Uterine fibroids: symptoms and signs. Dimensions for the operation and the prognosis for life

Fibroids - this is one of the most common gynecological pathologies noninflammatory nature, which, in the opinion of many of today's professionals, not a true tumor.

Is a benign, hormonally controlled hyperplasia of the muscular layer of the uterine wall of mesenchymal origin, which develops as a result of somatic cell mutations, occurring under the influence of various damaging factors.

It is presented in the form of a tumor consisting of intertwined muscle and connective tissue fibers. In clinical practice, found the body of the uterus myoma and uterine cervix.

What it is?

Uterine fibroids - a benign tumor that occurs in the muscle layer of the uterus - the myometrium. It is one of the most common diseases in women, reaching a rate of 12 - 25% of all gynecological diseases.

The highest incidence of uterine myoma falls on the late reproductive period and before menopause. It is believed that the true prevalence of fibroids is much larger and reaches more than 70% both in Russia and abroad.

The causes of uterine fibroids

Fibroids is polyetiological disease, a role in the development of which can play the following risk factors:

• hormonal imbalance;
• inflammatory pathology of the female reproductive system;
• the use of intrauterine contraceptive, e.g., helices;
• complicated during childbirth;
• performing abortions;
• adenomyosis;
• obesity;
• disease of the thyroid gland, adrenal glands, organs of the hypothalamic-pituitary system.

Fibroids is hormone-dependent tumors, proof of which are the following facts:

• detected in tumor tissue receptors to sex hormones;
• usually after menopause and slump levels of sex hormones, tumor regress;
• fibroids often appears in women of reproductive age in the body that are experiencing high levels of estrogen;
• After menopause, fibroids can occur in women who are taking estrogen-containing agents.

Classification

Depending on the location of fibroids, there are several terms in clinical practice:

1. uterine fibroids on the leg - is not a separate gradation, because the leg can be submucosal fibroids and subserous. Within the definition of resolution can be marked legs myoma on a wide or a narrow base.
2. Interstitial or intramuscular fibroid - the tumor is located in the muscular wall of the uterus.
3. Submucosal, or submucosal fibroids - a tumor grows inside the uterus directly under the mucous membrane and enters the uterine lumen.
4. Subserous fibroids - tumor located on the outside surface of the uterus and is separated membrane, which separates the uterus and abdominal organs.

The first signs of uterine fibroids

In the initial stage of small size hysteromyoma noticeable symptoms is not accompanied. It can be detected at the next gynecological examination.

As the growth of uterine fibroids first symptoms may occur:

• long, heavy and irregular menstruation;
• constipation;
• infertility;
• bleeding;
• anemia;
• frequent urination;
• heaviness and constant pain in the abdomen;
• spotting during sexual intercourse;
• back pain;
• abdominal enlargement is not associated with significant weight gain;
• Frequent miscarriages.

The dangerous uterine fibroids on the leg? When twisting "legs" occurs inflammation and tumor gap. It causes severe bleeding, severe abdominal pain and fever. This condition can be fatal.

symptoms

With larger units there is dysfunction of adjacent organs: constipation, disturbances of emptying the bladder, frequent urination. In some cases, tumor nodes can cause compression of the ureter with a further violation of the outflow of urine from the kidney, leading to kidney destruction. The symptoms of compression of adjacent organs often occur when large amounts of units and lower nodes localization.

