Uterine fibroids with hemorrhagic syndrome treatment. Fast-growing interstitial-subserous myoma of the uterine body, complicated by pain and hemorrhagic syndromes. Chronic endometritis is in remission. Chronic posthemorrhagic anemia of moderate severity

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A detailed comparative analysis of the results of examination of women with uterine fibroids complicated by hemorrhagic syndrome during hormonal therapy (main group - n=43) and patients in whom complications were not observed during conservative treatment of uterine fibroids with hormonal drugs (comparison group - n=33) is presented. . The control group was represented by practically healthy women (n=27). The state of the immune system was assessed by the content of cytokines IL-1β, IL-2, IL-4, IL-6, γ-INF, TNF-α and the apoptosis marker Fas-L in serum blood of women, using the solid-phase immunoassay method. Additionally, an examination was carried out to identify IgG and IgM antibodies to pathogens of urogenital infections (chlamydia, ureaplasmosis, trichomoniasis, cytomegalovirus and herpetic infections) using the enzyme-linked immunosorbent assay (ELISA). It was established that the occurrence of hemorrhagic syndrome during hormonal therapy for uterine fibroids is associated with chronic urogenital infections that contribute to disorders of the immune status, reduction of the function of Th1 and Th2 lymphocytes, significant inhibition of apoptosis, which dictates the need for a more detailed examination of women with this pathology in order to improve methods of conservative treatment of uterine fibroids and reduce the incidence of complications and insufficient effectiveness of hormonal therapy.

complications of hormone therapy.

urogenital infection

cytokines

uterine fibroids

1. The influence of uterine artery embolization on the state of the immune system in patients with uterine fibroids / I.E. Rogozhina, N.F. Khvorostukhina, U.V. Stolyarova, I.V. Neufeld // Fundamental Research. – 2011. – No. 9-2. – pp. 290-294.

2. Divakova T.S., Bekish V.Ya. The role of apoptosis induced by Luprid Depot in the treatment of women with interstitial uterine fibroids in reproductive age // Reproductive Health Eastern Europe. – 2014. – No. 1 (31). – pp. 123-128.

3. Zatsepin A.V., Novikova V.A., Vasina I.B. Comparison of the effectiveness of pharmacological methods of anti-relapse treatment of uterine fibroids after conservative myomectomy // Kuban Scientific Medical Bulletin. - 2012. - No. 2. - P. 88-93.

4. Kichigin O.V., Arestova I.M., Zanko Yu.V. Risk factors for the development of uterine fibroids and the quality of life of patients operated on for uterine fibroids // Motherhood and Childhood Protection. – 2013. – No. 2 (22). – P. 36-41.

5. Mukasheva S.A., Manambaeva Z.A., Kenbaeva D.K. Clinical and immunological parallels in uterine fibroids // Bulletin of the Kyrgyz-Russian Slavic University. – 2013. – T. 13, No. 6. – P. 169-171.

6. Nikitina E.S., Rymashevsky A.N., Naboka Yu.L. Features of vaginal microbiocenosis in women of late reproductive age with uterine fibroids // Medical Bulletin of the South of Russia. – 2013. – No. 3. – P. 63-65.

7. Radzinsky V.E., Arkhipova M.P. Uterine fibroids: problems and prospects of the beginning of the century // Medical Council. – 2014. – No. 9. – P. 30-33.

8. Sidorova I.S., Levakov S.A. Modern view on the pathogenesis of uterine fibroids // Obstetrics and Gynecology. – 2006. – Appendix. – P. 30-33.

9. Tikhomirov A.L. Myoma, pathogenetic rationale for organ-preserving treatment. - M., 2013. – 319 p.

10. Khvorostukhina N.F., Novichkov D.A., Ostrovskaya A.E. The role of sexually transmitted infections in the pathogenesis of complications of hormone therapy for uterine fibroids // International Journal of Experimental Education. – 2014. – No. 8-2. – pp. 51-52.

11. Khan A.T., Shehmar M., Gupta J.K. Uterine fibroids: current perspectives // Int. J.Women's Health. – 2014.–Vol. 6. – P. 95-114.

12. Long-term treatment of uterine fibroids with ulipristal acetate / J. Donnez, F. Vàzquez, J. Tomaszewski et al. // Fertil. Steril. – 2014. – Vol. 101. – No. 6. – P. 1565-1573.

13. Mifepristone for treatment of uterine leiomyoma. A prospective randomized placebo controlled trial / M. Engman, S. Granberg, A.R. Williams, C.X. Meng, P.G. Lalitkumar, K. Gemzell-Danielsson // Hum. Reprod. – 2009. – Vol. 24(8). – P. 1870-9.

14. Predictors of leiomyoma recurrence after laparoscopic myomectomy / E.H. Yoo, P.I. Lee et al. // J. of Minimally Invasive Gynecology. – 2007. – Vol. 14, No. 6. – P. 690-697.

15. Sachie N., Mayuko S., Kodo S. High Recurrence Rate of Uterine Fibroids on Transvaginal Ultrasound after Abdominal Myomectomy in Japanese Women // Gynecol. Obstet Invest. – 2006. – No. 6. – R. 155-159.

Protecting the reproductive health of the female population remains one of the priorities of modern healthcare. The most common tumors of the female reproductive system include uterine fibroids (MM), the frequency of which varies from 20 to 40% and ranks second in the structure of gynecological diseases. The problem is becoming increasingly socially significant given the trend towards late pregnancy planning and the rejuvenation of the population of patients with MM . As is known, many scientists consider changes in the endocrine system to be the basis of tumor pathogenesis. At the same time, the question remains debatable: whether MM is a truly hormonally dependent disease or has an inflammatory genesis. Research in recent years has proven the important importance of dysbiotic disorders, sexually transmitted infections and dysfunction of the immune system in the pathogenesis of MM.

Among the numerous treatment options for MM in women of fertile age, preference is given to organ-saving methods, including conservative myomectomy using hysteroscopy, laparoscopy and laparotomy, embolization of the uterine arteries, remote tumor destruction with MR-controlled focused ultrasound (FUS ablation of myomatous nodes). But even the use of minimally invasive organ-saving surgical techniques do not guarantee 100% effectiveness of treatment. Literary sources state that the probability of disease recurrence after conservative myomectomy within 5 years is 45-55%. And the share of hysterectomies performed for MM in the structure of surgical interventions reaches 60.9-95.3%. In this regard, priority in the treatment of MM remains with hormonal therapy, used both as neo- and adjuvant, and as an independent treatment option. However, despite the huge selection of hormonal drugs, often, against the background of their use, patients with MM experience side effects and complications (menstrual irregularities, metrorrhagia, an increase in the size of myomatous nodes), which dictates the need for further study of the pathogenetic features of the disease in order to optimize existing methods of conservative therapy.

Purpose of the study: to study the characteristics of the immune system and the causes of its dysfunction in patients with uterine fibroids complicated by hemorrhagic syndrome.

Material and methods of research: under our supervision there were 76 women with MM, the size of which did not exceed a 12-week pregnancy, with predominantly intramural and subserous localization of nodes, and with indications for conservative treatment. The main group consisted of 43 patients with MM and clinical hemorrhagic syndrome on the background of hormone therapy. In the comparison group (n=33), no complications were observed during conservative treatment of MM with hormonal drugs. The control group was represented by practically healthy women (n=27). All patients underwent a standard clinical and laboratory examination and ultrasound scanning with an abdominal and vaginal sensor on a HITACHI-5500 device using broadband, ultra-high-density convex sensors 3.5-5.0 MHz and cavity sensors 5.0-7.5 MHz. The state of the immune system was assessed by the content of cytokines in the blood serum of women. The study was carried out using solid-phase immunoassay. To determine interleukins (IL-1β, IL-4, IL-6), interferon (γ-INF) and tumor necrosis factor (TNF-α), we used Vector-BEST reagent kits, Novosibirsk. To determine interleukin IL-2, a set of reagents from Biosource, USA was used. To determine the Fas ligand (Fas-L), a set of reagents from Medsystems, Austria, was used. Additionally, an examination was carried out to detect IgG and IgM antibodies to pathogens of urogenital infections (chlamydia, ureaplasmosis, trichomoniasis, cytomegalovirus and herpetic infections) using enzyme-linked immunosorbent assay (ELISA).

Statistical processing of the research results was carried out using the Statgraphics (Statistical Graphics System) application package developed by STSC Inc.

Research results and discussion. The age of the subjects varied from 21 to 42 years and on average was 30.5±4.3 years in the main group, 31.2±5.4 years in the comparison group, 30.2±5.5 years in the control group , which did not have significant intergroup differences. General characteristics of the groups are presented in Table 1. A detailed study of the anamnesis showed a high frequency of genital pathology in patients with MM (Table 1). The proportion of chronic inflammatory diseases of the genital organs in the main group and in the comparison group exceeded that of the control group by 8 times, menstrual disorders such as hypermenorrhea, polymenorrhea, menorrhagia and metrorrhagia - by 20 times, benign diseases of the cervix - by 18 times. The use of intrauterine devices (IUDs) for contraception was monitored only in groups of women with MM. In addition, it should be noted that only every second patient with MM was able to realize reproductive function, while in the control group women who gave birth prevailed, and the frequency of spontaneous abortions was significantly higher in patients of the main group and the comparison group (Table 1).

