Fibroma without surgery. Fibroma of the uterus: symptoms and treatment. Symptoms of a fibrous tumor of the uterus

Fibroma is a benign tumor of the uterus that forms in the connective tissue of the uterus. Thanks to modern technologies, it can be detected not only with the help of ultrasound diagnostics, but also with MRI. If necessary, these procedures allow you to find out the number and location of fibromatous nodes.

Fibroma formations can grow up to several centimeters, but there have been cases when they could reach enormous sizes. According to statistics, this tumor mainly occurs due to hormonal failure.

The causes of fibroids are still unknown. However, there are factors that can influence its manifestation. Most of the problems of the appearance of a benign tumor are associated with hormonal disruptions, as well as with a predisposition to their formation, such factors include:

• artificial termination of pregnancy;
• genetic predisposition;
• cardiovascular diseases;
• heavy menstruation;
• obesity;
• stress;
• spontaneous abortion;
• inflammation of the reproductive organs.

Kinds

There are two classifications according to which diseases are divided. The first of them - by the number of myomatous nodes. Fibroma happens:

• single - has only one node and can reach various sizes;
• multiple - several nodes are formed at once.

The second classification is according to the distribution of nodes in the reproductive organ. Fibroids are divided into:

• Submucosal formations - are closer to the cavity of the reproductive organ. However, they are quite rare, sometimes they can descend into the vulva or into the neck.
• Intermuscular - located in the muscle layer.
• Subperitoneal - appear on the outside of the uterus;
• Interconnective bonds.
• Cervical - located on the cervix.

Most often, interstitial fibroma occurs - an intermuscular connective tissue tumor localized in the thickness of the uterine wall. This is typical for a small single fibroid.

Complications

In most cases, there is no chance of a fibroma turning into a malignant tumor, but there is a chance of complications. The disease can adversely affect pregnancy or cause spontaneous miscarriage. The patient may face the problem of conceiving a child, as well as such consequences as:

• an increase in fibromatous formations;
• development of bleeding, anemia;
• squeezing neighboring organs;

All these complications can further lead to deformation of the reproductive organ.

Symptoms

Usually, in most girls, fibroma is painless, but 15-20% of patients show symptoms:

• failure of menstruation (heavy bleeding, which can lead to anemia);
• pain in the lower abdomen;
• feeling of heaviness;
• pain during sex;
• dysfunction of the genitourinary system (frequent urination);
• problems associated with the reproductive system (infertility, miscarriages).

In case of discomfort in the lower abdomen or in case of heavy bleeding, you should immediately contact a therapist who will conduct tests.

Diagnostics

Most often, the tumor is detected during examination by a gynecologist. Diagnosis is confirmed by pelvic ultrasound. Thanks to ultrasound diagnostics, the attending physician determines the size, number of formations and the location of the fibroids. Additional tests are being done to differentiate this disease.

Treatment

Methods of treatment depend on the number of fibromatous nodes and location. Methods are divided into:

• conservative therapy;
• surgical intervention;
• non-surgical methods.

conservative

Currently, only one drug is used for the treatment of fibroids. It blocks the production of progesterone, due to which the tumor grows. This therapy is recommended for young patients with small fibromatous nodes that do not exceed 2 centimeters. If the size of the uterine fibroids exceeds this limit, then all recommendations for the operation appear.

Surgical

Removal of fibroma is carried out using myomectomy or hysteroresectoscopy. This method is recommended if the girl is going to get pregnant in the near future. Each technique is selected purely individually so as not to injure the genitals and not cause even more harm.

These methods for surgical removal of fibroids are used if:

• the formation is outside the uterus;
• the myomatous node is located inside and is easy to cut.

Surgical removal of uterine fibroids occurs only in cases where other therapies have failed or are not suitable.

Embolization

Embolization is a technique that does not require surgery to get rid of uterine fibroids. This method will allow you to finally get rid of fibroids, and after treatment there are no relapses, unlike surgery. In 95 cases out of 100 there are no complications. This is the safest method of treatment, but there are also disadvantages. This method is currently the most expensive.

• patients who do not plan to have children in the near future;
• with symptomatic fibroma in a patient who has begun menopause;
• if a woman is going to become pregnant in the near future, however, she has multiple fibromatous nodes located in different places of the uterus. In such cases, surgery to remove uterine fibroids is not appropriate.

Rehabilitation

After removal of uterine fibroids, several rules should be followed in order to avoid complications:

• avoid stress, as the seams may open;
• after the operation, you need to be careful, you should alternate work and rest;
• stay away from stressful situations;
• after surgery, you need to visit a doctor at least once a year;
• sexual life can be conducted only after 2 months;
• in loads should be returned gradually within 3 months;
• avoid damage;
• proper nutrition;
• balanced sleep pattern;
• make a schedule and stick to it.

Benign tumors in the uterus are common pathologies that occur more often in women of reproductive age. The absence of symptoms in the early stages leads to the fact that they are detected by chance when a pelvic ultrasound is done. Sometimes this happens when a woman is being tested for pregnancy. It is important to know what complications this disease can result in, in what cases treatment is performed and by what methods. Distinguish between fibroids and fibroids of the uterus. In structure, they are somewhat different, but in their manifestations and complications are very similar.

Content:

Types of fibroma

Fibroma is a benign tumor. Just like fibroids, it originates in the wall of the uterus, and then can grow towards the outer (serous) membrane, towards the uterine cavity, or increase inside the muscles. The difference between these tumors lies in their structure. Myoma is formed from muscle tissue cells, and fibroma - from connective tissue cells. Such a tumor is most often found in women 20-40 years old, but can begin to develop at a later age.

Fibroma of the uterus is formed when a small vessel in the uterine wall is blocked. Connective tissue begins to grow around this place, forming a capsule. Fibroma can be single or multiple, when nodes of different sizes, localization and degree of "maturity" grow.

Video: What is the difference between fibroma and fibroids

Stages of development and types of fibroma

Perhaps the appearance of 3 types of uterine fibroids, each of which corresponds to a certain stage of its development.

simple fibroma. At the first stage, the tumor germ is formed from dividing cells of the connective tissue and the neoplasm slowly increases to 3 cm in diameter.

Proliferating. In the second stage, the tumor "ripens". Cells are actively dividing, but without atypical structural changes. The innovation is growing rapidly.

