Uterine fibroids 6 8 weeks what to do. Influence of the size of uterine fibroids on the symptoms and choice of method of treatment of pathology. What is uterine artery embolization

This video discusses in detail (but understandable and accessible) the method of uterine artery embolization: history, features and myths. In 12 minutes you will get a complete understanding of the method and find answers to most questions.

Uterine fibroids - for many women, this diagnosis sounds like a bolt from the blue, and it often happens that a misconception about this diagnosis dooms the patient to difficult experiences and completely unjustified surgical interventions.

What I would like to talk about below are the main theses:

uterine fibroids - it's not scary at all (again dispelling myths)
there are modern techniques to avoid surgery and organ loss
uterine fibroids cannot be treated with Duphaston
there is a prevention of the development of uterine fibroids
with uterine fibroids, you can get pregnant and give birth

Some statistics:

about 80% of all operations in gynecology are performed for uterine fibroids - 90% of these operations are removal of the uterus
every third woman after 55 years of age had her uterus removed due to a diagnosis of uterine fibroids
the average age of women who have their uterus removed because they have uterine fibroids is 42 years

Why everyone is offered to operate on myoma?

If all operations for uterine fibroids are removed from the work of the gynecological department, then in fact doctors will sit without work and categorically not carry out the terrible plan of “surgical activity”. “Surgical activity” reflects how many patients were operated on from among those admitted. This indicator should be high - otherwise they swear very much ...

And some of the doctors are simply not interested in new technologies and do not know that they can be treated differently.

So to myoma...

What is uterine fibroids and why is it so scary?

Uterine fibroids have long been considered as a true benign tumor that can transform into a malignant neoplasm. And since any tumor must be removed, and preferably together with the organ in which it grows, there was no alternative to removing the uterus for this disease. The only compromise was organ-sparing fibroid nodule surgery – this womb-sparing option was mostly reserved for nulliparous women to give them a chance to have a baby. Sooner or later, these women, having fulfilled their reproductive plan, found themselves on the operating table for removal of the uterus due to a relapse of the disease.

Attitudes towards the nature of fibroids began to change in the mid-1990s. New opportunities for scientific research have shown that although it looks similar, it is not a benign tumor. It became known that fibroids degenerate into a malignant tumor so rarely that, in general, this probability is comparable to the development of a malignant tumor in the uterus, without the presence of myomatous nodes in it. And finally, in terms of their characteristics, fibroids were compared with a common wen on the skin, an atherosclerotic plaque in a vessel, and a keloid scar, which made it possible to significantly reduce oncological alertness in relation to this disease.

As a result of special studies, it was possible to show that myoma has a greater prevalence than previously thought. If earlier it was thought that it occurs in 30% of women over 35 years old, now it is known that fibroids develop in more than 80% of women, but in most women this disease is asymptomatic.

At the moment, uterine fibroids appear to be a kind of reaction of an organ (uterus) to damage. The main damage to the uterus is menstruation, or rather a large number of periods.

There is an ancient Russian proverb “If you don’t give birth to Yerema, you will give birth to fibroids” - and the ancients, as usual, were right, but they could not explain it from a scientific point of view.

The body of a woman was conceived by nature for procreation. It was supposed to be in the reproductive cycle from the moment of maturity. Pregnancy, breastfeeding, one or two periods and again pregnancy. So for the life of a woman it was supposed to survive 30-40 menstruations, and most likely the uterus is adapted to this. In practice, it happens that a woman gives birth to 1-2 children, usually by the age of 30 and rarely breastfeeds for more than 1 year. In this mode, a woman experiences about 400 menstruations in her life.

Like any frequently repeated process, menstruation negatively affects the woman's body in general, and her genitals in particular. Think about it: how could it be provided by nature that every month you have to experience a whole set of negative sensations, in their effect on the body, comparable to a disease. Headaches, pain in the abdomen and body, bleeding, bad mood, decreased performance, changes in appetite, etc. This list can be continued for quite some time. This is how the body responds to its unfulfillment.