Table 1

General characteristics of the groups of examined women

Indicator under study	Main group		Comparison group		Control group
Obstetric and gynecological history
Spontaneous abortion
Disorders of the ovarian-menstrual cycle
Chronic inflammatory diseases of the genitals
Ectopic cervix
Using an IUD
Extragenital diseases
Obesity
Diseases of the cardiovascular system
Diseases of the gastrointestinal tract

The most prevalent extragenital pathologies in MM were obesity, diseases of the cardiovascular system and gastrointestinal tract (Table 1). The data obtained are consistent with the opinion of most researchers about the importance of risk factors in the occurrence of MM. At the same time, the incidence of somatic and genital pathologies in the main group and the comparison group was comparable. A distinctive feature of the group of women with MM complicated by hemorrhagic syndrome was the presence of anemia of varying severity (97.7%).

For the purpose of hormonal therapy for MM, patients in both groups received Buserelin-depot (3.75 mg every 4 weeks), the duration of drug use varied from 1 to 6 months. In the main group, complications in the form of persistent hemorrhagic syndrome (from minor to heavy uterine bleeding) after the start of hormone therapy were noted by 26 women (60.5%) during the first month, 17 (39.5%) - from 2 to 3 months.

The results of the ultrasound examination showed that the size of the uterus in the groups of women examined ranged from 6-7 to 12 weeks of pregnancy. According to ultrasound data, the average volume of the uterus in the main group was 394.2±178.6 cm³, in the comparison group - 396.7±172.3 cm³ (P>0.05). The most common localization of nodes was subserosal-interstitial and interstitial, less often - subserous (Fig. 1). The number of myomatous nodes varied from 3 to 6, and the sizes of MM nodes ranged from 2.5 to 5 cm.

Rice. 1. Localization of myomatous nodes in groups of examined women

The additional use of Dopplerography in the work made it possible to determine the nature of vascularization of myomatous nodes. In patients with MM complicated by hemorrhagic syndrome during hormone therapy, the hypervascular type of tumor predominated, which confirms a previous study by I.E. Rogozhina et al. The authors found that the main diagnostic criteria for a comprehensive ultrasound examination of MM complicated by uterine bleeding are the hypervascular type of myomatous nodes, as well as an increase in the maximum blood flow velocity and the peripheral resistance index in the uterine arteries. In the main group, characteristic signs of Doppler sonography were recorded in our work in 90.7% of observations (n=39), and in the comparison group - in 30.3% (n=10).

A) b)

Rice. 2: a) hypervascular and b) hypovascular type of blood supply to uterine fibroids

The results of the study of the immune system showed a significant decrease in all studied cytokines in patients with MM, while a more pronounced decrease in indicators was found in the group of patients with clinical hemorrhagic syndrome (Table 2). The concentrations of IL-1β, IL-2, IL-4, IL-6 and γ-INF in patients in the comparison group decreased by 1.3 times compared to control data, and the content of TNF-α decreased by 1.5 times (P<0,05). В основной группе уровнипро- и противовоспалительных цитокинов снижались в 1,4-2 раза.

table 2

Results of a study of the immune system in groups of examined women

Study parameter (pg/ml)	Main group	Comparison group	Control group

* P - significance of differences with the control group (P<0,05);

#P - reliability of differences with the comparison group (P<0,05).

The γ-INF/IL-4 ratio in patients with MM decreased slightly in comparison with the control group (from 3.6 to 3.5), and in the combination of MM with hemorrhagic syndrome to 3.3, which indicates a reduction of predominantly Th-1 lymphocytes compared to Th-2 cells and suppression of the cellular immune response to a greater extent in MM. A number of researchers also associate the progression of the tumor process with immunosuppression and the inability of cells to undergo apoptosis. When studying the apoptosis marker in the Fas-L cell population (Table 2) in groups of examined women, we noted a decrease in its level from 0.30±0.05 pg/ml in the control group to 0.21±0.02 pg/ml - in the comparison group, with a progressive decrease in its content (2 times) in the blood serum of patients with MM in combination with hemorrhagic syndrome. Decrease in Fas-L concentration in MM (P<0,05) относительно показателей контрольной группы свидетельствует о снижении цитотоксического киллинга, осуществляемого Т- и NК-клетками, что способствует медленному прогрессированию заболевания и согласуется с мнением И.С.Сидоровой .Выявленные прогрессирующие нарушения синтеза цитокинов и угнетение апоптоза при ММ, осложненной геморрагическим синдромом на фоне гормонотерапии, послужили основанием для поиска причин возникновения дисфункции иммунной системы у данного контингента больных.

Considering the high incidence of chronic inflammatory diseases of the genitals in patients with MM, we included in the examination plan for women an enzyme-linked immunosorbent test (ELISA) to detect IgG and IgM antibodies to pathogens of urogenital infections.

The ELISA results showed that in the comparison group, chlamydia was diagnosed in 14 patients (42.4%), ureaplasmosis - in 19 (57.6%), herpes viral infection - in 15 (45.5%). Moreover, using ELISA in women with good tolerance to hormone therapy, only IgG to causative agents of urogenital infections was detected. In the main group, IgG and IgM antibodies to chlamydial infection were found in 34 examined women (79.1%); ureaplasma - in 35 (81.4%), and chronic trichomoniasis, herpetic and cytomegalovirus infections were diagnosed in all cases (Fig. 3).

Rice. 3. Results of examination of women using ELISA

to pathogens of urogenital infections

It should also be noted that the detection of IgM to pathogens of urogenital infections in patients of the main group indicated the activation of a chronic inflammatory process of the genitals, the manifestation of which, in our opinion, was hemorrhagic syndrome in the form of uterine bleeding of varying severity. In addition, it can be assumed that the prescription of hormonal drugs for the conservative treatment of MM against the background of chronic endometritis of a specific etiology has a potentiating immunosuppressive effect on the woman’s body, increasing the frequency of side effects and complications.

Conclusion. The results of a study of the cytokine profile in patients with MM complicated by uterine bleeding during hormone therapy indicate pronounced disturbances in the immune status, reduction in the function of Th1 and Th2 lymphocytes and, as a consequence, a significant inhibition of apoptosis in this pathology, which may contribute to further tumor growth and progression diseases. The occurrence of hemorrhagic syndrome during hormone therapy for MM is more typical for the hypervascular type of tumor (90.7%). The significant importance of the infectious factor and sexually transmitted infections in the pathogenesis of complications of conservative treatment of MM has been revealed. It has been established that hemorrhagic syndrome during hormone therapy for MM is associated with exacerbation of chronic urogenital infections, which dictates the need for a more detailed examination of women with this pathology in order to improve methods of conservative treatment MM, reducing the incidence of complications and increasing efficiency.

Reviewers:

Salov I.A., Doctor of Medical Sciences, Professor, Head of the Department of Obstetrics and Gynecology, Faculty of Medicine, Saratov State Medical University named after. IN AND. Razumovsky" of the Ministry of Health of Russia, Saratov;

Vasilenko L.V., Doctor of Medical Sciences, Professor of the Department of Obstetrics and Gynecology, Faculty of Education and Training, State Budgetary Educational Institution of Higher Professional Education "Saratov State Medical University named after. IN AND. Razumovsky" of the Ministry of Health of Russia, Saratov.

Bibliographic link

Khvorostukhina N.F., Stolyarova U.V., Novichkov D.A., Ostrovskaya A.E. CAUSES OF IMMUNE SYSTEM DYSFUNCTION IN PATIENTS WITH UTERINE FIBROID COMPLICATED BY HEMORRHAGIC SYNDROME // Modern problems of science and education. – 2015. – No. 4.;
URL: http://site/ru/article/view?id=20803 (access date: 02/01/2020).

We bring to your attention magazines published by the publishing house "Academy of Natural Sciences"

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Uterine fibroids are one of the most common benign tumors, observed in approximately 20-40% of women of reproductive age and occupy 2nd place in the structure of gynecological diseases. Despite the variety of clinical symptoms, the main manifestation of fibroids, which often requires emergency surgical intervention, remains hemorrhagic syndrome. According to most researchers, the occurrence of uterine bleeding with fibroids is associated with dysregulation in the hypothalamus-pituitary-ovarian system. At the same time, the results of Doppler ultrasound of the uterine arteries in uterine fibroids remain controversial. I.A. Ozerskaya et al. (2014) found that in women over 35 years of age suffering from uterine fibroids, an increase in maximum and end-diastolic velocities and a decrease in indices of peripheral resistance of the uterine arteries. And the results of morphological studies of the myometrium and myomatous nodes, published by D.V. Dzhakupov et al. (2014) confirm the role of hypertension in the large arteries of the uterus in the pathogenesis of bleeding in fibroids. Among the numerous treatment options for uterine fibroids in women of fertile age, preference is given to organ-preserving methods. But even the use of minimally invasive organ-saving surgical techniques does not guarantee 100% effectiveness of treatment. Literary sources state that the probability of disease recurrence after conservative myomectomy within 5 years is 45-55%. And the share of hysterectomies performed for uterine fibroids in the structure of surgical interventions reaches 60.9-95.3% (Zatsepin A.V. et al., 2012).