Presarcoma. At the third stage, fibroma growth stops and its “aging” begins, during which many deformed (atypical) cells appear.

In some cases (especially during menopause), the fibroma decreases in size and may even disappear. This is what distinguishes it from a malignant tumor. But the reappearance of nodes is possible if the causes of the disease are not eliminated.

Fibroma Complications

The consequences of the formation and growth of fibroids can be:

Addition: Due to the growth of the tumor, the size of the abdomen increases, as during pregnancy. There are even cases of medical errors when these two conditions are confused. For convenience, the size of the tumor is calculated both in centimeters and in obstetric weeks of pregnancy. A large tumor is considered to be larger than 10 weeks (greater than 6 cm in diameter).

Complications during pregnancy

Fibroma of the uterus often causes the impossibility of conception, not only because of hormonal disorders, against which it is formed. This is a mechanical obstacle to the movement of spermatozoa if it is located close to the cervix or in it itself. Submucosal tumor blocks the entrance to the fallopian tubes.

If pregnancy has occurred, then submucosal neoplasms are of particular danger for its preservation. The sharp hormonal surge that occurs during pregnancy sometimes provokes tumor growth. This reduces the volume of the uterine cavity, which interferes with the normal development of the fetus. It may not be positioned correctly, which subsequently interferes with its progress through the birth canal. Fibroma in the cervix prevents the baby's head from passing into it.

In some cases, such a tumor causes an ectopic pregnancy, miscarriage, or premature birth. Most often, in the presence of an internal tumor, childbirth is carried out using a caesarean section. At the same time, nodes in the organ cavity are removed.

If the tumor is small and does not grow, it is not removed during pregnancy. The indication for surgery is rapid growth and an increased risk of complications.

Video: Can pregnancy occur in the presence of fibroids

Reasons for the formation of fibroids

The main cause of fibroids in the uterus is hormonal disorders. Any factors leading to an increase in the content of estrogens in the blood against the background of a decrease in the level of progesterone contribute to the emergence and growth of a neoplasm. Hormonal failure can have a different origin:

1. Pathologies in the uterus (uterine variant). The production of hormones in the ovaries is normal, but their effect on the development of uterine tissues is weakened due to a decrease in the sensitivity of the receptors located in them. This condition occurs as a result of damage to the endometrium during abortion and curettage, as well as its insufficient development (hypoplasia).
2. Ovarian dysfunction (ovarian variant). The ratio of estrogens and progesterone is disturbed due to the occurrence of inflammatory and infectious diseases of the ovaries, as well as the formation of cysts.
3. Violation of the production of pituitary hormones (central variant). The production of hormones in the ovaries is disrupted due to malfunctions in the hypothalamic-pituitary system of the brain. In this case, the ratio of FSH / LH deviates from the norm, which leads to a hormonal shift. The reason for the malfunction of the pituitary gland can be brain injuries, stress experienced by a woman, neurological diseases, disorders of the autonomic nervous system. In some cases, heredity plays a role.

Factors contributing to hormonal failures are diseases of the thyroid and pancreas, liver. Excess estrogen can be formed as a result of long-term use of hormonal drugs.

The cause of underdevelopment of the endometrium are cardiac and vascular pathologies, congenital abnormalities in the development of the uterus, late puberty. Provoking the growth of uterine fibroids can be the installation of an intrauterine device, abortion, diagnostic procedures, complicated childbirth.

Often the disease appears with obesity, metabolic disorders, diabetes mellitus. Such tumors are formed against the background of diseases of the mammary glands (for example, mastopathy).

Video: Causes and symptoms of uterine tumors

Symptoms and signs of fibroids

At an early stage of node development, there are no symptoms. They appear when the size of uterine fibroids reaches 5 cm or more.

Cycle disorders

One of the first signs of the disease is the occurrence of menstrual irregularities: menstruation becomes profuse and painful. This is due to the fact that tumor growth contributes to the pathological growth of the endometrium.

With an increase in nodes, the tone of the uterus decreases, its contractility, due to which menstruation becomes longer and more irregular, intermenstrual uterine bleeding occurs.

Pain in the abdomen and lower back

Twisting of the leg, its separation, compression of nerve endings and impaired blood circulation lead to severe pain in the abdomen, not associated with the arrival of menstruation. Localization of pain, as a rule, depends on the location of the nodes of uterine fibroids.

In the presence of a subserous and interstitial tumor, there is a pulling pain in the pubic region and in the lower back, which is associated with stretching of the uterine wall and peritoneum. Submucosal fibroma is characterized by the appearance of spasmodic pains in the lower abdomen, aggravated during menstruation, radiating to the bladder and rectum.

Bleeding

They can occur both as a result of menstrual disorders, and as a result of injury to the tumor. Abundant blood loss leads to symptoms of anemia (dizziness, weakness, fainting, irregular heartbeat).

Impact on the pelvic organs

The pressure of the tumor on the bladder is manifested by difficulty urinating. An inflammatory process occurs that can spread to the kidneys. There may be an increase in temperature, the appearance of pus in the urine. If the node is located on the back wall, then it presses on the rectum. This causes flatulence and constipation.

Node Birth

A large submucosal fibroma of the uterus through the cervix enters the vagina, which leads to rupture of the tumor, the occurrence of severe bleeding. There are pain and inflammation.

Diagnostics

If there are fibrous nodes in the uterus, the muscular wall is denser, there are tubercles on it, which are found on palpation of the abdomen. Ultrasound is used to detect nodes, determine their number and localization. Clarify the number and location of nodes in relation to other organs allow tomography methods. MRI confirms the benign nature of the tumor.

Using the same method, you can understand whether the neoplasm is a subserous uterine fibroma, myoma, or ovarian cyst. For the same purpose, diagnostic laparoscopy is performed. A diagnostic method such as hysterosalpingography (x-ray of the uterus with the introduction of a contrast agent) is used. This makes it possible to detect a change in the shape of the uterus, to examine the condition of the fallopian tubes.

Hysteroscopy of the cervix and its cavity makes it possible to detect submucosal tumors, as well as to perform a puncture biopsy to take neoplasm cells for analysis to detect their atypical structure.

Treatment

If the fibroma of the uterus is small in size (no more than 5-6 obstetric weeks), then doctors do not prescribe treatment, a waiting tactic is used. Every 3-4 months, a gynecological examination of the patient is carried out, an ultrasound scan is done once a year.

