Myoma of the uterus - Causes, symptoms and treatment. MF.

Uterine fibroids ( synonyms: fibromyoma, fibroma) is a benign tumor that develops from the muscular tissue of the uterus, consisting primarily of connective tissue elements. The incidence of myoma incidence by 35 years is 35-45% of the total female population. The peak incidence falls on the age group of 35-50 years, but recently the uterine myoma is "younger" and quite often diagnosed in women of young reproductive age.

Depending on the location in the structure of the uterus, the following types of myomas are distinguished:
- interstitial( or intramural) - the tumor is located in the thickness of the uterus wall;
- submucous - a significant part of the tumor protrudes into the uterine cavity, which leads to deformation of the cavity;
- subserous - the tumor grows subperitoneally;

Causes of uterine fibroids

For possible reasons leading to the development of uterine fibroids include:

- hormonal disorders clinically manifested by malfunctions of the menstrual cycle: late onset of menstruation, too profuse monthly, leading to sudden fluctuations in sex hormones -increase or, conversely,estrogens and progesterone;

is an irregular sexual life, especially since the age of 25;disharmony in sexual life - it is interesting that women experiencing problems with orgasm achievement are more likely to develop uterine myoma;
- mechanical factors: abortion, diagnostic curettage, traumatic birth;
is the genetic predisposition;
- concomitant diseases: high blood pressure, obesity, diabetes, thyroid diseases;
is a sedentary lifestyle.

Symptoms of uterine fibroids

Often, uterine fibroids do not give any symptoms and is a finding during a preventive examination at a gynecologist. Or it happens that the symptoms are rather smoothed and are often perceived as a variant of the norm. The most vivid symptoms are observed with submucous tumor location and with large sizes of myoma of any kind.

Photo Large uterine fibroids node

Possible symptoms of uterine fibroids that can alert you:

- profuse and prolonged menstruation( menorrhagia).Sometimes bleeding is so abundant that the woman does not have time to change the gaskets. Often there are acyclic bleedings, not associated with menstruation - "metrorrhagia."Menorrhagia and metrorrhagia lead to iron deficiency anemia - the level of hemoglobin gradually decreases. There is weakness, pallor of the skin, which is not always noticeable and is perceived as a malaise;
- pain in the lower abdomen and in the lower back. If the circulation in the myomatous node is disturbed, the pain is acute. However, more often the tumor grows gradually and the pains are rather noisy, even if the myoma is large;
- a violation of the function of neighboring organs - the urinary and gastrointestinal tract, in particular, this refers to the bladder and the rectum - the tumor squeezes these organs. As a result, there may be difficulties with urination, chronic constipation.

For this reason, patients with uterine myoma often refer to urologists and proctologists.

If you have the above symptoms, you need advice from a gynecologist.

Diagnosis of uterine fibroids

Diagnosis of fibroids does not present difficulties. When gynecological examination - the size of the uterus is increased. To confirm the diagnosis, additional research methods are used:

- ultrasound of the pelvic organs using a vaginal sensor. For better visualization, the study is performed with a filled bladder. The method is highly informative and allows to reveal the sizes of a tumor and its form;
- hysteroscopy - the method is informative for the recognition of submucous and interstitial with centripetal( deforming cavity) myoma growth. During hysteroscopy, the gynecologist takes a biopsy( piece of tissue) from the uterine cavity for further histological examination;
- laparoscopy - is used only when fibroids can not be distinguished from an ovarian tumor;
- CT and MRI - are rarely used due to the high cost of research.

The scope of diagnostic studies is determined by the gynecologist in each case. Most often for the diagnosis is enough to examine the chair and ultrasound of the pelvic organs.

Treatment of uterine fibroids

Treatment of uterine fibroids can be conservative, surgical or combined( both, and others).