Purpose: To study the characteristic features of the parameters of complex ultrasound diagnostics for uterine fibroids complicated by hemorrhagic syndrome.

Material and methods; The main group consisted of 98 patients with uterine fibroids complicated by uterine bleeding; the comparison group (n = 87) included patients with uterine fibroids without severe hemorrhagic syndrome. The control group included 60 practically healthy women. Ultrasound examinations were performed on a HITACHI-5500 device using broadband, ultra-high-density convex sensors 3.5-5.0 MHz and cavity sensors 5.0-7.5 MHz. Statistical processing of the research results was carried out using the Statgraphics (Statistical Graphics System) application package developed by STSC Inc.

Research results. The age of the examined women varied from 21 to 42 years and on average was 30.5 ± 4.3 years in the main group, 31.2 ± 5.4 years in the comparison group, 30.2 ± 5.5 in the control group years, which did not have significant intergroup differences. Patients of the main group and the comparison group were comparable in the presence of genital and somatic diseases.

According to ultrasound data, the average volume of the uterus in the main group was 394.2 ± 178.6 cm?, in the comparison group - 396.7 ± 172.3 cm? (P > 0.05). In most cases, there was a typical uterine fibroid: in the body of the uterus, myomatous nodes were diagnosed in 83.7% of patients in the main group and in 86.2% of the comparison group. Atypical uterine fibroids with isthmus localization of the node were detected in 16.3% and 13.8%, respectively. In patients of the main group, subserous-intramural (n = 26; 26.5%) and submucosal-intramural (n = 33; 33.7%) localization of nodes prevailed. In the comparison group, a greater share was occupied by submucosal-intramural localization of nodes (n = 34; 39.1%). Purely submucosal localization of nodes was found 2 times more often in the main group, which, in all likelihood, was the main cause of uterine bleeding. In 45 women of the main group (45.9%) and 47 women of the comparison group (54.0%), the tumor was represented by a single myomatous node. In other cases, the number of uterine fibroid nodes ranged from 2 to 5. In the main group, 14 patients (14.3%) had more than 5 fibroid nodes, and in the comparison group - 7 (8.1%). In most cases, fibroid nodes had average sizes (30-60 mm): the main group - 48%, the comparison group - 48.8%. At the same time, the average linear size of the dominant myomatous node corresponded in the main group - 44.3 ± 21.2 mm, in the comparison group - 42.1 ± 19.8 mm (P > 0.05).

The additional use of Dopplerography in the work made it possible to determine the nature of vascularization of myomatous nodes. In patients with uterine fibroids, in combination with ongoing bleeding, the hypervascular type of tumor prevailed: in the main group, characteristic Doppler signs were recorded in 89.8% of cases, in the comparison group - in 52.9%. In each artery, we also examined spectral analysis of blood flow with measurements of linear blood flow velocity (LBV) and resistance index (RI). When assessing BFV, the main attention was paid to changes in only angle-independent parameters: maximum blood flow velocity (V max) and minimum blood flow velocity (V min). IR was used for qualitative assessment of blood flow. Calculation of uterine hemodynamic parameters was represented by the average value between the right and left uterine arteries. Analysis of qualitative indicators of uterine hemodynamics showed that V max in the uterine arteries in patients with uterine fibroids averaged: in the main group 82.11 ± 2.06 cm/sec, in the comparison group - 62.32 ± 2.45 cm/sec, which was 1.3-1.8 times higher than the control values ​​(45.16 ± 1.23 cm/sec) (Pk< 0,05). Вместе с тем, средние показатели Vmin были значительно выше в контрольной группе женщин, в то время как в основной и группе сравнения констатировано снижение V min, соответственно в 2,5 и в 1,3 раза (Рк < 0,05). Более выраженные изменения параметров допплерометрии наблюдались в основной группе. Кроме того, у пациенток основной группы выявлено возрастание ИР маточных артерий в 1,6 раза (0,90 ± 0,02) по отношению к данным контрольной группы (0,54 ± 0,02; Рк < 0,05) и в 1,3 раза в сравнении с аналогичным параметром группы сравнения (0,69 ± 0,03), что свидетельствует о достоверном повышении периферического сопротивления в маточных артериях при миоме матки, осложненной геморрагическим синдромом. При этом установлена достоверная разница показателей маточной гемодинамики (ЛСК и ИР) в основной группе и группе сравнения (Ро-с < 0,05).

Conclusion. The results of the analysis showed that the main diagnostic criteria for a comprehensive ultrasound examination for uterine fibroids complicated by hemorrhagic syndrome are: the prevalence of the hypervascular type of tumor (89.8%), as well as an increase in the maximum blood flow velocity, a decrease in diastolic blood flow against the background of an increase in the resistance index in the uterine arteries.

Bibliographic link

Khvorostukhina N.F., Ostrovskaya A.E., Novichkov D.A., Stepanova N.N., Korotkova T.V. THE SIGNIFICANCE OF COMPREHENSIVE ULTRASONIC RESEARCH IN UTERINE FIBROID COMPLICATED BY HEMORRHAGIC SYNDROME // International Journal of Experimental Education. – 2016. – No. 6-2. – P. 290-291;
URL: http://expeducation.ru/ru/article/view?id=10269 (access date: 02/01/2020). We bring to your attention magazines published by the publishing house "Academy of Natural Sciences"

Myoma is a benign tumor that grows from connective tissue on the walls or in the uterine cavity. The incidence rate by age 35 is 35-45% among the entire female population. The peak incidence occurs in the age group of 35-50 years.

Uterine fibroids can range in size from a small nodule to a tumor weighing about a kilogram, when it is easily identified by palpation of the abdomen. Signs of the disease may not appear immediately. The more advanced it is, the more difficult the treatment and the greater the likelihood of complications.

Let's take a closer look at what kind of disease this is, what the characteristic signs and symptoms are, and what is prescribed as treatment for a woman.

Myoma: what kind of disease is it?

Uterine fibroids (fibromyoma, leiomyoma) are the most common benign tumor of the uterus, hormonal-dependent (develops with an increased content of female sex hormones estrogen).

Myoma certainly has signs of a tumor, but it also differs from it, so it is more correct to correlate it with tumor-like formations. Despite its benign nature, fibroids can cause a lot of trouble, including uterine bleeding and complications during pregnancy, so treatment must be approached responsibly.

The occurrence of uterine fibroids usually occurs in her body, but in rare cases it can also occur in the cervix. Fibroids that develop in muscle tissue are considered typical, while those that form in the neck or ligaments are considered an atypical form of the disease.

The myomatous node begins its development from a growth zone located around a thin-walled blood vessel. In size, such growth can range from several millimeters to several centimeters; most often in women, multiple fibroids occur when several tumors form at once.

Causes

Myoma ranks 2nd in the structure of gynecological diseases. Its frequency in reproductive age averages 16%-20% of cases, and in premenopausal age it reaches 30-35%.

Myoma appears as a result of mutation of a single cell. Its further division and development of the tumor is influenced by changes in hormonal levels in the body, a violation of the ratio of estrogen and progesterone. During menopause, when the production of female sex hormones decreases, the tumor may disappear on its own.

The following reasons lead to uterine fibroids:

• Hormonal disorders are a sharp decrease or increase in the level of progesterone or estrogen, which are clinically manifested by various menstrual disorders.
• Irregularity of sexual activity, especially after 25 years. As a result of sexual dissatisfaction, blood flow in the pelvis changes, and stagnation prevails.
• Disturbance in the production of sex hormones in ovarian diseases
• Prolonged stress, heavy physical work
• The presence of chronic infectious diseases, such as chronic pyelonephritis, chronic tonsillitis, etc.
• Diseases of the endocrine glands: thyroid, adrenal glands, etc.
• Disorders of fat metabolism in the body (obesity).
• Mechanical damage, difficult childbirth with ruptures, abortions, complications after surgery, consequences of curettage.
• Hereditary factor. The risk of developing fibroids increases significantly in those women whose grandmothers and mothers had such a tumor.

It has been proven that women who have given birth are less likely to develop nodes. Often this tumor can appear during pregnancy. Especially if the first pregnancy is late.

Classification

I have several classifications of such formations. According to the number of nodes, uterine fibroids can be of the following types:

• Single;
• Multiple.

