The uterus is a muscular organ composed of three layers, of which the thickest myometrium (muscular layer).
Uterine fibroids - a benign hormone-dependent tumor, which is characterized by the development of the nodes in the muscle layer. Uterine fibroids are often found in women aged 35-50 years, but recently there is a trend to a rejuvenation of the disease (in women 25 years and younger).
Kinds
Localization of myoma nodes isolated:
- subserous myoma (node grows toward the abdominal cavity and stored under subserous shell);
- interstitial myoma (node grows thicker myometrium);
- submucous myoma or submucosa (node grows into the uterine cavity and is under the mucous membrane);
- cervical myoma (node located in the cervix).
Depending on the size of fibroids, which are compared with the timing of pregnancy, isolated
- myoma of small (5-6 weeks)
- medium (7-11 weeks)
- large size (over 12 weeks).
By the nature of uterine fibroid growth emit spurious growth node / nodes which increase with edema and poor circulation in the formation (necrosis node) and real growth (proliferation of muscle cells).
According to the number of nodes emit myoma with a single node and multiple fibroids.
For clinical manifestations of uterine fibroids may be asymptomatic and symptomatic.
According to the histological structure and the dominance of myoma nodes in a given tissue are distinguished:
- uterine myoma (contains only muscle cells);
- uterine fibroids (Contains connective tissue);
- uterine fibroids (Equal connective and muscular tissue).
Causes
By the predisposing factors for fibroids include hormonal imbalances, in particular the excess estrogen in the body.
It also provokes the disease factors include mechanical uterine trauma and genetic predisposition:
- heredity (the presence of uterine fibroids in relatives of the first and second generations);
- menstrual irregularities, beginning with the first cycle (menarche), including combined with sexual infantilism;
- Disorders of menstrual function is not treatable, especially with metabolic disorders (diabetes, obesity);
- chronic gynecological and extra (non-reproductive system) diseases;
- abortion and uterine curettage;
- lack of exercise (low mobility);
- irregular sexual life (rare or sexual acts, not ending orgasm);
- stress, heavy physical labor;
- prolonged sun exposure;
- lack of birth and breastfeeding history.
Symptoms of uterine fibroids
Often, uterine fibroids is a random finding during the passage of a preventive examination by a gynecologist. Many women with uterine myoma not complain or do not attach importance to evidence of disease.
The main symptom is a disruption of the menstrual cycle. Typically, menstruation becomes long and heavy (especially when submucous myoma) appear intermenstrual bleeding. Permanent loss of blood leads to anemizatsii patient (fatigue, malaise, fatigue, pale skin, etc.).
In addition, patients can be confusing pain in the abdomen pulling or aching. Pain can be both permanent and appear only during menstruation. When necrosis of myoma node or birth (submucosal fibroids) are acute pain, cramping.
For large size of uterine fibroids join syndrome compression of adjacent organs. In this case, often there is increased frequency of urination, or chronic constipation.
In the presence of submucosal fibroids develop difficulty conceiving and carrying a pregnancy.
Diagnostics
Differential diagnosis of uterine fibroids is carried out with ovarian tumors and uterine cancer.
Diagnose uterine fibroids is easy. Already at the first gynecological examination, the doctor with 90-100% certainty can diagnose. Palpation is determined by the enlarged uterus with one or more dense nodes. Its mobility is not limited.
Additional survey methods include:
- Pelvic ultrasound: To determine the size and location of nodes, the deformation of the uterus, endometrial thickness (fibroids often combined with hyperplasia or polyps endometrium).
- hysteroscopy: Examination of the cervix and uterine cavity by a special device - hysteroscopy. The method is irreplaceable in the diagnosis of submucosal uterine fibroids and uterine fibroids interstitial. Allows biopsy.
- Laparoscopy: is used in difficult cases, for example, to detect changes in the secondary myoma nodes (hemorrhage, necrosis).
- Diagnostic curettage: shown conducted at all detected uterine myomas in order to establish and endometrial pathology exception uterine cancer.
Treatment of uterine fibroids
Treatment of patients with uterine myoma has been an obstetrician-gynecologist.
Treatment of the disease can be either conservative or operative. Selection of a particular method of treatment depends on the size of fibroids, presence or absence of growth, related chronic diseases, patient's age and desire to maintain reproductive function.
drug therapy
Conservative treatment is the appointment of hormonal drugs. The objective of such therapy is to delay surgical menopause when fibroids regresses. Use hormonal drugs of different groups:
- progestins (norkolut, djufaston, premolyut) course for 4-6 months;
- androgen derivatives (danazol, gestrinone) rate at 6-8 months;
- agonists, gonadotropin releasing hormone (buserilin, Zoladex) for 3-6 months;
- oral hormonal contraceptives (Yasmin, Janine, Regulon);
- Mirena intrauterine device (containing a progestogen - levonorgestrel) for 5 years.
Surgery for Uterine fibroids
Indications for surgery:
- uterine size greater than 12 weeks of pregnancy;
- submucosal uterine fibroids;
- uterine fibroids in combination with adenomyosis or ovarian tumors;
- the rapid growth of fibroids (3 weeks of pregnancy for 6 months);
- persistent bleeding causing anemia.
Operative treatment of uterine fibroids may be of several types:
- conservative myomectomy (husking fibroids with uterine preservation) is carried out in women who wish to preserve reproductive function;
- hysteroresectoscopy (removal of knots in hysteroscopy) is carried out at submucosal fibroids;
- hysterectomy (total hysterectomy with or amputation of uterus neck with preservation of its stump and neck);
- uterine artery embolization (leiomyomata blood supply is interrupted, whereby they regress).
Complications and prognosis
The prognosis of uterine myoma favorable. After menopause, fibroids regress on their own.
After a hysterectomy, patients are taken to the dispensary after 5 years, and after myomectomy observed life as possible relapse.
Complete recovery after uterine artery embolization occurs in 50% of cases.
Complications of uterine fibroids:
- necrosis myoma node;
- birth submucosal node;
- hemorrhagic anemia;
- malignancy of the tumor;
- infertility;
- miscarriage;
- postpartum hemorrhage;
- endometrial hyperplasia.