1. Interstitial uterine fibroids (with intermuscular location nodes) leads to longer, abundant and painful menstruation. Very often heavy, prolonged and painful menstruation observed in the combination of uterine fibroids and adenomyosis. Also, when growth intermuscular node of it can grow towards the uterine cavity. With such marked localization fibroids the same symptoms as in the submucous node growth, and their severity depends on the submucous node fragment sizes.
2. For submucosal location node (submucous myoma) most typical heavy menstruation, and in large size, when the assembly It begins to occupy a large area of ​​the uterus, bleeding from the genital tract lose their cyclicity, and sometimes not at all terminated. With this arrangement, a node in a patient due to heavy bleeding from the genital tract is almost always anemia. Submucosal fibroids can give pain cramping in nature, most often occurring in the days of menstruation. Submucous node represents a kind of "foreign" to the body of the uterus, from which it is trying to escape. Sometimes, these sites can even self "to be born." This process is accompanied by a very strong cramping pains and bleeding.
3. Subserous (subperitoneal) fibroids often manifests clinically pain symptoms. Localized pain in the abdomen and / or back. Their appearance is connected with the tension of the uterine ligament apparatus and the pressure of the growing fibroid on the nerve plexus of small pelvis. In case of violation of circulation in the site of pain is acute and very intense.

Pain is accompanied by the development of fibroids in three women and can have different origins. In interstitial sites of small size are marked painful menstruation. Constant aching pain observed in patients with severe growth nodes. When node necrosis pronounced pain syndrome, may experience a rise in body temperature, phenomena of intoxication. Also emergency situation may occur in the presence of the patient subserous nodes "on the leg." When thin "leg" assembly torsion occurs; disturbed food in the node. This is often manifested acute condition: severe pain, with the possible development of peritonitis. This situation requires urgent surgical intervention.

Diagnostics

Diagnostic process in suspected myoma formation involves the following activities:

1. Anamnesis. Particular importance is given to the patient's age criteria, such as myoma pathology is found predominantly in women of reproductive age. As a rule, women have complaints regarding menstruation, which may become more persistent, heavy, painful, irregular.
2. Ultrasound diagnosis malotazovyh bodies helps accurately identify myoma formation, define its parameters, location.
3. Gynecological examination. Performed on the gynecological chair with the necessary tools. Taking into account the mother body size, the location of the ovaries, cervix shape and motility and so forth.
4. Diagnostic curettage. Usually it conducted to determine the endometrial changes, and also to avoid cervical or uterine cancer.
5. Gisterograficheskoe study. Hysterography relates to radiopaque techniques allowing visually see the uterine cavity. For this patient in the uterine body injected contrast agent, and then the picture is taken.
6. Laparoscopy. This technique relates to surgical methods. The laparoscope is inserted through the puncture in the peritoneum, and outputs the monitor image of the studied organ. During the procedure, it is possible to obtain a biomaterial for histology or removing small tumors, and so on.
7. Hysteroscopic study. It helps to visualize the uterine cavity. Performed by using a special apparatus that is inserted into the uterus. Such a method is not only a diagnostic purpose, but also therapeutic. In this way, different polyps removed, prepared for histological examination biomaterial.

The approach to the treatment of uterine fibroids is determined in accordance with the formation step.

Than to treat uterine fibroids?

There are two main methods of treatment of uterine fibroids:

1. Conservative treatment - with medication and non-invasive procedures.
2. Surgical treatment - through surgery.

The choice of treatment depends on the severity of clinical symptoms of uterine fibroids, myoma node sizes, the woman's age, intention to have children in the future.

The basis of the method laid conservative use of hormonal drugs inside and injection, as well as symptomatic therapy (pain, treatment of anemia, decrease of blood loss, etc.). Conservative therapy is only effective for the containment of tumor growth. conservatively eliminate uterine fibroids impossible. Therefore, non-invasive treatment method is mainly used in women in the older age of childbearing.

In this constrained increase in tumor before menopausal period. At this time, the probability of self-sucking tumor.

fibroid treatment without surgery

Non-surgical treatment of uterine fibroids is a complex of measures, including the observance of proper diet, the use of immunomodulators, herbal medicine, physiotherapy allowed, hormonal drugs.

The treatment consists of the following steps:

• Anti-inflammatory therapy of infectious processes gynecological;
• Activation of the immune system with special preparations;
• Adjustment of diet and diet;
• Normalization of the endocrine system;
• Formation of smooth psycho-emotional background;
• Elimination of bleeding;
• Treatment of anemia;
• Actuation of the menstrual cycle back to normal.