According to the sizes there are:

• Large;
• Average;
• Small myomatous neoplasms.

Depending on the size of the myomatous nodes, which are compared with the duration of pregnancy, there are

• small fibroids (5-6 weeks),
• medium (7-11 weeks),
• large sizes (over 12 weeks).

Depending on the size and location of the nodes, there are 3 types of uterine fibroids:

• leiomyoma - consist of smooth muscle tissue;
• fibroma - consists of connective tissue;
• fibroids - consists of connective and muscle tissue.

Based on their location relative to the muscle layer – the myometrium – fibroids are classified as follows:

Interstitial uterine fibroids

It is located in the center of the myometrium, i.e. muscular layer of the uterus. It is characterized by large sizes. It is completely located in the thickness of the muscular layer of the uterine wall (occurs in 60% of all cases of the disease).

Submucosal fibroid

What it is? Submucosal or submucosal - grows in the direction of the endometrium. If such a node is partially (more than 1/3) located in the myometrium, it is called intermuscular with centripetal growth (towards the uterine cavity). It may also have a stem or a wide base. Pedicled fibroids can sometimes “fall out” of the cervical canal, becoming twisted and infected.

Subserosal

Subperitoneal (or subserous) - the node is located under the mucous membrane of the outer layer of the uterus, near the peritoneum. Subserous fibroids are divided into the following types:

• "Type 0". A knot on a wide base is 0-A, a knot on a leg is 0-B.
• "Type 1". Most of the node is located in the serous membrane.
• "Type 2". Most of the tumor is located in the thickness of the myometrium.

Stages

There are three stages of fibroid morphogenesis:

• Formation of the rudiment (active growth zone) in the myometrium.
• Growth of an undifferentiated tumor.
• Growth and maturation of a tumor with differentiated elements.

The rate of development of myomatous nodes depends on many factors:

• The presence of chronic gynecological pathologies;
• Long-term use of hormonal contraceptives;
• Having had a large number of abortions in the past;
• Prolonged ultraviolet irradiation;
• Absence of childbirth and lactation in women after 30.

With the rapid growth of a myomatous tumor, a woman observes menorrhagic changes (excessive bleeding during menstruation), anemic signs, and hyperplastic tissue changes occur in the uterus.

An increase in tumor size does not always occur unambiguously, so the following is distinguished:

1. Simple. Slowly growing and asymptomatic uterine fibroids of small size, often single. Often simple fibroids are diagnosed accidentally.
2. Proliferating. It grows quickly and provokes clinical manifestations. Diagnosed as multiple uterine fibroids or single large ones.

It is usually recommended to treat fibroid nodes in young women, especially if the tumors are bothersome or interfere with pregnancy. Depending on the location of the node and its size, the doctor may first prescribe conservative therapy - taking medications, and if there is no effect, surgery.

The first signs in a woman

A fibroid can only be recognized when it has reached a sufficiently large size. As uterine fibroids grow, the first signs may appear:

• The appearance of sharp pain of a cramping nature not associated with menstruation in the lower abdomen;
• long, heavy and irregular menstruation;
• constipation;
• bleeding;
• frequent urination;
• heaviness and constant pain in the lower abdomen;
• bleeding during sexual intercourse;
• lower back pain;
• abdominal enlargement not associated with significant weight gain;
• frequent miscarriages.

All these signs may be present with other gynecological problems. Therefore, they are not enough to make a diagnosis. The presence of a tumor can only be confirmed by a thorough examination and ultrasound.

Symptoms of uterine fibroids

Often, uterine fibroids do not give any symptoms and are found during a routine examination by a gynecologist. Or it happens that the symptoms are quite smoothed out and are often perceived as a variant of the norm.

The growth of uterine fibroids is accompanied by the appearance of symptoms, the most common of which are:

• Pain during the intermenstrual period, varying in duration, arising in the lower abdomen, sometimes radiating to the lumbar region, upper abdomen or legs;
• Menorrhagia is an increase in menstrual flow. Heavy bleeding is dangerous because after some time it can result in anemia. More heavy bleeding indicates that the muscles of the uterus are contracting less well, in which case medical attention is required.
• Pelvic organ dysfunction, which are manifested by frequent urge to urinate and constipation. These symptoms occur when the nodes are subserosal, cervical or interligamentous, as well as when the tumor volume is large.
• Feeling of heaviness increases, the presence of something foreign in the stomach. Sexual intercourse becomes painful (if the nodes are located on the vaginal side). The belly grows, as during pregnancy. A sprain increases the nagging pain in the abdomen.
• Miscarriage, infertility - occur in 30% of women with multiple fibroids.

In the photo below, you can see the fibroid from different sides:

It is impossible to independently determine whether you have the disease. If the above symptoms appear, you should definitely undergo an examination by a gynecologist. These signs can also be accompanied by more dangerous diseases, such as uterine or ovarian cancer, endometriosis.

	Symptoms in a woman
For submucosal	manifested by various menstrual cycle disorders, heavy and prolonged menstruation, uterine bleeding, which often results in anemia. Pain syndrome is not typical for such fibroids, but if the myomatous node falls from the submucosal layer into the uterine cavity, cramping, very intense pain occurs.
With intramural	appears in the middle layer of muscle tissue of the uterus and is accompanied by cycle disturbances and pain in the pelvic area
For subserous	It often occurs without symptoms, so the pain is minor and appears rarely: pain in the lower back, back pain, as well as urination problems and constipation.

Complications

Uterine fibroids pose a danger to a woman’s health in terms of the development of complications of the disease. With regular monitoring by a gynecologist and careful attention to her health, a woman can significantly reduce the risk of complications.

Complications of uterine fibroids:

• necrosis of myomatous node;
• birth of a submucosal node;
• posthemorrhagic anemia;
• tumor malignancy;
• infertility;
• miscarriage;
• postpartum hemorrhage;
• hyperplastic processes of the endometrium.

In order to avoid complications, you should begin treating fibroids in a timely manner (immediately after detection). Surgical intervention is rarely required and is more often associated with existing complications of the disease.

Fibroids and pregnancy

Uterine fibroids are found in 8% of pregnant women undergoing pregnancy monitoring. For most women, during pregnancy the size remains unchanged or decreases.

Danger:

• development of fetoplacental insufficiency (changes in the structural and functional properties of the placenta, which can lead to impaired fetal development);
• threat of miscarriage at various stages.

Most often, women with uterine fibroids are offered to give birth by cesarean section due to the risk of various complications, such as:

• untimely discharge of amniotic fluid (this occurs due to increased tone of the muscular layer of the uterus or improper positioning of the fetus);
• risk of heavy postpartum bleeding;
• risk of premature placental abruption (most often this occurs if the fibroid is located behind the placenta).

During a cesarean section, a woman may have the tumor removed immediately so that she can plan another pregnancy in the future.

Diagnostics

The first signs of fibroids are very similar to the symptoms of other gynecological pathologies. Therefore, to make a correct diagnosis, it is necessary to conduct a series of laboratory instrumental studies. Only a correct and timely diagnosis can guarantee successful treatment and a speedy recovery.

Diagnostics include:

• Gynecological examination. It is carried out on a gynecological chair using the necessary instruments. The size of the uterine body, the location of the ovaries, the shape and mobility of the cervix, etc. are taken into account;
• Ultrasound of the pelvic organs using a vaginal probe. For better visualization, the study is performed with a full bladder. The method is highly informative and allows you to identify the size of the tumor and its shape;
• Laparoscopy - used only when myoma cannot be distinguished from an ovarian tumor;
• Hysteroscopy is an examination of the cavity and walls of the uterus using an optical hysterocope. Hysteroscopy is performed for both diagnostic and therapeutic purposes: identification and removal of uterine fibroids in certain locations.
• Biopsy. In some cases, during hysteroscopy or laparoscopy, a small sample of tissue is taken, which is then examined in more detail under a microscope.
• Diagnostic curettage of the uterine cavity: indicated for all identified uterine fibroids in order to establish endometrial pathology and exclude uterine cancer.

How to treat uterine fibroids?

The main goal of treating fibroids is to eliminate the cause of the disease and the harmful effects of the tumor on the surrounding tissue of the uterus, reduce its size, and stop growth. Both medical and surgical methods are used.

As a rule, treatment tactics are chosen depending on the size, location and clinical and morphological variant of the tumor, the hormonal status of the patient, the state of her reproductive systems, etc. Some experts believe that there is no need to rush into surgery, but it is wiser to monitor the woman’s health status before the onset of menopause.

Unfortunately, conservative treatment of fibroids is effective only under certain conditions, namely:

• relatively small size of the node (the size of the uterus does not exceed a 12-week pregnancy);
• asymptomatic course;
• the patient’s desire to preserve the uterus and, accordingly, reproductive function;
• inertial or subserous arrangement of nodes having an exceptionally wide base.