Conservative treatment of uterine fibroids

The goal of conservative treatment of uterine fibroids is to stop tumor growth, reduce its size and prevent complications. Conservative treatment is performed for all women who:

- the size of fibroids less than 12 weeks of pregnancy;
- myoma with subserous and interstitial node arrangement;
- there is no pronounced clinical picture with meno- and metrorrhagia and if there is no pain syndrome;
- if there are contraindications to surgical treatment( extragenital diseases).

The basis of conservative treatment is the use of hormonal drugs.

With the confirmed diagnosis of uterine fibroids, the following groups of drugs are used:

1) Androgen derivatives: Danazol, Gestrinone. The action of this group is based on the fact that androgens suppress the synthesis of steroid hormones of the ovaries. As a result, the size of the tumor decreases. Apply up to 8 months in continuous mode.

2) Gestagens: Duphaston, Utrozestan, Norcolut-normalize the growth of the endometrium in the presence of hyperplastic processes( proliferation of the endometrium), which often develop against the background of fibroids. For the myoma itself, the effectiveness is not high enough. Ideally, gestagens are prescribed for small sizes of fibroids and concomitant hyperplasia of the endometrium. Assign courses up to 8 months.

The appearance of the hormone "Mirena" in the Russian market over the past 10 years, which includes the progestogen-levonorgestrel, deserves attention. Due to the daily release of the hormone into the uterus, Mirena blocks the growth of the tumor. The spiral is placed for 5 years. Plus, the spiral is also in that, in addition to the therapeutic effect, Mirena protects from unwanted pregnancy.

3) Combined oral contraceptives KOK-Zhanin, Regulon, Yarina. Stop the growth of the tumor, if the size of the nodes is not more than 2 cm. Assign a minimum of 3 months.

4) Analogues of gonadotropin releasing hormone aHnRG( Buserelin, Zoladex).With continuous use, these drugs cause hypoestrogenia. Assign for 3-6 months, but no more, otherwise these drugs can cause menopause.

Surgical treatment of uterine fibroids

Unfortunately, conservative treatment of myoma is not always effective. Indications for surgical treatment of uterine fibroids are as follows:

- the size of fibroids more than 12 weeks of pregnancy;
- submucous knot arrangement, interstitial myoma with centripetal growth;
- rapid tumor growth;
- combination of myoma with ovarian tumors;
- meno- and metrorrhagia, which lead to anemia;
- with miscarriage and infertility.

Depending on the age of the patient, from the location of the myomatous nodes, a choice is made in favor of this or that surgical procedure.

Options for surgical treatment of uterine fibroids:

1) Uterine artery embolization( EMA) is a minimally invasive operation that has been introduced into the practice of surgeons over the past decades. Embolus is inserted into the uterine vessels, which covers the lumen of the arteries. Without blood supply there is necrosis( necrosis) of myomatous nodes. The method of choosing women of young age, interested in pregnancy.

2) Conservative myomectomy - myomatous nodes are removed, leaving only a healthy tissue. Operative access is laparoscopic or abdominal. The latter is more preferable. It is spent to women of reproductive age who are interested in pregnancy.

3) Hysteroresectoscopy - during hysteroscopy, the myomatous nodes are removed from the inner surface of the uterus. It is performed for women with a submucous knot arrangement.

4) Hysterectomy - removal of the organ. In this case, the principle "There is no authority - no problems" is in effect. Operative access - abdominal, laparoscopic or vaginal. The latter is used for small sizes of fibroids. Abdominal access is most often used. In this case, either a supravaginal amputation of the uterus or an extirpation of the uterus is performed. After extirpation, urinary incontinence develops quite often, so surgeons prefer an over-vaginal amputation of the uterus, provided that the patient has a healthy cervix and there are no large knots between the uterus and the neck.
No less relevant is the question that must be resolved before surgery or during - leave the ovaries or not. Surgical tactics are determined on an individual basis, taking into account the age of the patient and the presence or absence of formations on the ovaries.
Hysterectomy is suitable for all women with uterine myoma who have tumor sizes more than 13 weeks of gestation, with ineffective conservative methods, with rapid tumor growth, with ovarian tumors, with acute blood loss.