In the home treatment of uterine fibroids without surgery is the use of the following drugs:

1. Antiprogestageny. As a preparatory treatment before surgery or to treat fibroids often use "Mifepristone» (RU-486). This drug is not only eliminates the symptoms of disease, but also helps to reduce the formation of sizes.
2. Agonists of gonadotropin-releasing hormone. For drugs in this group include: triptorelin - (Dekapeptil, Diferelin, Dekapeptil depot), buserelin, goserelin (Zoladex), leuprorelin (Lyukrin depot). A disadvantage of the use of these agents in the treatment of uterine fibroids is that after the end of treatment units can be reduced in size, and long-term the use of these drugs is not acceptable since it can lead to the development of osteoporosis and other consequences for the female body due to lack of estrogen. Within six months, the use of these means, fibroids dimensions may be reduced by 50%, and also may decrease the intensity of symptoms fibroids. Often these drugs are used to reduce the size of uterine fibroids before surgery to reduce blood loss during surgery.
3. Combined oral contraceptives. These include combinations of: desogestrel with ethinyl estradiol (Mersilon, Marvelon, Novinet), ethinyl estradiol with norgestrel (Ovidon, Rigevidon). These tools help to effectively reduce the symptoms of uterine fibroids, such as pain in the abdomen, bleeding. However, for treatment of uterine fibroids to reduce its size, the tablets of this group is not a priority, as it does not always lead to a decrease of nodes. Under the action of this therapy only nodes, the original size which does not exceed 1.5 cm., May be reduced in size.
4. Progestins. The use of such media today is a controversial issue, since some doctors believe that the use of such preparations, and in particular of dydrogesterone ( "Djufaston") uterine myoma unacceptable. Others believe that the use of this medication is justified because it is the lack of progesterone is the cause of fibroid growth. Efficacy of therapy such means as lynestrenol ( "Orgametril", "Esklyuton") medoksiprogesterona acetate ( "test" "Depo Provera"), nor-ethisterone ( "Norkolut", "Primolyut Nord") is not proven for uterine fibroids, so many gynecologists do not recommend this drugs. However, use of these agents in combination endometrial hyperplasia and uterine myoma justified. The growth of fibroids is not just from a deficiency or excess of a hormone, but rather by an imbalance between hormones, so the use of these drugs should not be undertaken everywhere, and in the presence of readings.
5. Antigonadotropiny. Danazol (Vero danazol, danazol, Danoval, Danol, Danogen), gestrinone (Nemestran). Uterine fibroids, treatment with these drugs is rarely used, because they can not reduce the size of the nodes, but only help to reduce the intensity symptoms of fibroids, moreover, they have a number of undesirable side effects, such as the occurrence of acne, voice changes, hair growth on the body and face. These medications when myoma only be applied while the low efficiency of other treatments.

FUS ablation of fibroids

Treatment for fibroids, is the heating of tissue knots vysokointensivym focused ultrasound, by transmitting large amount of energy in a clearly localized area which comes after the application node tissue destruction - thermal necrosis. The principle of operation is very similar to the concentration of the sun's rays magnifying glass. The peak of development of the method is by far the combination of focused ultrasound source (transmitter mounted on the table) and the MRI apparatus. Conducting ultrasound through the anterior abdominal wall. MR scanner monitors the location and most importantly the heating temperature in real time.

The method allows for the destruction of well-defined area, without damaging healthy tissue. The area between "the treated" and healthy tissue is only a few rows of cells. Thus focused ultrasound today closer than ever closer to the notion of the "ideal surgical instrument" procedure is not It requires the introduction of instruments into the body cavity, anesthesia and hospitalization, but can not in all cases, and requires the correct selection patients. Substrate for exposure of focused ultrasound is a connective tissue located in the uterine.