For larger tumors, conservative treatment is used or an operation is performed to remove the fibroma.

Medical treatment

It is carried out in cases where the size of the nodes does not exceed 12 weeks, there are no uterine bleeding and severe pain, the tumor is located in the uterine wall or in the abdominal cavity. They try to resort to this method in the treatment of young patients, when it is necessary to preserve the full structure of the uterus so that the woman in the future can become pregnant and bear a child.

The main method in this case is replacement therapy to restore the natural ratio of estrogen and progesterone in the body. Preparations based on natural and synthetic hormones are used.

Progestins(drugs containing progesterone). By lowering the level of estrogen in the blood, they inhibit the growth of the endometrium. Fibroma of the uterus stops growing, and the emergence of new nodes is also prevented. For this, duphaston, utrozhestan, norkolut are used.

To normalize the menstrual cycle and reduce the intensity of menstruation (eliminate anemia), combined oral contraceptives(COC) containing hormones in small doses (regulon, yarina, janine). The Mirena intrauterine device has the same effect as the COC.

At the same time, anti-inflammatory drugs, vitamins, and iron preparations are prescribed during treatment.

GnRH analogues(buserilin, zoladex). In some cases, drug therapy is carried out before surgical removal of uterine fibroids in order to reduce estrogen levels, weaken blood circulation in the uterus and achieve temporary stabilization of the tumor. For this, preparations based on the pituitary hormone (GnRH) are used.

Treatment with hormonal drugs gives an effect after 3 months.

Surgical methods

Surgical treatment is performed when the size of fibroma nodes exceeds 12 weeks, the tumor grows faster than 4 weeks a year, there are pains, bleeding. Be sure to remove tumors with a thin stem, as well as those located near the pelvic organs.

Operations are also performed if the nodes are located in the cervix, the tumor occurs against the background of pathological growth of the endometrium. The complexity of the surgical intervention depends on the size of the tumor, its location, and the age of the patient.

fibromectomy- removal of the neoplasm by the laparoscopic method through punctures in the peritoneum (a low-traumatic method that does not leave scars on the body), laparotomy (through an incision above the pubis). Submucosal fibromas are removed by vaginal penetration into the uterine cavity through the hysteroscope tube and subsequent unscrewing of the tumor.

EMA- blocking the access of blood to the tumor by introducing gelatin into its vessels. Due to the deterioration of the blood supply, the tumor shrinks.

FUS-ablation. Uterine fibroma is destroyed by ultrasound.

If there are many large nodes, they are eliminated along with part of the body of the uterus, or the uterus is removed completely. There are various options for amputation of the uterus: with the preservation of the cervix and the adjacent part of the uterus, complete removal of the organ, removal of the fundus of the uterus (defundation) while preserving its body and cervix.

Fibroma of the uterus is a benign tumor that occurs in young women, the average age of patients is 30-40 years.

According to statistics, people of the Negroid race are more prone to the disease than Europeans.

Fibroma is often compared with myoma and fibromyoma, but based on the position of the morphological structure, they are different formations.

Fibroids and fibroids are made up of smooth muscles that make up the middle layer of the uterus, while fibroids are made up of fibrous tissue. Despite the fact that these tumors have a different origin and structure, they have much in common, and therefore the treatment for them is similar.

Uterine fibroma is not prone to malignancy, it slowly grows in size and can proceed for quite a long time without obvious symptoms. With late diagnosis, large tumors are detected, reaching in some cases up to 15-20 cm.

The nodes cannot exist asymptomatically, but often patients write off uterine bleeding for menstruation, hormonal age-related changes or endometrial hyperplasia, often associated with a neoplasm.

With timely detection and treatment, the disease does not pose a particular danger. Operations for fibroma are low-traumatic and do not give complications, therefore it is especially important to detect the tumor process in time and take appropriate measures to eliminate it.

Causes and varieties

The causes of a fibroid tumor are not exactly formulated today, but they note the connection of occurrence with the hormonal background and heredity.

Because, girls before puberty and menopausal women cannot suffer from fibroma (if uterine fibrosis is found in the latter, then most likely it existed before menopause and was asymptomatic).

Tumor growth during pregnancy may increase, and after childbirth, the neoplasm often returns to its previous size. This fact indicates the undoubted role of hormones in the female body in the development of the disease.

Predisposing factors may be:

• Late formation of menstrual functions;
• Multiple abortions, as well as intrauterine manipulations;
• Absence of childbirth by the age of thirty;
• Prolonged and uncontrolled use of hormonal contraceptives that contain an estrogenic component;
• Chronic inflammatory disease of the genital tract;
• Pathologies of other organs - diabetes, obesity, hypertension, etc.

Uterine fibromatosis germinates in the form of one dense node (with a nodular form of the tumor), although diffuse growth also occurs in the thickness of the uterine wall. The size ranges from a few millimeters to 1-3 cm, but in special cases it can be more - up to 20 cm.

Depending on the location of the tumor in relation to the attic walls, the following varieties are distinguished:

• Submucosal (submucosal) - located under the endometrium, has a tendency to cause pain and form bleeding;
• Subserous - develops under the serous, outer shell, has a thin leg, which can lead to torsion and necrosis of the node;
• Intramural - localized in the thickness of the muscular uterine wall, is the most common form;
• Interligamentous - located between the sheets of the ligament that supports the uterus.

Multiple fibromatosis of the uterus can also occur, if there are several nodes, and they are located in different parts of the uterus. Such a tumor is characterized by the most pronounced symptoms and often requires radical methods of treatment, reaching the removal of the uterus.

Symptoms

According to statistics, only every fourth fibroid formation gives clinical signs, and in other cases the disease is asymptomatic, and the tumor is detected by chance. The symptoms of a disease such as uterine fibroids are determined by the size of the tumor, the direction of its growth and location.

The main symptoms of uterine fibroids are soreness and bleeding. Pain in fibroids is often associated with compression of the nerve endings, both of the organ itself and of nearby structures during submucosal growth, if the tumor grows outside towards the walls of the small pelvis. The pain can be intense, pulling, cramping or aching, manifested in the lower abdomen. Sharp pain is a sign of torsion of the leg of the neoplasm and necrosis. Women with fibroma notice menstrual pain.

