stage, while continuing to control the process by means of MRI, the doctor sends ultrasound pulses to the tumor node. The cells of the node are heated to a certain temperature, as a result of which they die. After that, the doctor performs directed tissue cooling. There will be several such short sessions of ultrasound exposure, depending on the size of the tumor. MRI allows you to track the degree of tissue destruction and adjust the power of the ultrasound beam.
In general, FUS ablation can take up to 4 hours. The third stage of the procedure is a control magnetic resonance scan using a radiopaque substance.
Advantages of the FUS ablation method:
Non-invasiveness;
No need for anesthesia, postoperative care, intensive infusion therapy;
Absence of complications and side effects – blood loss, fever, intoxication;
Preservation of the uterus and reproductive activity, respectively;
Short terms of rehabilitation;
Absence of relapses in the development of myomatous nodes;
High efficiency of the method even in the presence of multiple and large nodes;
Significant reduction in the size of fibroids immediately after treatment;
Quick relief from the unpleasant symptoms of the disease.
During the procedure, the woman needs to lie still. Due to a long stay in the prone position, discomfort may occur in the neck, feet, knees. All changes in your condition should be reported to the nurse and the doctor conducting the treatment.
The following symptoms should not be tolerated:
Burning or stabbing pains in the lower abdomen;
Stitching and shooting pains in the back, small of the back, region of the sacrum, and in the legs.
What can a doctor prescribe?
With conservative therapy, several groups of medicines are used. Let’s consider each in more detail.
Combined oral contraceptives
The combination of ethinyl estradiol and desogestrel:
Treatment with contraceptive preparations containing combinations of 2 hormones is effective in reducing the severity of pain and reducing bleeding. From therapy with such drugs, one can expect a reduction in the size of only those tumors that initially had a size of up to 1,5 cm.
Gonadotropin-releasing hormone agonists
The action of these drugs is based on the creation of a temporary “artificial menopause” in a woman’s body. Under the action of hormones, ovarian function is suppressed. Agonist drugs (analogues) of natural gonadotropin-releasing hormones (AGHRH) inhibit the production of pituitary sex hormones that affect the functioning of the ovaries.
Under the influence of AGRG, the ovaries “fall asleep”, ovulation does not occur, the uterine mucosa does not change cyclically – menstruation stops. This process is completely reversible, after the abolition of drugs, all functions are restored. Treatment lasts no more than 6 months. During this period, the size of the tumor can decrease up to 50%, the symptoms of fibroids become less pronounced.
Cons of using drugs:
Possible full recovery of tumor size after discontinuation of treatment;
It is forbidden to take drugs for a long time (longer than 6 months) due to the high risk of osteoporosis and other complications of insufficient estrogen levels.
It is advisable to prescribe AGRG before surgery for uterine myoma in order to reduce the size of the tumor.
Antiprogestagen
Like GRH agonists, drugs in this group are used before surgery to remove uterine fibroids. Under the influence of hormonal therapy, myomatous nodes decrease in size, the symptoms of uterine fibroids weaken.
Antigonadotropins
The action of antigonadotropins is to reduce the intensity of symptoms without reducing the size of the tumor. Often, when they are used, undesirable side effects occur (increased hair growth on the face and body, a change in the timbre of the voice, the appearance of rashes).
Antigonadotropins are used to treat uterine fibroids quite rarely, only in the absence of the effect of treatment with other hormonal drugs.
Gestagens
To date, the use of gestagens is becoming less and less justified. Some gynecologists consider the use of gestagens effective, because. With a lack of progesterone, tumor growth occurs. Many doctors, on the contrary, speak out categorically against the use of any gestagens for the treatment of fibroids. The mechanism of tumor formation is not based on the amount of any hormone, but on the imbalance of the entire hormonal system of a woman.
Currently, the use of gestagens is prescribed for a combination of uterine fibroids and endometrial hyperplasia.