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

1. Combined oral contraceptives containing desogestrel and ethinyl estradiol. These medications help suppress and alleviate the first symptoms of fibroids in women. However, drugs in this group do not always help to reduce tumors, so they are used only when the size of the node does not exceed 1.5 cm.
2. Androgen derivatives: Danazol, Gestrinone. The action of this group is based on the fact that androgens suppress the synthesis of ovarian steroid hormones. As a result, the size of the tumor decreases. Use for up to 8 months continuously.
3. Antiprogestogens. Helps stop tumor growth. Treatment can last up to six months. The most famous drug in this group is Mifepristone;
4. Antigonadotropins (Gestrinone)– prevent an increase in the size of uterine fibroids, but do not help reduce existing sizes.

FUS ablation. One of the modern ways to combat fibroids. In this case, the tumor is destroyed by ultrasound under the control of a magnetic resonance imaging scanner.

A woman receiving conservative treatment for uterine fibroids should be examined at least once every 6 months.

A set of recommendations has been developed for such patients:

1. It is strictly forbidden to lift heavy objects, which can lead to prolapse of the uterine body and other complications;
2. Stress that negatively affects hormonal levels is unacceptable;
3. Increase the consumption of fruits, berries, herbs, vegetables, as well as fish and seafood;
4. Walk more often (this helps improve blood flow);
5. Avoid sports that place stress on the abdominal muscles (you can do free swimming and yoga);
6. It is also worth noting that patients with diagnosed fibroids should avoid exposure to heat. This means that you need to give up long sunbathing, visiting the bathhouse, sauna and solarium, as well as hot showers.
7. Undergo restorative treatment with vitamins 4 times a year (select the complex together with your doctor).

Surgical treatment: surgery

Mandatory indications for invasive therapy are:

• the size of the tumor is more than 12 weeks and it puts pressure on nearby organs;
• myomatous formations provoke heavy uterine bleeding;
• there is an acceleration in the growth of fibroids (by 4 weeks in less than a year);
• necrotic changes in the tumor;
• twisting of the pedicle of the subserous node;
• nascent submucosal myoma (emergency laparotomy is indicated);
• combination of myomatous nodes with adenomyosis.

There are different options for surgical treatment of uterine fibroids. Among them, three main areas can be distinguished:

• removal of the entire uterus and nodes;
• removal of myomatous nodes while preserving the uterus;
• surgical disruption of blood circulation in fibroids, which leads to their destruction.

Depending on the type of fibroid, its location, and size, the doctor chooses the type of surgery to remove the fibroid. Myomectomy today is performed in 3 ways:

• Laparoscopy - through small holes in the abdomen
• During hysteroscopy, a special instrument is inserted into the uterus through the vagina.
• Strip surgery through an incision in the lower abdomen is performed very rarely.

Rehabilitation after surgery

Rehabilitation of the female body depends on a variety of factors:

1. For example, if the operation was performed using an open method, then the recovery process is slower.
2. The patient is offered to limit physical activity, not forgetting that measured walking can only be beneficial and will contribute to accelerated healing.

Maintaining proper nutrition

There is no special diet, you just need to stick to a healthy diet.

• First of all, it is a varied and balanced diet that meets a woman’s energy needs, including vitamins and microelements.
• Food is taken 5 times a day; overeating and long breaks between meals are not allowed.
• A healthy diet involves eliminating frying and using baking, stewing or boiling when preparing dishes.

Allowed products for fibroids

Prohibited Products

The basis of the diet should be the following products: vegetable oil – sunflower, flaxseed, rosehip, corn, etc.; any fruits, herbs, vegetables, berries; dark varieties of bread, with the addition of coarse flour and bran; cereals, legumes; fish products, mainly sea fish; fermented milk products (fresh); nuts, seeds, seeds; high-quality varieties of green and black tea, herbal tea; compote or jelly based on berries or fruits.

Undesirable foods should be excluded from the diet: margarine, oil mixtures (spreads), limited butter; fatty meat, lard; sausages, smoked products; hard cheese with a high percentage of fat, processed cheese, sausage cheese; baked goods and baked goods made from white flour; sweets, including cakes, ice cream, cream pies.

Folk remedies

Before you start using folk remedies for fibroids, be sure to consult with your doctor.

1. Tampons with burdock root juice are applied topically. Add honey, sea buckthorn and St. John's wort oil, mumiyo to the juice and mix thoroughly. The tampon is placed overnight for 21 days.
2. Sea buckthorn berry oil. To do this, make cotton swabs, soak them in oil and place them in the morning and evening. The course lasts 2 weeks. It can be repeated if necessary.
3. Take 4 tsp. flax seeds, pour half a liter of boiling water and simmer over low heat for 10 minutes. At this time, stir the broth. When it cools down, drink half a glass, 4 times a day. The course lasts 15 days, then take a break for 15 days, and repeat the course.
4. Tincture of walnut partitions. You can buy it ready-made at the pharmacy and use it according to the instructions, or you can prepare it yourself: pour 30 grams of partitions with vodka (1 glass) and leave in a dark place for 3-4 weeks. Take 30 drops 30 minutes before meals with a glass of water. The course is 1 month, 2 weeks break and can be repeated.
5. Prepare an infusion of several flowers by brewing them with a glass of boiling water for 10 minutes. You need to drink it in the morning before breakfast, for a long time. The duration of admission is determined by the herbalist. Calendula infusions are used for douching. This plant can be used internally in the form of a pharmaceutical tincture.
6. Finely chopped boron uterus grass(50 g) pour 500 ml of vodka. Leave for ten days in a dark place, shaking regularly. The first ten days take the infusion one teaspoon once a day, the next ten days - one tablespoon. Then take a break for ten days and repeat the treatment.
7. Using tampons gives good results, soaked in medicinal liquids. Shilajit should be diluted with water in a ratio of 2.5:10. Soak a cotton pad in the prepared solution and place it in the vagina. At the same time, mumiyo should be taken orally at a dose of 0.4 g. Therapy should last 10 days, after which a break of 1 week must be taken. Afterwards you can repeat the course.

Forecast

With timely detection and proper treatment of uterine fibroids, the further prognosis is favorable. After organ-conserving operations, women in the reproductive period are likely to become pregnant. However, the rapid growth of uterine fibroids may require radical surgery to exclude reproductive function, even in young women.

Prevention

The main preventive measures are as follows:

• proper nutrition with a predominance of fresh vegetables and fruits;
• taking vitamins and microelements that contribute to the normal synthesis of sex hormones;
• active lifestyle, playing sports;
• regular sexual intercourse;
• annual preventive examinations with a gynecologist with ultrasound.

We found out what uterine fibroids are and what treatment is most effective. Remember, when visiting a doctor regularly, if a tumor occurs, it will be found at the very beginning, while its size is small and the woman does not even suspect the presence of fibroids. Timely detection of a tumor will allow it to be cured without the use of surgery and preserve the ability to bear children.

By location and direction of growth:

Subserous - growth of a myomatous node under the serous membrane of the uterus towards the abdominal cavity (including intraligamentous, intraligamentous location); such nodes may have a wide base or a thin stalk connecting them to the myometrium.

Submucosal (submucosal) - the growth of a myomatous node under the mucous membrane of the uterus towards the uterine cavity, deforming it (birth, birth).

Intramural (interstitial) - growth of a node in the thickness of the muscular layer of the uterus (in the body of the uterus, in the cervix).

According to clinical manifestations:

Asymptomatic uterine fibroids (70-80% of cases).

Symptomatic uterine fibroids (20-30% of cases) - clinical manifestations of symptomatic uterine fibroids (menstrual cycle disorders such as menometrorrhagia, hyperpolymenorrhea, dysmenorrhea; pain syndrome of varying severity and nature (pulling, cramping); signs of compression and/or dysfunction of the pelvic organs ; infertility; recurrent miscarriage; secondary anemia).

Indications for surgical treatment of fibroids:

1. Symptomatic fibroids (with hemorrhagic and pain syndrome, the presence of anemia, a symptom of compression of adjacent organs).

2. The size of fibroids exceeds the size of a pregnant uterus for 12 weeks.

3. Presence of a submucosal node.

4. The presence of a subserous fibroid node on a stalk (due to the possibility of torsion of the node).

5. Rapid tumor growth (4-5 weeks a year or more).

6. Growth of nodes in postmenopause.

7. Myoma in combination with endometrial or ovarian pathology.

8. Infertility due to uterine fibroids or recurrent miscarriage.

9. Presence of concomitant pathology of the pelvic organs

10. Cervical localization of the myomatous node.

11. Malnutrition, node necrosis.

Surgery

The decision to perform hysterectomy or myomectomy is made depending on: the woman’s age, the course of the disease, the desire to preserve reproductive potential, the location and number of nodes.

Our clinic performs uterine artery embolization. Embolization is a promising method for the treatment of symptomatic uterine fibroids - both as an independent method and as a preoperative preparation for subsequent myomectomy in women of reproductive age, which can reduce the amount of intraoperative blood loss.