If the tumor compresses the bladder, there may be pain in the suprapubic region, as well as frequent urge to urinate. Tendencies to constipation, back pain are characteristic of neoplasms growing in the direction of the rectum and sacrococcygeal region.

Uterine bleeding is the most common sign of submucosal and intramural fibromas, when the presence of a neoplasm stimulates multiple growth of the endometrium to hyperplasia. If the bleeding is cyclical, then it is called menorrhagia, if chaotic - metrorrhagia. Bleeding can be very intense and cause anemia.

Fibroma can also be diagnosed with menopause. In this case, the tumor does not manifest itself in any way and has a tendency to spontaneous regression, because there is a natural decrease in the concentration of sex hormones.

Most fibroid tumors are benign and do not cause significant damage. The danger is a large tumor that compresses the nearby structures of the small pelvis, nerves and blood vessels.

Profuse blood loss can cause severe anemia, which requires replacement therapy and timely treatment. There is practically no risk of malignancy with fibroma. It is believed that oncological connective tissue tumors (called fibrosarcomas) are formed initially as such, without going through a benign stage.

Diagnosis and treatment

To diagnose uterine fibroids, you must first consult a doctor who, with the help of palpation, will fix an increase in the size of the uterus or determine the presence of individual tumor nodes.

Additionally, the doctor prescribes, in case of suspicion, ultrasound, MRI and hysterosalpingography. It is important to note that it is not always possible to distinguish between fibroma and myoma, especially if a pronounced connective tissue component is observed in the myoma.

In order to differentiate these neoplasms, a biopsy is performed, followed by a histological examination of an already removed tumor.

How to treat uterine fibroids? Uterine fibroma can be treated both conservatively and surgically by removing the neoplasm node. The need for surgery is determined by the location, size of the fibroma itself, and the severity of symptoms of formation.

Medical impact. The use of conservative treatment is indicated for small fibromas that cause uterine bleeding and severe pain, as well as if there are contraindications for surgery (severe pathologies of other organs, patient refusal). Older women with uterine fibroids may be offered observation, because during menopause and with a natural decrease in the synthesis of sex hormones, the tumor usually regresses.

You can try to cure a small fibroid tumor without surgery using hormonal drugs, as well as drugs that reduce the negative manifestations of the tumor (pain, anemia, bleeding).

Hormone therapy entails some side effects, and also has contraindications, therefore, the expediency of carrying out, drugs and regimens are determined by a gynecologist or gynecologist-endocrinologist.

Among the common side effects of this hormone therapy are hot flashes, dry mucous membranes of the genital tract, emotional lability and osteoporosis. Treatment of uterine fibroids with hormonal agents should be carried out only under the supervision of specialists and not more than the prescribed period, because with inadequately prolonged use of such drugs, the risk of dangerous side effects, including thrombosis, increases.

Hormone therapy is justified for small tumors in women of reproductive age. Since uterine fibromatosis is sensitive to estrogen hormones, drugs are used to treat it, which reduce their effect on the neoplasm:

• Antigonadotropins - are able to reduce the production of estrogen by the ovaries and the pituitary gland of gonadotropic hormones, while reducing estrogenic stimulation of the tumor;
• Gestagens (duphaston, norkolut) - are able to normalize the menstrual cycle, are prescribed for mild fibromatosis of the uterine body, which is accompanied by endometrial hyperplasia and bleeding;
• Intrauterine system "Mirena", locally releasing the hormone levonorgestrel;
• Combined oral contraceptives (Yarina);
• Analogues of gonadotropin-releasing hormones (zoladex) cause a decrease in the concentration of estrogens. They show a temporary effect, therefore, they are more often prescribed before the planned surgical intervention in order to reduce the size of the neoplasm.

Symptomatic therapy is aimed at eliminating anemia caused by blood loss, pain syndrome, hyperplastic changes in the endometrium. Also, for this purpose, anti-inflammatory drugs, analgesics and hormones are prescribed, which normalize the menstrual cycle.

Surgery. This treatment is carried out in patients with large fast-growing fibromas, which are located under the serous membrane, as well as with severe uterine bleeding and severe pain.

Surgical tactics depend on the properties of the neoplasm and its localization. Hysteroscopic access (through the uterine cavity) is considered less traumatic. It is used for submucosal tumors. Subserous or intramural nodes cannot be removed by hysteroscopy, so laparoscopy is used. Such minimally invasive interventions are prescribed to young patients who wish to preserve not only the organ, but also the function of childbearing.

Large fibromatous nodes, tumors, suspicions of a malignant process require the most radical operation. It is possible to completely remove uterine fibroids along with the organ itself (hysterectomy), along with the nodes of neoplasms. It should be noted that with a disease such as uterine fibromatosis, the need for intervention rarely arises.

Among the minimally invasive interventions, it is also worth mentioning uterine artery embolization and ablation of the tumor node. The principles of these manipulations are no different from those for uterine fibroids. For embolization, a substance is injected into the arteries of the uterus, which causes sealing of the tumor vessels, as well as regression of the tumor. Fibroma ablation consists of exposure to ultrasound, which usually causes an increase in the overall body temperature and "vaporizes" the tumor. The procedure should be carried out under MRI guidance.

Patients, afraid of numerous medical and diagnostic procedures, are trying to cure fibroids with the help of folk remedies. But the tumor does not decrease in size and will not stop its growth, not a single decoction or herbal infusion can lead to the disappearance of the neoplasm, so you should not avoid meeting with the doctor.

Uterine fibroma is a benign tumor that is more common in young women, the average age of patients is 30-40 years. It has been noticed that people of the Negroid race are more prone to fibroma than Europeans.

Fibroma is built from mature connective tissue, giving it a dense texture. Often, fibroma is identified with or fibromyoma, however, from the standpoint of the morphological structure they are different tumors. Fibroids and fibromyomas are made up of smooth muscles that make up the middle layer of the uterus (myometrium), while fibromas are made up of fibrous tissue. Despite the different structure and origin, these tumors have much in common, and therefore the tactics for them are largely similar.

Fibroma is not prone to malignancy, slowly increases in size and can be asymptomatic for quite a long time. Late diagnosis leads to the detection of large tumors, reaching in some cases 10-20 cm. Of course, such large nodes cannot exist asymptomatically, but often the patient herself writes off heavy menstruation or uterine bleeding for age-related hormonal changes or endometrial hyperplasia, usually concomitant tumor.

