Uterine fibroids is a true benign tumors of the uterus. It develops from muscle tissue.
Depending on the ratio of muscle and connective tissue in its composition before the tumor had different names: myoma, fibroma, Fibroid. However, taking into account that nodes are more likely to develop fibroids because of muscle cells, most authors consider more appropriate term - leyofibromioma (fibroids).
Uterine fibroids has its own characteristics:
- This is the most common tumor of the uterus in women 35-55 years
- It is capable of growth, reduction and even complete disappearance of menopause. However, 10-15% of patients in the first 10 years postmenopausal tumor may grow.
- Fibroids Uterine small size (up to 10 weeks of pregnancy) can long maintain a stable state, but under the influence of provoking factors (inflammatory process uterus and appendages, scraping the uterus, prolonged venous congestion of the pelvic organs) increases rapidly and very fast (so-called "jump growth ").
- For tumors characterized variety of clinical options, depending on the location, size, location and growth character.
- Uterine Fibroids has autonomous growth, due to the influence of growth factors and the formation and growth of hormone-sensitive receptors.
- Like any tumor growth and development fibroids process accompanied by the formation of new blood vessels, but in this case different from normal blood vessels, as have a sinusoidal character.
Start of uterine fibroids nodes accounted for 30 years, when women accumulate somatic, gynecological diseases and neuroendocrine disorders.
Causes and risk factors
For further growth nodes requires further accumulation of unfavorable factors that cause tumor progression:
- lack of childbirth and lactation to 30 years
- abortion
- prolonged inadequate contraception
- chronic, subacute and acute inflammation of the uterus and appendages
- stresses
- ultraviolet irradiation
- education cysts and ovarian cysts.
At the age of 44-45 years old accounted for the highest rate of surgical interventions (most often it is the removal of the uterus), indication which is the rapid growth of fibroids Mukti, its large size, the combination of tumor pathology of the endometrium and ovaries.
The growth of fibroids is amplified at the age of 35-45 years, when the reduced functional ovarian activity and their sensitivity to hormones, there chronic functional voltage regulation systems (neuroendocrine, hormone, immune) and often disturbed homeostasis (internal balance organism).
Negative role played by the existing long-term neuroendocrine disorders, pathological climacteric, The effect of factors such as obesity, Impaired glucose and lipid metabolism, endometriosis, adenomyosis.
The manifestations of uterine fibroids
Uterine fibroids are very diverse clinical course. Complaints of patients depend on many factors: localization and tumor size, disease duration, presence of concomitant gynecological pathology, etc. The preponderance of these or other factors is reflected in the symptomatology disease.
Often, the main and most early symptom of uterine fibroids is a menstrual dysfunction - uterine bleeding or smearing prolonged Meager bloody issues. Along with uterine bleeding is often marked by pain, usually localized in the abdomen, in the lumbosacral region, sometimes spread to the lower limbs.
Treatment
uterine fibroid treatment - a very difficult problem, because despite the hormonal dependence, this tumor is very heterogeneous.
Surgery
Initially unconditional evidence should be identified for surgical treatment:
- submucosal fibroids localization
- large node size (the total value corresponds to the uterus 14 weeks gestation)
- uterine bleeding, accompanied by chronic anemia
- rapid tumor growth
- acute disturbance fibroids power (torsion subserous node legs, loss of the tumor)
- the combination of uterine fibroids endometrial hyperplasia, A tumor of the ovary
- compression of the ureter, the bladder, the rectum
- Choose the node in uterine tube angle, which is the cause of infertility
- cervical and neck-peresheechnaya localization
- neregressiruyuschaya and increased uterine fibroids in postmenopausal age.
The surgical procedure is largely determined by the patient's age.
Up to 40 years if there are indications for surgery, if possible due to technical features produce conservative myomectomy. It is especially advantageous to remove myoma medium size units (in diameter from 2 to 5 cm), it has not happened yet their intense increase in size. A preferred procedure is laparoscopic. Recurrences at the conservative myomectomy for uterine fibroids occur in 15-37% of cases.
After 40 years and postmenopausal age in the presence of surgical indications require surgery removal of myoma of the uterus, as If fibroids are not regressed in the first 2 years post-menopause, its further existence is accompanied by the threat posed by cancer (adenocarcinoma, sarcoma).
According corr. Academy of Medical Sciences, Professor JS Sidorova, uterine fibroids growth risk factors are: the presence of cysts and ovarian cysts, endometrial proliferative processes, untimely termination of hormonal activity of the ovaries (delayed menopause) and severe obesity, metabolic disturbance or disease liver.
Conservative treatment of uterine fibroids:
Conservative treatment is conducted immediately after the detection of fibroids small and medium sizes, can, in some cases hinder further growth of tumors, prevent the operation to remove the uterus, retain the ability to give birth child.
Indications for conservative treatment:
- the young age of the patient
- the small size of the uterus myoma modified (10-12 weeks gestation)
- intermuscular location of the fibroids
- the relatively slow growth of fibroids
- no deformation of the uterine cavity.