The "gold standard" of treatment uterine fibroids In Western Europe and the USA, myomectomy is recognized - surgical removal of uterine fibroids. During this operation, “husking” of myomatous nodes is performed, followed by their removal and careful suturing of the uterine body. A characteristic feature of a myomatous node is the presence of a capsule around it. Therefore, removal (“husking”) of the node can be performed within the capsule without damaging the surrounding myometrial tissue.

Organ-saving operations are performed via transvaginal and transabdominal approaches. The first includes: vaginal myomectomy and hysteroresectoscopy of myomatous nodes.

Transabdominal access includes laparotomy, minilaparotomy and laparoscopy.

The undoubted advantages of laparoscopic and minilaparotomy approaches are: minimal trauma, better cosmetic effect, lower likelihood of developing adhesions, shorter hospital stay and postoperative rehabilitation. However, when myomatous nodes are larger than 8 cm in size and have intraligamentary localization, there is a high risk of bleeding from the bed of the myomatous node, which can lead to massive blood loss and access conversion; in this case, laparotomy access is optimal.

There are the following approaches to perform hysterectomy:

vaginal;

laparoscopic;

laparoscopically-assisted vaginal;

hysteroresectoscopic;

combined.

I would especially like to dwell on the vaginal approach for hysterectomy, in which hemostasis options are possible: traditional ligation of ligaments and vessels, hemostasis using electrosurgical techniques, which significantly reduces the time of surgical intervention, reduces intraoperative blood loss, reduces the degree of tissue trauma, and postoperative pain.

The advantages of vaginal access are:

Less invasive access;

Cosmetic effect – absence of wounds on the anterior abdominal wall;

Short periods of hospital stay;

Short rehabilitation periods;

Low incidence of postoperative complications and absence of complications in the late postoperative period.

Usage laparoscopic The technique for performing it has advantages similar to vaginal access: low invasiveness, cosmetic effect, short hospital stay in the postoperative period.

The use of combined (laparoscopic and vaginal) access allows you to solve problems that cannot be solved for each access when used in isolation, such as: adhesions of the pelvic and abdominal organs, endometriosis, diseases of the uterine appendages, poor uterine descent (including in nulliparous women) .

Among all the gynecological diseases that modern women face, fibroids occupy a leading place. The presence of a tumor often frightens the patient and raises many questions. Let's figure out what a fibroid node in the uterus is, how to deal with it, and what dangers the pathology poses.

Essence and problems

Nodular uterine fibroids are a benign neoplasm that originates between the healthy tissues of the organ, pushing them apart. The term itself does not identify a separate disease; it is used in non-professional circles. ICD-10 code: D25 – uterine leiomyoma. This is one of the most common pathologies of the reproductive system encountered by women of childbearing age. It is quite rarely diagnosed in patients during menopause and never before menarche.

A myomatous nodule may have one or more nuclei. It develops slowly, often latently (without external manifestations), which makes diagnosis difficult at the initial stage of the pathological process. Usually multiple fibroids are detected when several nodes grow at once, but single ones also occur.

Some experts are of the opinion that nodular fibroids are always multiple in nature. The only difference is at what stage of development the formations are.

Small tumors do not cause problems, but without proper treatment they reach significant sizes, causing compression of blood vessels and nearby organs, affecting reproductive function, the functioning of the gastrointestinal tract and urinary system. The disease is accompanied by severe acyclic bleeding, which threatens anemic syndrome. In medical practice, there are known cases of the development of hematometra, when the evacuation of menstrual blood is disrupted and the uterus is filled with secretions. In this case, surgical intervention will be required, otherwise there will be serious consequences for the woman’s health.

Some fibroids can provoke disruption of the functioning of the endocrine system and cause obesity. Often inflammation develops in myomatous nodes, which can lead to peritonitis or sepsis.

Until recently, fibroids were considered a precancerous condition. Today, most doctors are of the opinion that the tumor is benign, but debate about possible degeneration continues. It is believed that in the presence of provoking factors, a myomatous node can turn into a cancerous tumor.

Why is it developing?

Nodular fibroids are considered a hormone-dependent tumor, so the main reason for the development of pathology is a change in hormonal levels in the female body, namely an increase in estrogen and progesterone hormones. Because of this, hyperplastic changes occur in the cells of the muscular layer of the uterus.

The growth of the tumor causes the absence of pregnancy and lactation. Every month, a woman’s body prepares for conception, and when this does not happen for too long, a malfunction may occur, which triggers the formation of fibroids. At risk are patients with late puberty (the norm is up to 15 years), irregular menstrual cycles, heavy and prolonged periods, dissatisfaction with sexual relations and abstinence from them.

Most often, women aged 25 to 55 experience the disease. During this time, the body has already suffered certain pathologies, disruptions in the functioning of the endocrine and other systems, and has been exposed to stressful situations. The development of uterine fibroids is facilitated by a decrease in natural immune defenses.

Factors that increase the risk of disease

There are many reasons for the appearance of nodular uterine fibroids. Factors that provoke the disease should be avoided. These include:

• metabolic disorders in the body;
• traumatic effects on the uterus (abortions, miscarriages, diagnostic curettages, gynecological operations);
• uncontrolled use of contraceptives;
• use of an intrauterine device;
• infectious, inflammatory processes in the organs of the genitourinary system;
• venereal diseases;
• obesity, sedentary lifestyle;
• cystic and other formations;
• poor environment, harmful working conditions;
• bad habits;
• frequent stress.

If a woman has had cases of myomatous formations in her family, then the risk of developing pathology increases.

Classification of myomatous formations

Certain classifications of fibroid nodes are based on various criteria for assessing fibrous formations. Judging by size, there are large (over 6 cm), medium (in the range of 4-6 cm) and small (up to 2 cm). The form of neoplasms can be diffuse (when the node does not have a clear outline, and the myometrium grows diffusely) or nodular (single or multiple myoma formations of a smooth, round shape).

The placement of fibroids relative to other layers of the wall of the reproductive organ distinguishes the following types of fibromatous neoplasms:

1. Subserous - develops on the outer part of the uterus, grows towards the peritoneum.
2. Submucosal (submucosal) - originates under the thin mucous membrane (endometrium) inside the uterus.
3. Interstitial (intermuscular) - nodes form inside the muscle layer, that is, the walls of the uterus.
4. Intramural (intramuscular) - the tumor appears in the middle layer of muscle tissue.
5. Subserous-interstitial – a tumor of the interstitial type that develops towards the peritoneum.
6. Intraligamentary (interligamentous) - develops between the broad ligaments of the uterine body.

A special form of pathology is calcified fibroid, in which tumor formation occurs in the calcium membrane. Static, slowly progresses, responds poorly to drug therapy.

Symptoms

At the initial stages of its development, small-nodular uterine fibroids, like other benign neoplasms, do not manifest themselves in any way. Over time, a woman develops unpleasant signs of pathology in the reproductive organ:

• pain in the lower abdomen;
• heavy menstrual bleeding (sometimes clot-like), increased duration of menstruation;
• pressing feeling, heaviness in the stomach;
• organ compression;
• acyclic bleeding;
• yellowish mucous discharge;
• inability to conceive, miscarriages, premature births;
• causeless growth of the abdomen.

The pain can be nagging, aching, sharp, cramping, and can radiate to the lower back, leg, side, or buttocks. Excessive blood loss leads to anemia, which causes dizziness, shortness of breath, nausea, pale skin, and fainting. The patient's appetite decreases and her general health worsens.

Compression of internal organs causes problems with urination: frequent urges appear, the process becomes difficult and painful. The pressure of the myomatous node on the rectum leads to constipation.

Diagnosis of nodular fibroids

Uterine fibroids are usually detected during a routine visit to the gynecologist. Deformation of the uterus, its enlargement, nodular seals are felt upon palpation. But based on examination alone, a diagnosis cannot be made. A number of laboratory and instrumental studies will be required that will accurately determine the nature and number of formations, location, size: urine and blood tests, smears for atypical cells and flora, ultrasound, CT, MRI, hysteroscopy, Dopplerography.

Usually, for uterine fibroids, ultrasound or hysteroscopy is prescribed. Gray or dark hypoechoic formations are visualized on the screen - structures that have a density less than that of neighboring tissues. In this case, you can visually evaluate the neoplasm, take an image to monitor the pathology over time, and take a sample (biopsy).

Complications with fibroids

Myoma formations of large and medium sizes become the culprits of painful sensations. By exerting pressure on nearby organs and blood vessels, fibroids provoke disruptions in their functioning. For example, lymphostasis, which is accompanied by stagnation of lymph in the system, develops as a result of compression of the lymph nodes.

Often, multinodular fibroids are aggravated by additional diseases of the reproductive system. Pathology occurs in combination with:

• endometriosis (adenomyosis), when the tissues lining the uterine cavity grow into its muscle layer;
• erosion of the cervix, which develops against the background of a tumor;
• various forms of endometrial hyperplasia;
• adenomatous polyps.