With timely detection, the tumor is not dangerous and can be cured even by conservative methods, and operations for small fibroids are less traumatic and do not give complications, so it is important to suspect the tumor process in time and take the necessary measures to eliminate it.

Causes and types of uterine fibroids

The causes of fibroid tumor of the uterus are not precisely formulated, but the connection of its occurrence with hormonal fluctuations and heredity is noted. So, girls before puberty and women in menopause do not suffer from fibroma, and if it was found in the latter, it probably existed before menopause and was asymptomatic. During pregnancy, tumor growth may increase, and after childbirth, the fibroma returns to its original size. This fact also speaks of the undoubted role of the hormones of the female body in the development of the disease.

Predisposing factors include:

• Late formation of menstrual function;
• Frequent abortions and intrauterine manipulations;
• Lack of childbirth by the age of 30;
• Long-term and uncontrolled use of hormonal contraceptives containing an estrogen component;
• Chronic inflammatory diseases of the genital tract;
• Pathology of other organs - obesity, diabetes, hypertension, etc.

Usually fibroma grows in the form of a single dense node - the nodular form of the tumor, although diffuse growth is also possible in the thickness of the uterine wall. The size varies from a few millimeters to 2-3 cm, but it can be more - up to 20 cm in diameter.

types of uterine fibroids

Depending on the location of the tumor in relation to the walls of the uterus, several of its varieties are distinguished:

1. Submucosal (submucosal) - located under the endometrium, tends to cause pain and bleeding;
2. Subserous - develops under the outer, serous, membrane, may have a thin leg, which is fraught with torsion and necrosis of the node;
3. Intramural - located in the thickness of the muscular wall of the uterus, the most common form;
4. Interligamentous - between the sheets of the broad ligament that supports the uterus.

There is also a multiple fibroma, when there are several nodes and they are located in different parts of the organ. Such a tumor is characterized by more pronounced symptoms and often requires radical methods of treatment up to the removal of the uterus.

How does fibroma appear?

According to statistics, only every fourth fibroid tumor gives clinical signs, in other cases the disease is asymptomatic, and the tumor can be detected by chance. Signs of a neoplasm are determined by its size, location and direction of growth.

The main symptoms of uterine fibroids are pain and bleeding. Pain in fibroma is usually associated with compression of the nerve endings of both the uterus itself and nearby structures with submucosal growth, when the tumor grows outward in the direction of the walls of the small pelvis. The pain is intense, cramping or pulling, aching, in the lower abdomen. Sharp pain may be a sign of torsion of the tumor stem and necrosis. Typically, women with fibroma complain of painful menstruation.

If the neoplasm compresses the bladder, then there are unpleasant sensations in the suprapubic region and frequent urge to urinate. A tendency to constipation and pain in the lower back are characteristic of a tumor growing in the direction of the rectum and sacrococcygeal region.

Uterine bleeding is the most common sign of submucosal and intramural fibroids, when the presence of a tumor stimulates excessive growth of the endometrium up to hyperplasia. If the bleeding is cyclical, then it is called menorrhagia, if chaotic - metrorrhagia. Bleeding can be so intense that it causes anemia.

Fibroma can also be diagnosed with menopause. At this age, the tumor is usually asymptomatic and prone to spontaneous regression, as there is a natural decrease in the concentration of sex hormones.

In general, most fibroid tumors proceed quite benignly, without causing significant damage. A large tumor becomes dangerous, squeezing neighboring structures of the small pelvis, blood vessels and nerves. In addition, heavy blood loss can cause severe anemia requiring replacement therapy, and therefore require timely treatment. The risk of malignancy with fibroids is minimal. It is believed that malignant connective tissue tumors (fibrosarcomas) arise initially as such, without going through the stage of benignity.

Fibroma during pregnancy

Many young women suffering from uterine tumors are concerned about the question: will they be able to give birth to a healthy baby? In general, a small fibroma does not prevent either the onset of pregnancy or its successful completion. The exception is large fibromatous nodes and neoplasms located in the area of ​​​​the fallopian tubes, when the entrance to them is closed by a tumor, which interferes with fertilization and the movement of the egg to the endometrium.

Large fibroids pose a danger to the normal development of the fetus, as they can disrupt its normal position in the uterus, provoke miscarriages and premature births. The cervical localization of the tumor is most dangerous due to the risk of complicated delivery and massive bleeding. All pregnant women diagnosed with fibroids should be under the supervision of specialists, and in dangerous forms of the tumor, it is better to get rid of it before pregnancy or childbirth, if possible.

Diagnosis and treatment

To detect uterine fibroids, you should first go to the doctor, which, upon palpation, will fix an increase in the size of the organ or the presence of individual tumor nodes. Additionally carry out ultrasound procedure, hysterosalpingography, MRI. It should be noted that it is not always possible to distinguish between fibroma and myoma, especially if the connective tissue component is pronounced in the myoma. To differentiate these tumors, biopsy or histological examination of an already removed neoplasm.

Uterine fibroma is treated both conservatively and by removing the tumor node. The need for surgery is determined by the location, size of the fibroma, and the severity of the symptoms of the tumor.

Medical impact

Conservative treatment is indicated for small fibromas, not causing uterine bleeding and pain, as well as in the presence of obstacles to the operation (severe pathology of other organs, the patient's unwillingness). Elderly patients with uterine fibroids may be offered observation, since during menopause, with a natural decrease in the synthesis of sex hormones, the neoplasm also regresses.

You can try to cure a small fibroid tumor without surgery using hormonal drugs, as well as means to reduce the negative manifestations of the neoplasm (pain, anemia, bleeding). Hormone therapy has some side effects and may be contraindicated in some patients, so the expediency of its implementation, the choice of the drug and the regimen for its administration is carried out by a gynecologist or gynecologist-endocrinologist.

Among the most common side effects of hormone therapy are hot flashes, a feeling of heat, dryness of the mucous membranes of the genital tract, emotional lability, and osteoporosis. Treatment with hormones should be carried out under the supervision of a specialist and not more than the prescribed period, since with inadequately long-term use of such drugs, the risks of serious side effects, in particular thrombosis, increase.

Hormone therapy is justified for small tumors in women of reproductive age or premenopause. Since fibroids are sensitive to estrogen hormones, drugs that reduce their effect on the tumor are used to treat it:

Symptomatic therapy It is aimed at eliminating pain syndrome, anemia caused by blood loss, hyperplastic changes in the endometrium. For this purpose, anti-inflammatory drugs, iron preparations, analgesics, hormones that normalize the menstrual cycle are prescribed.