Conservative treatment is to normalize systemic disorders specific to patients with fibroid uterus, among them:
- chronic anemia,
- inflammation of the uterus and appendages,
- violation of the blood supply to the pelvic organs with a predominance of venous stasis and decreased arterial blood supply,
- violation of the functional state of the nervous system and the autonomic balance.
The methods of correction system disorders include the following:
- adherence to a healthy lifestyle (normalization of sleep, a balanced diet, physical activity, avoiding harmful habits, control of body weight);
- normalization of sexual activity;
- periodic intake of vitamins and minerals in the winter and spring;
- anemia;
- neurotrophic effects if the patient exhibits traits disharmonious personality.
If you become pregnant, not even planned, you must preserve it, because postpartum decrease in the uterus, breast-feeding child at least 4-6 months, help her transition change in the composition of fibroids in a simple and in some cases, termination of further development.
For the prevention of imminent removal of the uterus during tumor growth is of great importance to preserve and maintain the reproductive function of up to 40 years.
The efficacy of hormone therapy is quite different depending on the nature of hormonal disorders and the presence and density of receptors in the nodes myoma and myometrium. The fibroma, where predominates the connective tissue, as well as in large units hormone receptors are usually absent. Therefore, hormone therapy in these patients is not effective enough.
Nevertheless, it is used in the correction of disorders of the menstrual cycle. For this purpose, use progesterone and its derivatives (dydrogesterone, cyproterone acetate), and androgen derivatives, 19-norsteroidov (levonorgestrel, norethisterone acetate). Recent undesirable at a young age, obesity, diabetes diabetes, Cardio-vascular diseases.
The most promising drugs in the treatment of patients with uterine fibroid are antigonadotropiny (gestrinone, danazol), which have anti-estrogenic and anti-progesterone effect, causing temporary amenorrhea (cessation of menstruation), as well as agonists of gonadotropin-releasing hormone (triptorelin, goserelin, buserelin), inducing a state of reversible hypogonadism.
antigonadotropiny following drugs registered in Russia:
- Depot 3.6 mg goserelin n / k; triptorelin 3.75 mg / m and s / c; leuprorelin 3.75 mg / m formulation is a ready set with different modes of administration. Treatment starts with 2-4 days of the menstrual cycle: 1 injection every 28 days.
- Endonasal spray - 0.2% buserelin acetate 0.9 mg per day. Treatment starts with 1-2 days of the menstrual cycle: 0.15 mg every nososvoy course 3 times a day at regular promezhukt time.
Preparation for surgery using antigonadotropiny the presence of uterine fibroids allows organ-sparing surgery using endoscopic techniques.
To date, it describes several strategies for long-term therapy antigonadotropiny that avoid significant side effects while maintaining high clinical efficacy:
- Add-back mode - antigonadotropiny combination with low doses of estradiol.
- On-off mode - therapy antigonadotropiny intermittent (three-month therapy with a three-month break to 2 years).
- Drow-back - high dose antigonadotropiny for 8 weeks with a transition to a lower dose of the drug for 18 weeks.
Likely response to treatment can be predicted in most cases 4 weeks after the first injection.
The formulations are well tolerated, do not possess the antigenic properties are not cumulate not affect the blood lipid profile. Side effects: hot flushes, sweating, vaginal dryness, headache, depression, Nervousness, changes in libido, seborrheaPeripheral edema, prospective memory impairment, decreased bone density.
Cessation of therapy results in restoration of the normal menstrual cycle and estrogen status of approximately 60-100 days after drug withdrawal and rapid regrowth uterine fibroids to its original size (within the first 3-4 menstrual cycles), with all clinical symptoms (although some authors note that these symptoms are less expressed).
Prevention of uterine fibroids
In addition to general advice on compliance with the rational mode of life, prevention of common diseases in children and adults age, playing the role of an exception of abortions, timely correction of hormonal disorders, adequate treatment of gynecological diseases.
There is a specific prevention of uterine fibroids. This is a timely implementation of the reproductive function. The first delivery is recommended at age 22, the second in 25 years, following the planned birth to 35 years. Later first birth lead to premature aging of myocytes reduce adaptive capacity to the expansion and contraction. Abortions inflammation and damage the structure of the myometrium.
It should be borne in mind that the most part of the period of detection of uterine fibroids account for 30-35 years, when added up action of damaging factors.
It is necessary to keep the first pregnancy, especially in young women with so-called hereditary myoma. Abort causes the growth of fibroids and myomas microscopic assemblies are formed intensively growing.
Should avoid excessive UV radiation, elevated temperature effects, especially after 30 years. If there is a hereditary risk (uterine fibroids in the mother and close relatives) tumor develops 5-10 years earlier, ie, in 20-25 years. Continued breastfeeding for 4-6 months after birth normalizes content prolactinWhich affects the change in fibroid growth.
This article is based on information of breast cancer - Independent publications practitioners