Every month, the whole body of a woman tunes in to pregnancy, all organs and systems are prepared. In the second phase of the cycle, these processes accelerate, the uterus increases slightly in size, preparing to quickly begin to grow in response to the onset of pregnancy. Pregnancy does not occur and again the whole body begins to return its “settings” to its normal state.

Obviously, repeated repetition of a complex multilevel process begins, on the one hand, to wear out the entire system, and on the other hand, “to form errors”, the number of which increases many times when combined with various diseases, infections and medical interventions. This is how most gynecological diseases are formed, including uterine fibroids.

A monthly maturing follicle in the ovary will sooner or later form into an ovarian cyst, a constant increase and rejection of the uterine mucosa - polyps or hyperplastic processes; endometriosis - there is no menstruation at all.

Myoma is formed at the beginning in the form of tiny rudiments located in the muscular membrane of the uterus. These are groups of ordinary muscle cells of the uterus, but in their properties they correspond to cells that are in the period of pregnancy. As one American scientist said, “uterine fibroids are a single-cell pregnancy.” Indeed, each myomatous node grows from one cell.

Under conditions of repetitive menstrual cycles, accompanied by fluctuations in hormones, the rudiments of myomatous nodes begin to grow. At the same time, some grow faster, others slowly, and others may even regress and disappear. Various damaging factors accelerate the growth of the rudiments of myomatous nodes, which include:

abortions
inflammation
medical interventions (curettage, traumatic childbirth benefits, operations)
endometriosis

After all, it is known that after inflammation or abortion, myomatous nodes begin to grow.

There are also juvenile fibroids that occur in young girls under 25 years old. It is believed that damage to the cells of the uterus, which leads to the growth of these nodes, occurs in them during intrauterine development. The progenitor cells of the muscular membrane of the uterus take a very long time to develop during pregnancy and have a long unstable period. In this unstable state, they are most susceptible to various damaging factors. Thus, if cells receive a defect in the prenatal period, then they only need a hormonal stimulus in the future to start growing. This hormonal stimulus is the onset of menstruation.

Diagnostic approaches

At a time when ultrasound was practically unavailable, and the quality of the devices left much to be desired, it was almost impossible to detect small myomatous nodes. Basically, doctors had to deal with already large nodes that could be found by hand or with patients who complained of heavy menstruation. In fact, these were already running cases. It was then that indications for the removal of the uterus were formulated, which exist to this day. In these indications, apart from other items, there are two very subjective criteria: "the size of the uterus corresponding to more than 12 weeks of pregnancy" and "the rapid growth of fibroids"

When myomatous nodes begin to grow in the uterus, the uterus itself increases in size accordingly. Since the uterus normally increases in size only during pregnancy, the increase in the uterus due to myomatous nodes began to be measured by weeks of pregnancy. For example, "uterine fibroids 7-8 corresponding to 7-8 weeks of pregnancy."

Estimating the size of uterine fibroids in weeks of pregnancy is an extremely subjective thing. The uterus with myomatous nodes, as a rule, increases unevenly - the nodes grow in different directions, some stretch in width, some in length. In addition, the thickness of the subcutaneous fatty tissue of the anterior abdominal wall and the height of the uterus are important in assessing the size of the uterus. All this leads to the fact that one doctor can look at a woman on a chair and say that she has uterine fibroids for 8 weeks, and another, after looking, will say that there are all 12 weeks. In fact, during the operation, it turns out that the size of the uterus barely reaches 6-7 weeks of pregnancy.

"Rapid growth" is also a very subjective criterion, as it is directly related to the desire or ability to correctly determine the size of the uterus in the weeks of pregnancy. The criterion of "rapid growth" was introduced in connection with the fear that the rapid growth of myomatous nodes is highly suspicious in relation to the malignant transformation of fibroids. This fact has been repeatedly refuted, since it has been shown that in the vast majority of cases, the rapid growth of myomatous nodes is not associated with malignant degeneration of fibroids, but is a consequence of secondary degenerative changes.