Connective tissue stores energy well, and allows you to reach the required temperature for thermal necrosis. Thus, very well treated by FUS amenable to the so-called fibroids, which make up 70% of all fibroids. Leiomyomas, or fibroids cell is absolutely not suited to treatment by FUS due to the absence of the substrate for high intensity exposure and blood supply that does not allow for sufficient heat tissue.

The period of testing method and its introduction into clinical practice of improper selection of patients is the cause of frequent relapses and erroneously interpreted as an ineffective method. To assess the possibility of focused ultrasound ablation patients need to undergo MRI in determining the type of fibroids. In recent years, numerous works of various authors, based on retrospective studies of patients treated, The high efficiency of the method is not inferior to that of other methods of treatment of uterine fibroids, subject to the right application.

Indications for use of FUS ablation against standard uterine fibroids are the indications for the treatment of organ-uterine myoma. Depending on the clinical challenges posed by a gynecologist, application techniques may in four tactical options. 1. Organosberegajushchih treatment of uterine fibroids. 2. Prevention of clinical manifestations of uterine fibroids (eliminating the expectant outpatient practice in relation to the growth of fibroids). 3. Site preparation for transcervical fibroid myomectomy (as a result of FUS-destruction reduced node size and the intensity of the blood flow, which significantly reduces the risk of possible complications and facilitates surgery); 4. In order to postpone surgery.

Unlike other methods, MRgFUS ablation of uterine fibroids - a non-invasive, organ-preserving method, without hospitalization, no pain, the woman retains the highest possible chances in comparison with other methods of a successful pregnancy, it has a minimal complication rate among all of the methods of treatment of uterine fibroids (currently less 0,05%). The method has been recognized in many countries CE (Europe), FDA (USA), MHLW (Japan), CFDA (China), ANVISA (Brazil), Canada FDA, KFDA (Korea), of Russia, and Taiwan.

Uterine artery embolization (EMA)

This is the introduction of special plastic balls in the uterine artery to stop the blood supply to certain areas of the uterus and fibroids. EMA procedure has very limited indications for use and is used mainly in women older than 40 years with submucous myoma nodes and severe uterine bleeding.

Application of the methods of uterine artery embolization in women of reproductive age, according to the recommendations of the European and the American Society of Obstetricians and Gynecologists is prohibited. In the literature, there is a huge number of publications that illustrate the consequences of poorly performed uterine artery embolization. As a rule, these are young nulliparous women aged 25-35 years who have been unable to have children as a result of embolization procedures regarding small fibroids, not demanding treatment.

When shown the operation to remove the uterus with fibroids?

Indications for radical surgical treatment of uterine fibroids:

1. Tumor size of 12 weeks (tumor volume compresses the adjacent organs, blood vessels, interfering with their normal operation);
2. The rapid growth of myoma node (4 weeks per year);
3. Fibroid is causing massive bleeding;
4. Severe pain;
5. Torsion of the legs and necrotic myoma node;
6. Birth submucous myoma node;
7. The combination of endometriosis and uterine fibroids;
8. Suspected malignancy fibroids.

Depending on the size, location and type of fibroids doctor selects the most suitable type of surgery to fix it. Myomectomy today in three ways:

• laparoscopy - through a small opening in the abdomen;
• through the vagina with a special tool - hysteroscopy;
• lane operation - open pit, through an incision in the lower abdomen (very rare);
• sparing surgery if possible, and stop the growth of fibroids in other ways not possible, the treatment involves a complete resection of the uterus - a hysterectomy.

Hysterectomy and laparotomy are the most popular methods of operation, because they have several advantages: fast recovery operations, saving for the future ability to become pregnant and bear a child, the almost complete absence of traces of operation.

prevention

Prevention of uterine fibroids is the subject of diet, sleep and rest, reducing stress. An important method of prevention of uterine fibroids is timely pregnancy and birth (before 25 years), as well as preventive checkups at the gynecologist.