Such “duets” add unpleasant symptoms to a woman and need to be treated urgently. There are complications that are dangerous to life and health. These include necrosis of tumor tissue, purulent processes, and the birth of a myomatous node. Cell death occurs due to torsion of the stalk and malnutrition of the neoplasm. Accompanied by symptoms of intoxication of the body (nausea, vomiting, fever).

Therapeutic areas

The choice of treatment for nodular fibroids depends on many factors: the degree of neglect of the pathology, its size and location, the general condition of the patient, contraindications and the desire to have children in the future.

There are two ways to cure fibroids: conservative and surgical. At the initial stages of the disease, preference is given to the first, but in the absence of positive changes, surgery is prescribed.

Conservative treatment

The goal of drug therapy is to shrink the myomatous node and stop its further growth. In this case, hormonal drugs, sedatives, drugs that increase immunity, and vitamin complexes are prescribed.

The disadvantage of conservative treatment is that the risk of relapse after completion of therapeutic measures is very high.

Surgical treatment

Surgery will be required to remove a large tumor. There are a number of indications for its implementation: severe uterine bleeding, rapid tumor growth, nascent fibroids, and other pathological processes. Emergency surgical intervention is performed for hemorrhagic syndrome in a patient with uterine fibroids, even if the woman’s condition is serious due to large blood loss. In especially severe cases, complete removal of the uterus is required.

Unconventional methods

Traditional medicine recipes will not get rid of myomatous formations, but will only remove the symptoms. Infusions and decoctions based on medicinal plants can be used as additional therapy in parallel with the main treatment. Any medications should be taken only after consultation with your doctor.

To minimize the risk of developing uterine fibroids, you need to follow a diet, lead a healthy lifestyle, and regularly undergo gynecological examinations and ultrasounds.

What is nodular uterine fibroid: causes of occurrence and what is the danger of the disease

Nodular uterine fibroids are a very common pathology that is diagnosed in a large number of women.

At its core, it is a benign formation in the uterus that develops in the myometrium and consists of one or more nodes.

The disease is more common in women after 30 years of age.

Diagnosed in 15% of menopausal women.

What it is?

A nodular tumor consists of several nuclei; the development of this formation occurs at an extremely slow pace, so it is very difficult to diagnose the disease in the early stages.

Like any other neoplasm, nodular fibroids grow between tissues, and as they grow, they increasingly compress nearby organs.

Not so long ago, uterine fibroids were considered a precancerous condition, so the woman had the entire organ removed to avoid the development of an oncological process. Today, doctors are confident in the benign quality of this formation, which, nevertheless, should be treated and, if necessary, operated on. Nodular fibroids develop as a result of changes in myometrial cells.

Existing types

Depending on where exactly the myomatous node is localized, nodular uterine fibroids are divided into the following: kinds , How:

1. Subserous - the node is located on the outer shell of the organ. Such nodes may have a leg (long or short). Myomas with a long stalk are more dangerous, since the stalk can twist, thereby provoking necrosis.
2. Submucosal - the tumor is located under the mucous membrane. This form is usually accompanied by sore pain, bleeding, and, as a result, anemia.
3. Interstitial - nodes that are localized deep in the muscle layer. Such nodes can grow both inside the cavity and out.

Read also about intramural fibroids.

What is the danger of the disease?

The danger of myomatous nodes that a woman is unable to conceive or bear a child. In addition, as a result of the presence of some forms of nodular fibroids, a woman may experience breakthrough bleeding, which can lead to anemic syndrome.

Nodular leiomyoma can interfere with bowel and bladder function. Some types of fibroids (for example, leiomyoma) can provoke obesity and disruption of the endocrine system. Nodular formations tend to inflammatory processes, which can result in sepsis or peritonitis.

In some cases, a hematometra may develop - a uterus that is filled with menstrual fluid. This phenomenon requires immediate surgery, as it can lead to serious complications. The worst danger of nodular fibroids is, of course, its possible degeneration into a cancerous tumor.

Causes

Causes nodular fibroids are varied, but doctors identify the main ones:

1. Hormonal disorders. These may be fluctuations in the level of sex hormones, mainly progesterone and estrogens. Such pathologies may be accompanied by heavy menstrual bleeding and disruptions in the menstrual cycle.
2. The presence of inflammatory diseases that become chronic.
3. Late labor or its absence at all.
4. Lack of regular sex life. At the same time, stagnation and changes in blood flow begin in the pelvis.
5. Gynecological surgical interventions - abortions, curettage, difficult childbirth.
6. Inactive lifestyle.
7. Heredity.
8. The presence of endocrine diseases - thyroid problems, diabetes, obesity.

Symptomatic manifestations

Like most benign tumors, nodular fibroids are asymptomatic at the beginning of their development.

Formations in the initial stages can be treated conservatively; in other cases, treatment will most likely be surgical.

As the disease progresses, a woman may begin to worry about the following: symptoms:

• prolongation of the menstrual period;
• intermenstrual bleeding;
• heavy menstrual flow;
• painful sensations before and during menstruation, as a rule, pain is felt in the uterine area, but sometimes patients complain of lumbar pain;
• anemic syndrome, which is caused by significant blood loss;
• with large tumor sizes, the volume of the abdomen increases, which is a visual sign of the presence of myomatous formation in the uterus.

Fibroids of significant size put pressure on the intestines and bladder, and various pathologies from these organs can occur - constipation or problems with urination.

Other types

Uterine fibroids can be nodular or diffuse. Nodal ones, in turn, are divided according to their location into their own types, which were discussed above. As for the diffuse type of formation, it is characterized by the absence of a specific form and node, and is represented by an increase in muscle tissue in the form of a vague neoplasm. Most often, this type of fibroid develops against the background of frequent inflammatory processes in the organ.

Fibroids can vary in size:

• up to 2 cm, fibroids are considered small;
• up to 6 cm – average;
• fibroids larger than 6 cm are called large.

Also, fibroids are differentiated according to their relationship to the uterine axis:

• fibroids located in the body of the organ - corporal;
• if the growth of fibroids is directed towards the vagina, it is a cervical tumor;
• if the formation puts pressure on the bladder and causes problems with urination, it is an isthmus fibroid.

Read also about multiple fibroids.

Diagnostic measures

Diagnosis of myomatous nodular formations is not considered difficult. Most often, fibroids are diagnosed in the gynecologist's chair. But only on the basis of this study it is impossible to say about the shape of the fibroid, its size and exact location.

Therefore, additional hardware tests are prescribed:

• Doppler examination;
• hydrosonography – ultrasound examination, which is carried out using a special liquid;
• laparoscopic examination, which in addition to diagnosis involves removal of the formation;
• hysteroscopy – transvaginal examination of the uterine cavity using a hysteroscope.

In some cases, a clinical blood test is necessary, since the submucous form of fibroids often provokes the development of anemia, which can be determined by the low level of hemoglobin in the patient’s blood.

Conservative treatment

Conservative treatment is advisable for small formations; it can only be prescribed by a competent specialist. Self-prescribing drugs can lead to serious consequences.

Doctor prescribes therapy vitamin supplements (this is especially true in the presence of fibroids that cause bleeding). As a rule, B vitamins, iron supplements, and folic acid are prescribed.

Hormonal therapy is also prescribed, which includes:

• gonadotropin antagonists that slow down estrogen synthesis - Goserelin, Buserelin, Leuprorelin and others;
• androgen derivatives;
• gestagens;

In case of significant blood loss, tranexamic acid is prescribed, which prevents the destruction of platelets.

Tumor size for surgery

Decision on surgical intervention accepted by doctors if there are certain indications:

• large fibroids - more than 12-15 obstetric weeks;
• rapid growth of nodes - over the course of a year the tumor increases by several obstetric weeks;
• severe pain that is not relieved by medications;
• simultaneously with fibroids, a woman begins to develop other pathologies of the reproductive system;
• prolonged and heavy menstrual bleeding;
• compression of other organs by fibroids, which impairs their functionality;
• necrosis;
• torsion of the legs.

Surgical intervention

The surgery can be performed in the following ways:

1. Hysterectomy. This is the complete removal of the reproductive organ; this type of operation is indicated when other operations are inappropriate. Also, such an intervention is prescribed for women who have reached menopause, as well as those who have a predisposition to malignant processes.
2. Myomectomy. Organ-preserving surgery. Prescribed for women with small nodules, nodular formations on a long stalk.
3. Laparotomy. All surgical procedures are performed through an incision made in the abdominal cavity. This type of intervention is not often practiced, and it is prescribed only for very large fibroids or if the formation has led to deformation of the uterus.
4. Laparoscopy. A minimally invasive way to get rid of myomatous formation through centimeter punctures in the abdominal cavity.