Recent research
Scientists from the University of Brussels conducted research at St. Luke’s Hospital to understand how the contraceptive drug Esmya acts on uterine fibroids. As part of Esmya tablets, the main active ingredient is ulipristal acetate. And since in the process of development and growth of fibroids, the level of not only estrogen, but also progesterone matters, it was decided to study the effect of Esmya and progestogen blockers.
The experiment involved 550 women who were shown surgical treatment of uterine fibroids. All subjects were divided into two groups. One group was given a placebo as a “treatment” for 3 months, the other was given Esmya tablets.
In parallel, another study was conducted: a comparison of the action of Esmya and injections of progestogen hormone blockers.
The results of two experiments revealed the following:
After the use of Esmya, the size of uterine fibroids is reduced, the intensity of the symptoms of the disease is reduced;
90% of the studied patients noted a positive effect from taking Esmya tablets;
In 50% of patients who took Esmya, the need for surgical treatment disappeared (the effect is similar to the use of injections of progestogen blockers);
After taking Esmya tablets, there are no such side effects as when using injections of hormone blockers – hot flashes, degeneration of bone tissue;
After treatment for 6 months, there was no resumption of tumor growth, whereas after the cessation of injections of hormone blockers, myomatous nodes began to grow again.
It is likely that thanks to the efforts of scientists, the problem of uterine fibroids will soon be solved much faster and easier than at present.
Prevention of uterine fibroids
Since uterine fibroids is an urgent problem, due attention should be paid to the prevention of this disease from a young age. Although there is no single theory for the occurrence of fibroids, it is worth trying to prevent all possible causes of the tumor.
Stress. Cultivating psychological comfort within yourself is what every woman should strive for. Of course, stress cannot be completely avoided. However, you need to learn how to respond correctly to conflict situations, not to carry in your soul resentment, unspoken claims and many years of experience. Learn more about stress and how to manage it ➤
Healthy lifestyle. A balanced diet, optimal physical activity, sufficient exposure to fresh air, hardening procedures, compliance with the regime of work and rest – at first glance, banal truths can really help in maintaining women’s health.
Weight control will avoid obesity, which, as we have indicated, is a risk factor for the development of uterine fibroids. Every extra 10 kg of weight increases the likelihood of disease by 20%.
The diet should include a sufficient amount of fresh vegetables and fruits, whole grains, replace simple carbohydrates with complex ones. You should drink plenty of clean water, especially during the hot season.
Regular physical exercises help to improve the activity of the endocrine system in general and the sex glands in particular. The acceleration of blood flow improves the supply of oxygen to the pelvic organs, which improves all metabolic processes in the gynecological field.
After physical exertion, it is optimal to carry out water hardening activities – a contrast shower, douches, rubdowns.
Medical supervision. Every woman should at least once a year, and preferably once every six months, undergo an examination by a gynecologist. If necessary, the doctor will prescribe an ultrasound of the pelvis. In no case should such an examination be neglected, based on the fact that “nothing bothers.” Detection of fibroids in the early stages will make it possible to dispense with a non-invasive or conservative method of treatment.
Contraception, family planning. It is extremely important to organize rational contraception in order to avoid interruption of an unwanted pregnancy. Contraceptive issues should be discussed with a gynecologist. Often the best choice will be the use of oral contraceptives, which is another preventive factor against the occurrence of uterine fibroids. You just have to choose the right drug.
With a genetic predisposition to the development of uterine fibroids in a young woman, it is necessary to keep the first pregnancy.
Childbirth at the optimal age (the first – up to 22 years, the second – up to 25, the next – up to 35 years) followed by breastfeeding reduces the risk of developing a tumor, and sometimes contribute to the resorption of existing fibroids. The state of motherhood, the period of lactation provides not only a harmonious psychological state of a woman, but also normalizes the level of sex hormones in the body.
Harmonious intimate life. Regular, full-fledged sex life with the obligatory achievement of orgasm with each sexual intercourse significantly reduces the risk of developing any tumors in the gynecological sphere, including fibroids. This is due to the acceleration of blood flow throughout the body and in the small pelvis in particular, a comfortable psychological state, and an increase in the work of the endocrine system.