Surgical tactics

Surgery is carried out for patients with large fibromas, rapidly growing, located under the serous membrane on a thin stalk or submucosally, with severe uterine bleeding and anemia, severe pain.

The choice of surgical tactics depends on the properties of the tumor and its localization. The least traumatic hysteroscopic access through the uterine cavity. It is good for submucosal tumors, but subserous or intramural nodes are unlikely to be removed during hysteroscopy, so they will be used laparoscopy. Such minimally invasive interventions are indicated for young patients who want to preserve not only the uterus, but also the reproductive function.

left: hysteroscopic access through the uterine cavity, right: laparoscopy

Large fibromatous nodes, multiple tumors, cases suspicious of the malignancy of the process require a more radical operation. So, it is possible to completely remove the uterus (hysterectomy) along with tumor nodes. It should be noted that with fibroma, the need for such a traumatic intervention does not often arise.

Among the minimally invasive interventions, one can also mention uterine artery embolization and ablation of the tumor node. The principles of these manipulations do not differ from those. For embolization, a substance is injected into the uterine arteries, causing sealing of the tumor vessels and regression of the neoplasm. Fibroma ablation consists in exposure to ultrasound, which causes a local increase in temperature and "evaporation" of the tumor. The procedure is carried out under the control of MRI.

uterine artery embolization

Many patients, afraid of numerous diagnostic and therapeutic procedures, try to treat fibroma with folk remedies. I would like to warn you right away: the tumor will not decrease and will not stop growing, no decoctions or herbal infusions will lead to its disappearance, so it is better not to avoid meeting with a specialist.

However, the use of folk remedies is still possible to reduce some of the symptoms of the tumor. For example, the use of a decoction of nettle or oak bark reduces the intensity of uterine bleeding, chamomile helps to reduce inflammatory changes in the genital tract, often associated with tumors and hormonal imbalances.

Fibroma is classified as a tumor with a low risk of malignancy, therefore, with slow growth and no symptoms, observation is sufficient. Timely treatment of the tumor avoids negative consequences in the form of severe anemia, torsion of the leg and necrosis of the tumor node. There are no specific measures to prevent the occurrence of fibroids, but women who want to avoid meeting this pathology are advised to exclude abortions, treat inflammation of the genital tract in a timely manner and visit a gynecologist at least once a year, even if there are no visible reasons for this.

Video: uterine fibroids - the program "About the most important"

Update: October 2018

One of the most common gynecological diseases is uterine fibroids. It is noted that this pathology is found in young women of childbearing age, in about 20% of cases, and the older a woman becomes, the higher the risk of this disease.

In women under the age of 20, fibroma is diagnosed in 20%, between the ages of 20 and 30 years, the tumor develops in 30%, and up to 40 years it is detected in 40%. A connection between fibroma and the race of a woman has also been established; in representatives of the Negroid race, the disease occurs more often than in European women.

What is uterine fibroma

Fibroma of the uterus, like fibroids or uterine fibroids are classified as benign neoplasms., which originate in the muscle tissue of the organ and differ only in their histological structure.

Thus, uterine fibroma is a tumor formed by connective tissue, which gives it density (myomas, unlike fibromas, are more elastic). Fibroid tumors or fibromas, in addition to the uterus, can also develop in other organs: ovaries, mammary glands, skin. The size of the tumor may not exceed a few millimeters or reach 30 cm.

Classification of fibroid tumors

Fibroma of the uterus can be single or multiple. When there is one node, as a rule, it reaches a significant size, they talk about nodular fibroma of the uterus. The fibrous node is located in the connective tissue pseudocapsule. In the case of several nodules, they speak of multiple uterine fibroids.

Depending on the histological examination, the following morphotypes of fibromas are distinguished:

1. simple - the tumor grows slowly, there are no proliferative processes;
2. proliferating - increased activity of cell division, characterized by rapid growth, the number of pathological mitoses reaches 25%, but there are no atypical cells;
3. presarcoma - many foci of atypia are detected.

Causes of fibroids

Currently, the causes of uterine fibroids are not precisely defined, although there is a connection with hormonal changes and a genetic predisposition.

It is noted that uterine fibroids never develop in girls before puberty and in menopausal women. In the mechanism of tumor development, both estrogen and progesterone fluctuations play a role, which increases the number of cell divisions in the formation. But even with both conditions, a fibroid tumor of the uterus does not always develop.

Certain predisposing factors have been established that “spur” the onset of education:

• late formation of menstrual function;
• artificial and spontaneous abortions;
• first birth at age 30 or more;
• intrauterine manipulations (installation and removal of the IUD, hysteroscopy);
• childbirth complicated by inflammation of the uterus;
• long-term use of combined oral contraceptives;
• chronic inflammatory diseases of the uterus and appendages;
• hormonal dysfunction of the ovaries;
• rare sex life or its absence;
• obesity or overweight;
• sedentary lifestyle;
• diabetes;
• thyroid pathology;
• diseases of the cardiovascular system (hypertension);
• stress;
• phlebeurysm;
• fibrocystic mastopathy.

Symptoms

According to statistics, only every fourth woman with uterine fibroids has clinical symptoms. The clinical picture of a fibroid tumor depends on many factors. Firstly, from the age of the woman and the prescription of the existence of her tumor. Secondly, on the location of fibrous nodes, their number, direction of growth and premorbid background. And, of course, from the presence of concomitant gynecological and somatic diseases.

The main signs of this pathology include pain, cycle disorders with uterine bleeding, infertility and disruption of nearby organs.

Uterine bleeding

Fibroma of the uterus provokes the growth of the endometrium, which often leads to its hyperplasia. In the early stages of the development of fibroids, menstrual irregularities manifest themselves in the form of profuse prolonged menstruation (menorrhagia), which makes the patient consult a doctor.

As the tumor progresses, such disorders become more pronounced, they are joined by acyclic bleeding (metrorrhagia). Chronic blood loss leads to anemia in a woman, which is accompanied by fatigue and weakness, dizziness and pale skin and mucous membranes.

