Myoma (leiomyoma, fibromyoma) is a benign hormone-dependent tumor of the uterus.
There are several reasons justifying the appearance of uterine fibroids.
- Violation of the production of sex hormones;
- Chronic inflammatory diseases of the female genital sphere (chronic salpingo-oophoritis, sexually transmitted infections);
- Abortions, intrauterine contraceptives;
- Diseases of the endocrine glands: thyroid, adrenal glands, etc .;
- Genetic predisposition to the appearance of uterine fibroids.
- Typical location of the nodes in 95% in the body of the uterus is intramural (the tumor is located in the thickness of the uterus wall), sub mucous (growth of fibroids occurs towards the uterus, causing deformation of the uterus) and sub serous (growth of fibroids occurs towards the abdominal cavity);
- Atypical location of the nodes in 5% – in the cervix – cervical form, intraligamentous (interlinking arrangement of nodes).
Clinical manifestations of uterine fibroids: the clinic is characterized by a wide variety, depending on the patient’s age, the duration of the disease, the location and size of the tumor and the presence of associated pathological processes.
The main symptoms of uterine fibroids are:
- Uterine bleeding (heavy, prolonged menstruation), often leading to anemization of a woman (decrease in hemoglobin);
- Pulling pains, heaviness in the abdomen. The pains can be sharp and cramping, aggravating during menstruation;
- Dysfunction of neighboring organs, for example, frequent urination;
- Delayed stool, which leads to compression of the nodes of adjacent organs.
Uterine fibroids can cause miscarriage. Uterine fibroids are often combined with endometriosis of the body of the uterus – adenomyosis.
Diagnosis of uterine fibroids.
- Gynecological examination;
- Pelvic ultrasound – transvaginal and transabdominal examination. An ultrasound examination of the uterus (ultrasound) reveals an increase in the size of the uterus, as well as a uterine fibroids node, even in the early stages of the development of the disease, when the size of the fibroids does not exceed 1 cm in diameter;
- MRI of the pelvis (if necessary);
- Hysteroscopy (with submucous forms of fibroids), hysterosalpingography.
Treatment of uterine fibroids depends on the age of the woman, the size of uterine fibroids, as well as other factors. In some cases, treatment of uterine fibroids is carried out with the help of hormonal preparations, in other cases surgery is necessary (removal of the tumor — myomectomy, removal of the uterus — hysterectomy, etc.)
- Conservative treatment of uterine fibroids
Conservative treatment of uterine fibroids can prevent an increase in the size of fibroids and helps preserve the uterus, allowing you to have a baby in the future. Conservative treatment of uterine fibroids is possible in the case of small sizes of fibroids (up to 12 weeks), slow growth of fibroids.
- The main principles of treatment of uterine fibroids without surgery are the use of hormonal drugs, as well as symptomatic treatment (treatment of anemia, elimination of pain, etc.). In the treatment of uterine fibroids, hormonal drugs are used: combined oral contraceptives, gestagens, gonadotropic releasing hormone agonists, antigonadotropins.
Surgical treatment of uterine fibroids
Surgery for uterine myoma is indicated for large fibroids (more than 12 weeks), fast growth rates, severe symptoms of uterine fibroids (heavy uterine bleeding, abdominal pain, etc.).
There are several types of operations for uterine myoma:
- Laparoscopic myomectomy – removal of uterine fibroids using a laparoscope (instrument inserted into the abdominal cavity through small incisions on the anterior abdominal wall). Advantages of laparoscopic myomectomy: preservation of the uterus and the possibility of becoming pregnant in the future, rapid recovery after surgery;
- Hysteroscopic myomectomy – removal of uterine fibroids using a hysteroscope (a tool inserted into the uterus through the vagina). Hysteroscopic myomectomy is indicated for submucous myoma of the uterus (myoma that grows in the lumen of the uterus);
- Removal of the uterus or hysterectomy is a surgical method of treating uterine fibroids, which involves the complete removal of the uterus. The operation to remove the uterus is shown to women who do not want to have children in the future, as well as with large sizes of uterine fibroids, fast-growing fibroids, the presence of several large fibroid nodes;
- Embolization of the uterine artery – involves the introduction into the uterine artery of a special substance that stops the flow of blood through this artery, which stops feeding the uterine fibroids and leads to the death of the tumor. The disadvantages of this method of treatment of uterine fibroids are the possibility of infectious complications, as well as severe pain in the first few days after surgery;
FUS ablation (FUS ablation) of uterine fibroids is a new method for treating uterine fibroids, which consists of using focused ultrasound waves. With the help of FUS ablation of uterine fibroids, it is possible to reduce the size of fibroids without surgery. Contraindications to FUS ablation of uterine fibroids are: a woman’s desire to become pregnant in the future, more than 5 myomatous nodes.