“Climate control”. All women should be aware of the prevention of both general and local (pelvic area, thighs, buttocks, feet) hypothermia. It is necessary to avoid a long stay in a wet swimsuit, as well as sitting on wet ground, stone and other cold surfaces, even in summer on hot days.
Linen should be natural, because. synthetic fabrics in the cold contribute to rapid freezing, and in the heat – sweating. Clothing that is too tight, squeezing the body can also disrupt heat transfer.
If symptoms of inflammatory processes (pain, discharge, fever) occur, you should immediately contact a gynecologist to prescribe timely treatment. If you do not pay attention and wait that “everything will pass by itself”, you can contribute to the development of a focus of a chronic inflammatory process.
Ultra-violet rays. Women should not abuse exposure to the sun and tanning beds, under direct ultraviolet rays. Before sunbathing, it is necessary to apply a special protective cream to the skin.
Vitamins and minerals. In addition to eating healthy foods, it is important for a woman to periodically take additional vitamin and mineral complex preparations. Specifically, it is better to discuss this step with your doctor, who will prescribe a complex containing iodine, iron, magnesium, copper, selenium, zinc, as well as vitamins A, C, E with antioxidant properties.
Answers to popular questions
Is pregnancy possible with uterine fibroids? Yes, in the presence of fibroids, pregnancy is possible. It all depends on the size of the myomatous node and its location. If the knot does not prevent the fertilized egg from passing through the fallopian tube and implanting into the wall of the uterus, pregnancy occurs. The development of pregnancy should occur with the regular observation of a woman by an obstetrician-gynecologist.
Is it possible to give birth with uterine fibroids? It is possible, but each case is individual. The question of the management of childbirth (naturally or through a caesarean section) should be decided by your obstetrician-gynecologist.
Taking birth control pills for uterine fibroids. Since the fibroid is “younger”, and young sexually active women suffer from the disease, the issue of contraception is very relevant. With myoma, in the absence of individual contraindications, monophasic and combined hormonal contraceptives can be used. Oral contraceptives help regulate the menstrual cycle and reduce bleeding.
Is it possible to do massage with uterine fibroids? With fibroids complicated by bleeding, constant pain in the lower abdomen, rapid growth of the tumor, if malignant degeneration is suspected, massage is absolutely contraindicated! With uncomplicated myoma, massage is possible, but excluding the following areas of the body: lower abdomen, lumbar region, thighs, buttocks. Gynecological massage is also contraindicated in any uterine myoma.
Is it possible to sunbathe with uterine fibroids? No, you can not sunbathe either under direct sunlight or under solarium lamps. It is impossible to allow overheating of both the local area in the lower abdomen and the body as a whole – in order to avoid the growth and degeneration of the tumor.
Is it possible to play sports with uterine fibroids? In the absence of pain and intermenstrual bleeding, it is possible, but subject to several rules.
You should refrain from:
Weight lifting exercises;
Torsion of the hoop with weighting (sand, suction cups);
Dance life;
Use of warming belts.
Is contraception possible with a spiral for uterine fibroids? No, a conventional spiral cannot be used for uterine fibroids. In the absence of contraindications, contraception with a special Mirena coil for the treatment of fibroids is possible. The usual spiral increases bleeding during menstruation. When using the Mirena spiral, pain during menstruation is completely absent, and bleeding becomes scarce.
How to confirm the diagnosis of “uterine fibroids”? You should undergo a gynecological two-handed examination with palpation and ultrasound with a vaginal probe. Usually these two methods are sufficient. If necessary, computed tomography, magnetic resonance imaging, biopsy diagnostics, hysteroscopy are prescribed.
Is it necessary to undergo treatment if there is a small subserous myoma nodule of 2 cm? Yes. In any case, treatment of fibroids is necessary. In such a situation, conservative methods (without surgery) are indicated.
Do fibroids continue to grow during pregnancy? In the first two trimesters, there is a slight growth of the tumor. In the third trimester of pregnancy, the growth of fibroids stops.