The nature of menstrual bleeding depends on the localization of fibrous nodes in the uterine wall. In the case of a subserous location of fibrous nodes in 50% or more, women have moderate menstruation. With the interstitial location of the nodes in most patients, menstruation becomes plentiful. And in the case of submucosal uterine fibroids, menstruation becomes abundant and prolonged, and after a while, painful already in the early stages of tumor development. As the submucosal node grows, acyclic bleeding joins due to the capture of a large area of ​​the uterine cavity.

In addition, the duration and increase in blood loss in the case of interstitial and submucosal fibromas are due to a decrease in uterine tone and a violation of its contractile function. Also, the nature of uterine bleeding is influenced by the ongoing necrotic changes in the fibrous nodes. The expansion of the uterine veins also contributes to the violation of menstrual function.

pain

The nature of pain in uterine fibroids is determined by the localization of the nodes and their size. If the tumor is large, then there is a high probability of malnutrition in the node, which is accompanied by degenerative changes. Acute malnutrition of the tumor is accompanied by a clinical picture of an acute abdomen. The body temperature rises (up to 39 and above), the pains become acute and unbearable, symptoms of peritoneal irritation appear, in the general blood test, ESR acceleration and leukocytosis are noted. If the effect of conservative treatment of uterine fibroids is absent, an urgent operation is performed.

Pain syndrome in patients with fibroma has a different nature of occurrence and character. As a rule, patients complain of pain in the lower abdomen and in the lumbar region. With subserous and interstitial fibroma, constant aching pains are observed, which is associated with stretching of the peritoneum. Intense and prolonged pain is due to the rapid growth of the node.

If the fibroid tumor is large and characterized by slow and gradual growth, there are aching or pulling constant pains throughout the cycle.

Submucosal fibroma is characterized by the occurrence of cramping pain during menstruation and indicates a long-standing tumor. If the fibrous node is located on the anterior wall of the uterus, pain is given to the bladder. And when the node is localized on the posterior uterine wall, they radiate into the rectum.

In the case of an intraligamentary tumor, pain occurs in the region of the cervix, which is associated with the pressure of the tumor on the nerve plexus, which is localized in the internal pharynx of the cervix.

Violation of the work of adjacent organs

With a significant size of fibroid tumors, especially with intraligamentary fibroma, the ureters are compressed and infringed, which leads to expansion of the pelvicalyceal system and kidney hydronephrosis. If the fibrous node presses on the bladder, urination becomes more frequent.

With the localization of the fibrous node on the back wall of the uterus, the colon is compressed, which is accompanied by flatulence and constipation. Difficulties with defecation and pain arising in the process are observed with the posterior cervical arrangement of the nodes. Pain during intercourse is also possible.

Infertility

With uterine fibroids, 30% of patients have primary infertility.. The inability to get pregnant is due to hormonal disorders that caused the tumor. Also, infertility can be caused by the location of fibrous nodes. For example, if the nodes block the mouths of the fallopian tubes, the chances of conception are sharply reduced. With a submucosal location of the tumor, the implantation of a fertilized egg or the further development of the embryo becomes impossible.

Pregnancy against the background of fibroma

Is uterine fibroids dangerous during pregnancy? It is difficult to answer unambiguously. As already noted, in the presence of this disease, problems with conception and implantation are possible. If the size of the tumor is small, then pregnancy, as a rule, proceeds without complications. But uterine fibroma can increase during gestation, although after childbirth it returns to its original size.

Fibroid tumors of considerable size, especially submucosal ones, adversely affect the course of pregnancy. The node occupies a large part of the uterine cavity, which does not allow the fetus to fully develop. With the size of uterine fibroids 10 or more weeks, there is a high probability of late miscarriage or premature birth.

In addition, large nodes contribute to the incorrect location of the fetus, which complicates both the course of pregnancy and childbirth. With the cervical location of the tumor, an obstacle is created for the birth of the fetal head and the risk of bleeding during childbirth increases. Therefore, with large tumors, pregnancy, as a rule, ends with operative delivery.

Diagnostics

The diagnosis begins with a thorough history taking and patient complaints. During a gynecological examination, an enlarged uterus is palpated, with a bumpy and dense surface. The initial examination does not allow to differentiate fibroma from fibroids or sarcomas, so the doctor will prescribe an additional examination:

pelvic ultrasound

Ultrasound examination is a highly informative and reliable diagnostic method, and in 96% it allows to confirm/detect fibroma, the size of nodes and their number, localization and nature of growth, deformation of the uterine cavity.

Hysterosalpingography

The introduction of contrast into the uterine cavity and fallopian tubes helps to assess the condition of the endometrium, identify submucosal nodes and their sizes, determine the size and deformation of the uterine cavity, the patency of the fallopian tubes and the presence of an obstacle in their mouths.

Hysteroscopy

This method allows you to see the uterine mucosa, to determine the submucosal fibroma, even of small size. In the presence of suspicious areas of the mucosa, a piece of tissue is taken (biopsy) with subsequent histological examination. An interstitial fibroma is defined as a protrusion above the wall of the uterus and is smooth and pale pink in color.

CT and MRI

Computed and magnetic resonance imaging is performed to finally confirm the disease and exclude uterine sarcoma or fibroma or ovarian cystoma (in the case of a subserous node).

Diagnostic laparoscopy

It is carried out in difficult cases, when there is no way to distinguish a fibroid tumor of the uterus from a tumor-like formation of the ovary.

Treatment

How to treat uterine fibroids? The tactics of treatment is determined by the size and localization of the tumor and the duration of the disease, the presence / absence of clinical manifestations, comorbidities, the patient's desire to become pregnant and rapid growth or its absence (rapid growth is said to increase fibroma for 12 months for 4 or more weeks).

Conservative treatment

Uterine fibroma of small size (5 - 6 weeks) does not need treatment. In this case, dispensary observation is recommended (gynecological examination every 3 months and ultrasound examination annually).

Conservative therapy is prescribed in the following situations:

• the size of the uterus does not exceed 12 weeks;
• oligosymptomatic course (no menorrhagia and metrorrhagia, pain syndrome is insignificant);
• woman's desire to become pregnant;
• there are contraindications to surgical intervention;
• sessile subserous node and interstitial fibroma.

Hormone therapy is the basis of conservative therapy:

Androgen derivatives

This group of drugs inhibits the secretion of gonadotropins by the pituitary gland, and in the ovaries reduces the production of estrogens (danazol, gestrinone).