The combined method of is the "gold standard" for the treatment of uterine fibroids. Quite often after the operation, COCs and aHHRHG are prescribed a short course to avoid relapse. This does not apply to hysterectomy, where the problem is solved cardinally - by removing the organ.

Folk remedies for uterine fibroids

If you have found uterine fibroids, it is a signal to change your lifestyle. First, it concerns nutrition - you need to give up fatty foods and consume more products of plant origin. Eat foods rich in fiber. Recommended fish dishes. Secondly, with miomy categorically contraindicated thermal procedures: sauna, hot tub, solarium, rest in hot countries, bath, sunburn.

If you follow a certain lifestyle, you will be able to avoid surgical treatment or reduce the likelihood of relapse in the postoperative period.

Folk remedies can also be used with myomas, but I will make a reservation that everything is very individual. In some cases( for example, with the rapid growth of the tumor), excessive enthusiasm for folk medicine can lead to even greater complications. Phytotherapy is indicated for women with small tumor sizes. You can use tinctures of nettle, celandine, mint and hawthorn. Drink twice a day - morning and evening.

If we talk about alternative medicine in general, deserves attention to the use of anion pads "Love Moon", which contain negatively charged atoms. The effectiveness of gaskets, according to the producers, is due to the effect of anions on metabolism in the muscle cells of the uterus. Thus, when using gaskets, tumor growth slows down.

Complications of uterine fibroids:

- miscarriage, hypoxia and fetal hypotrophy;
- infertility;
- profuse uterine bleeding leading to anemia;
- degeneration of fibroids in sarcoma( malignant tumor);
- rapid tumor growth;
- malnutrition or torsion of the leg of the myomatous node;
- postpartum haemorrhage due to decreased uterine tone;
- endometrial hyperplasia of various types;
- development of hydronephrosis or pyelonephritis.

Prevention of uterine fibroids:

- regular visit to the gynecologist twice a year;
- ultrasound of the pelvic organs 1 time per year;
- regular harmonious sexual life with the achievement of orgasm;
- abortion, the use of modern hormonal contraceptives;
- physical exercises, fighting with increased body weight;
- reception of vitamins and microelements, which have antioxidant action - Vitamins A, E, C, iron, zinc, iodine, selenium.

Questions and answers of the obstetrician-gynecologist on the subject of uterine myoma.

1. I have a uterine myoma, I am 50 years old, there are no menstruation. Will fibroids grow?
No. Myoma is a hormone-dependent tumor, if there is no menstruation, there will be no growth.

2. I am 36 years old, I have interstitial myoma, did not give birth, there were abortions.
Hardly conceived. Will I be able to bear the child?
You need to go to a gynecologist, assess the condition of myoma, tone of the uterus, so that the doctor can prescribe adequate therapy.

3. I have fibroids for about 6-7 weeks, with a submucous knot that grows posteriorly. The doctor prescribed the supplements. Will they help me?
No, in your case, dietary supplements are ineffective. In this case, surgical treatment is indicated.

4. How does pregnancy affect myoma growth?
Pregnancy leads to a stop of fibroid growth, but in the first and second trimester a small tumor growth is possible.

5. At me a myoma, on ultrasound on a forward wall have found out a subserosic unit in the size 81 х 62х 76 mm. Can I save the uterus, or do I need to delete it?
In this case, the uterus can be saved. You will be treated with a conservative myomectomy, perhaps with laparoscopic access.

6. I have a myoma of 7-8 weeks. Is it possible to engage in physical education, rock the press?
If you do not have heavy bleeding and pain, then you can.

7. I have a small subserous node( 2 cm) - should I be treated?
Myoma should be treated at any size, in your case - conservatively.

8. What is the safest way to treat myoma?
Each method has its own side effects and possible complications, but this does not mean that it is they who will affect you.

9. Can I put a spiral with myoma?
No. The usual spiral provokes myoma. It is better to put a hormonal spiral "Mirena".

Obstetrician-gynecologist, Ph. D.Christina Frambos