Uterine fibroids in themselves are not a terrible disease; if they are noticed in time and treated correctly, no complications will arise. The advanced stage of fibroids is dangerous - it can lead to dangerous conditions that can end very badly.

Prevention

To reduce the risk of developing nodules in the uterus, it is enough to adhere to simple rules, which, in principle, should be the way of life of every woman:

• rejection of bad habits;
• proper and balanced nutrition;
• regular but moderate physical activity;
• maintaining optimal weight;
• pregnancy and childbirth under 40 years of age;
• careful attention to your body, which means regular preventive examinations with a gynecologist.

Possible consequences

The dangers of fibroids have already been mentioned above, and now we will talk about the consequences that a woman may face if she delays the treatment of fibroids in a conservative way, and does not leave doctors a chance to perform organ-preserving surgery.

That is, what consequences await a woman after removal of the uterus?:

• infertility;
• weight gain;
• decreased libido;
• increased risk of vaginal wall prolapse;
• pain during intimacy;
• depressive states;
• fast fatiguability;
• memory loss;
• problems with urination.

The genital area, of course, suffers most from hysterectomy.. Most women develop sexual dysfunction. However, in order for a woman’s sexual activity to normalize, a rehabilitation period is necessary, during which it is quite possible that psychological help will be required.

Conclusion and conclusions

To summarize, we can say that nodular formations in the uterus are a common phenomenon, and with timely treatment they are not so terrible. If the organ is preserved, a woman may well become pregnant and become a mother. As for menopausal women, proper treatment of the tumor reduces the risk of degeneration of a benign tumor into a malignant tumor to almost zero. Therefore, gynecologists strongly recommend that all women undergo regular preventive gynecological examinations.

Useful video

From the video you will learn what nodular uterine fibroids are:

What is nodular myoma?

Nodular uterine fibroids are a diagnosis that frightens women (especially nulliparous women or those planning another birth). But what is nodular fibroid and why is this female pathology dangerous?

What it is

Nodular fibroids are one of the types of benign uterine tumors. This tumor consists of several nuclei. Unfortunately, fibroids are almost impossible to detect through a gynecological examination in the first stages of development. The neoplasm also does not cause pain. Therefore, the tumor is often diagnosed already in the late stages of formation.

A nodular type tumor develops in the environment of healthy tissues, gradually beginning to put pressure on the body of the organ.

Women who have experienced or are experiencing serious hormonal changes are at risk for this disease. For the most part, these are middle-aged women on the verge of menopause (from 33 to 45 years).

Diagnostics

A tumor that has affected a large volume of tissue can be identified during examination in a gynecological chair by palpation of the uterus. The specialist will identify the formation of atypical relief, bumps and deformed areas.

More informative diagnostic methods are also used:

• ultrasonography;
• laboratory research methods (sampling and interpretation of urine and blood tests);
• Dopplerography.

The most accurate picture is revealed by hydrosonography. This is a type of ultrasound test that works on the uterine body, which is filled with fluid.

Types of nodular fibroids

The classification of nodular fibroids is based on the geography of the location of nodes in the body of the uterus:

• nodes of the submucosal space (bordering the muscular wall and the mucous layer of the organ; these neoplasms reach very large sizes and can descend to the vaginal tract);
• nodes of the muscle space (such nodes develop in a layer called the myometrium);
• subserous (nodules have a thin base or “leg” of small size, which ensures adhesion of the large head of the node to the uterus; the neoplasm develops at the junction of the myometrium and the outer membrane of the uterine body, i.e. the myomatous neoplasm is located under the membrane of the visceral peritoneum).

Fibroids are also correlated with weeks of pregnancy based on the size of the node. Small nodular fibroids do not cause a pronounced enlargement of the uterus, while large tumors can lead the organ to a state characteristic of the last weeks of gestation.

Reasons for appearance

The main reason for the development of uterine fibroids is hormonal imbalance. An imbalance in the formation of estrogen and progesterone causes hyperplasia in the myometrial layer. That is why doctors advise adjusting hormonal status under the strict supervision of specialists in order to avoid the development of concomitant pathologies.

It is also widely believed in the scientific community that nodular uterine fibroids can be caused by the fact that a woman ignores the reproductive function of the body. Those. If, over a sufficiently long period of time, the uterus renews the endometrium, but conception does not occur, the cells begin to change and develop into a tumor.

• genetics (very often fibroids develop in those women whose close relatives also struggled with a tumor of the uterine body);
• damage to the uterus (damage to the integrity of the uterine cavity can be caused by abortions, surgeries, diagnostics, and even gynecological examinations);
• physical inactivity (lack of physical activity);
• late birth;
• previously suffered inflammatory diseases of the reproductive system;
• stress and insomnia;
• bad habits (smoking, drinking alcoholic beverages and taking prohibited substances);
• disturbances in the body's metabolic processes.

Cases of fibroids occur more in women of reproductive age, when hormonal levels are at their peak. After menopause, the pathology is no longer observed, and previously formed fibroids in patients at the menopause stage begin to decrease.

The lack of regular sex, as well as the lack of orgasm during regular sex, negatively affects the reproductive system: stagnation forms, which over time can provoke pathology.

Diabetes mellitus, coupled with active excess weight gain, can also lead to tumor formation. This reaction of the body to obesity is due to the fact that a certain amount of hormones is produced in adipose tissue.

A small nodule does not cause any deviations in the body’s condition from the norm, so in the early stages a woman may not even be aware of the tumor. But during an examination in a gynecological chair, pathology can be detected.

Actively developing uterine nodular fibroids begin to bring painful discomfort and unpleasant sensations, and also manifest themselves in the form of a number of symptoms:

• too long or heavy periods;
• pain in the lower abdomen, pulling sensations or a feeling of heaviness;
• spotting not related to menstruation;
• frequent urge to “relieve need”;
• change in the relief of the abdominal wall;
• edema processes affecting the legs and hips;
• weakness;
• apathy and drowsiness;
• problems with conception;
• dizziness (if you suddenly change position, your vision begins to darken);
• migraine;
• loss of appetite;
• loss of healthy complexion (pallor is associated with anemia).

Try to immediately contact a gynecologist if you find yourself with more than 3 symptoms from the list. After all, treatment of nodular fibroids at the initial stage is a procedure with minimal intervention in all processes of the female body. But later stages require serious and often risky measures.

Drug treatment to prevent fibroid growth

Treatment for fibroids depends on how the symptoms of the disease manifest. If the symptoms are very mild or not visible, the woman is simply put under the supervision of a doctor and adjusts her lifestyle (giving up bad habits, increased stress, baths and solariums).

If symptoms appear, but the woman’s discomfort can be classified as “moderate,” hormonal therapy is prescribed:

• antagonists (suppress the natural production of estrogen, thus stopping the development of the tumor);
• tranexamic acid (affects platelets in the blood, stopping their breakdown);
• oral contraceptives (prevent the growth of tumors and provoke a reduction in small fibroid nodes).

Surgery

If six months after diagnosis and treatment were started, regression of the myomatous nodes is not observed, the woman is referred for surgery. The reason for prescribing surgery may be complications and untimely detection of fibroids (uterine size from the 12th week of pregnancy).

Surgical intervention for pathology can be of two types:

• radical (removal of the tumor along with the uterus);
• selective (removal of only myomatous nodes, without violating the integrity of the uterus).

Methods for surgical removal of fibroids:

• uterine artery embolization (a minimally invasive operation in which a catheter is inserted into the patient through the femoral artery and then the blood supply to the fibroids is blocked using polyvinyl alcohol);
• FUS ablation (neoplastic tissue is subjected to controlled heating through the abdominal wall using focused ultrasound; the result of the operation is the destruction of fibroid tissue);
• myomectomy (removal of fibroids under anesthesia in an operating room, through an access in the abdominal wall);
• hysterectomy (removal of the uterine body under general anesthesia).

Folk recipes

Traditional methods can help control uterine fibroids by affecting its growth and development. Herbal preparations, which are a natural source of certain hormones, have a pronounced positive effect.

• tincture with boron uterus (you need to boil a couple of spoons of boron uterus raw material in 350 ml of water for 15 minutes, then infuse the decoction for another 3 hours);
• tincture of marina root (mix dry root and vodka in a 1:1 ratio, then keep the mixture in a dark place for 7 days);
• tincture of red brush (pour boiling water over a couple of tablespoons of the raw material and leave for an hour).

Celandine and tartar also help well in treating pathology with folk remedies.

Compatibility with pregnancy

This pathology in most cases is incompatible with pregnancy, since fibroids cause temporary infertility or miscarriages.

The compatibility of fibroids with pregnancy depends on what kind of nodular form is observed in the woman. If at the time of conception the expectant mother already had a tumor in the uterus (submycotic type), then the risk of miscarriage is very high. But with subserous fibroids, it is quite possible to carry a child to term under the supervision of doctors.

• fibroids in the cervix;
• pathology in advanced form;
• too rapid progress in the development of the tumor.