Gestagens

These drugs normalize the growth of the endometrium in case of its hyperplasia. The effectiveness of gestagens in the treatment of fibroid tumors is low and they are prescribed for small nodes, which are accompanied by endometrial hyperplastic processes (norkolut, duphaston and utrozhestan).

intrauterine hormonal system

The Mirena IUD, when inserted into the uterine cavity, begins to secrete the hormone levonorgestrel, which inhibits the growth of fibroids and complements the contraceptive effect of the intrauterine device.

Combined oral contraceptives

GnRH analogues

Preparations of this group (zoladex, buserilin) ​​cause hypoestrogenism. By reducing the content of estrogens, the blood supply to the uterus decreases, in particular to the fibroma nodes, which helps to reduce their size. These drugs have a temporary effect and are prescribed 3 months before the operation.

Also, patients are advised to follow a certain diet with a high content of protein and foods rich in iron. In parallel, iron preparations and sedatives are prescribed, for the relief of pain, it is recommended to take non-steroidal anti-inflammatory drugs (indomethacin, nise) and painkillers.

Surgery

Surgery for uterine fibroids is performed in the following situations:

• large fibroma (more than 12 weeks);
• a rapid increase in the size of the uterus (by 4 or more weeks per year);
• failure of conservative treatment;
• severe symptoms (pain, bleeding leading to anemia, disruption of adjacent organs);
• malnutrition (necrosis) of the node;
• subserous node on the leg, and in case of torsion - an emergency operation;
• submucosal location of the fibroid node, "born" node;
• cervical location of the fibroma;
• endometrial hyperplasia, adenomyosis or other tumors of the genital area on the background of uterine fibroids.

What will be the surgical treatment depends, first of all, on the localization of the fibroid node and on the properties of the tumor. The desire of a woman to maintain reproductive function and the presence of concomitant gynecological pathology are also taken into account. The presence of uterine fibroids does not always mean the removal of the organ. As a rule, sparing minimally invasive operations are performed:

Transhysteroscopic myomectomy

A similar surgical intervention is performed with submucosal localization of the fibroid node. Perhaps its mechanical removal (unscrewing), electrosurgical or laser removal.

Laparoscopic myomectomy

Through Laparoscopic access, subserous and intramural fibromas are removed. If the node or nodes are located in the thickness of the myometrium, they are enucleated (husked) from the muscle wall, and with a subserous node, the formation is removed along with the leg. Such an operation allows you to save the uterus, which is especially important in women of childbearing age (not only menstruation is preserved, but also the ability to bear a pregnancy).

Embolization of the uterine arteries

The essence of the operation is the introduction of substances into the uterine arteries (pieces of a sponge made of gelatin or particles of polyvinyl alcohol), which disrupt the blood flow in the arteries, which leads to their occlusion (closure) and cessation of the growth of the node.

Ultrasound ablation or FUS

The node is evaporated with high-frequency ultrasound, the procedure is controlled under MRI.

Radical surgical treatment is to remove the uterus- hysterectomy and is performed for patients with multiple and large fibromas and who do not want to preserve reproductive function.

Possible options for hysterectomy:

Supravaginal amputation of the uterus

It can be performed both laparoscopically and laparotomically. And also through the vagina. When the uterus is amputated, the cervix and uterine stump are preserved.

Extirpation of the uterus

Both laparoscopic and laparotomy accesses are also possible. The uterus is removed along with the cervix.

Defundation of the uterus

It consists in removing the fundus of the uterus. Such an operation is referred to as semi-radical. After defundation, the rest of the organ functions as before.

Treatment with folk remedies

Folk remedies that are used for uterine fibroids are usually herbal treatment. Phytotherapy is used as an adjunct to the main course of drug treatment and only with the approval of a physician. Phytotherapy inhibits the growth of fibroids, reduces the severity of symptoms (bleeding, pain), has an anti-inflammatory and resolving effect:

Celandine

They prepare a tincture of celandine based on vodka, which they begin to take with one drop, adding one drop daily. Drink the tincture in a course until the total number of drops reaches 35.

strawberries

The whole plant is used (leaves, stems, roots and flowers). Strawberries are brewed like tea and drunk instead of other liquids.

pine nut

A pine nut shell tincture is prepared and taken in a teaspoon three times a day for a week. This is followed by a break of 7 days and again the course is repeated (up to 6 times).

Stinging nettle

Nettle infusion (a tablespoon of dry raw materials is brewed with a liter of boiling water) helps reduce bleeding, taken half a glass three times a day.

potato flowers

Dried potato flowers (1 teaspoon) are poured with a glass of boiling water and infused overnight. Take an infusion of a quarter cup three times a day for a month. After 2 months, the course of treatment is repeated.

Flax seeds

A decoction of flaxseeds is prepared, taken three times a day, 100 ml of decoction for 15 days.

Carrot decoction

Pour boiling water over carrot tops and boil over low heat for 5 minutes. Take half a glass three times a day.

potato juice

Daily, in the morning, drink freshly squeezed juice of one potato for 30 days.

Question answer

Question:
What are the complications of uterine fibroids?

Complications depend on the location of the fibroid tumor. It is possible to twist the legs of the subserous node, as a result of which the nutrition in it is disturbed, which requires immediate surgery. Necrosis of interstitial or submucosal nodes is not excluded, the clinic of which proceeds with the picture of "acute abdomen" and also requires emergency surgical intervention. If the fibroid node is located submucosally, it may be born, accompanied by cramping pain and bleeding.

Question:
What are the chances of getting pregnant after myomectomy?

Question:
Is the risk of malignant degeneration of fibroids high?

No, the risk of degeneration of uterine fibroids into cancer is very low and is no more than 1%.

Question:
How can the development of the disease be prevented?

Specific prevention, as fibroids, and uterine fibroids do not exist. But provoking factors should be excluded, which include numerous abortions, uncontrolled intake of oral contraceptive pills, inflammation of the appendages and uterus. You should lead a healthy lifestyle, give up bad habits, fight excess weight, regularly visit a gynecologist and undergo an annual ultrasound of the pelvic organs.

Question:
Does conservative myomectomy rule out the development of new fibroma nodes?

No. All women who have undergone conservative myomectomy are registered with a gynecologist until menopause. During the operation, only the nodes visible to the eye are removed, so the appearance of new ones and their growth is not excluded.