Now imagine how convenient the situation is when the indication for surgery is the subjective criterion in the form of the size of the myomatous uterus more than 12 weeks or "rapid growth" Under this "subjective sauce" the largest number of hysterectomy is performed, despite the fact that the true size of the uterus may be slightly larger norms.

Who needs it and why?

There are several reasons:

1. Dispensary registration in antenatal clinics

Each women's clinic has a dispensary record of women for various diseases. Most of the women are in the dispensary for fibroids. They are regularly invited to an appointment and observe the dynamics of the growth of myomatous nodes. The number of such women is increasing year by year. It is possible to remove a woman from dispensary registration after the disease has actually been cured, and the only radical method of treatment is amputation of the uterus. Therefore, after observing for some time, it is possible to write down on a card at one of the appointments that the uterine fibroids have grown up to 12 weeks of pregnancy, while “quickly” and send them for surgical treatment. After the removal of the uterus, the woman is removed from the dispensary. Again, reporting is required.

2.Surgical treatment of uterine fibroids - profit for the clinic and the implementation of the "surgical activity" plan

Monitoring a patient with fibroids is a troublesome and costly task. Any operation is always more expensive, whether it is the funds of an insurance company or personal gratitude from citizens. Now, when laparoscopic operations are performed in almost every major medical institution, the removal of the uterus by this method is put on stream. The technique of the operation is debugged, the intervention is relatively well tolerated. Here is what is proposed to quickly and efficiently solve the problem. If a woman no longer has reproductive plans, then convincing her that this is the simplest and easiest way to treat fibroids costs nothing. Polyclinics honestly direct, surgeons honestly cut off. In this case, the only indication for amputation may simply be the presence of uterine fibroids, even if it does not give any symptoms, even if the myomatous node is small and does not interfere with anything.

The main idea of all that I have written above is that the patient with uterine fibroids is actually being misled. Taking advantage of the fact that the patient is not oriented in matters of medicine, she is not told about all the available methods of treatment for her disease, or is provided with negative and false data about the effectiveness of alternative methods of treatment - either intentionally or simply out of ignorance.

How to treat uterine fibroids?

First, I would like to list all currently available treatments for uterine fibroids:

Drug treatment: GnRH agonists (zoladex, buserelin, diphereline, lucrine, etc.), progesterone receptor blockers (mifepristone)
Embolization of the uterine arteries
Conservative myomectomy (hysteroresectoscopy)
Amputation of the uterus

Thus, in addition to removal of the uterus and passive dynamic observation, there are other methods of treatment.

Dimensions of uterine fibroids

Despite the fact that the classification of uterine fibroids by weeks of pregnancy is accepted all over the world, in my opinion, in the era of ultrasound diagnostics, this approach to determining the size of uterine fibroids is somewhat outdated.

With the help of ultrasound, you can measure the size of each myomatous node, count their number and determine the localization. Such a detailed description of the uterus, modified by myomatous nodes, is more informative than the conclusion - "uterine fibroids 8-9 weeks."

In addition, the choice of treatment method, the prognosis of the disease and the conclusion about the possibility of pregnancy depends on the size of the nodes and their localization.

Choice of treatment for uterine fibroids

Before describing each of the treatments listed above, let's discuss in what situations it is possible to allow a simple observation.

A very important thought! The myomatous node appears in the uterus not immediately large, it grows from the rudiment and at the very beginning it cannot be detected even with ultrasound. Further, it increases in size and then the paths of all nodes diverge. Some nodes reach a certain size and stop growing, others slowly but surely continue their growth, and others can grow rapidly.

If there was only one node in the uterus, besides this node, new nodes may not appear. But there is another situation when the number of nodes increases.

No one knows how the node will behave - whether it will grow, stabilize, or disappear altogether. But you need to understand that fibroids have staging, and small nodes are actually the earliest stage of the disease, and large and very large fibroids are already advanced forms of the disease.

As you know, any disease is easiest to treat at an early stage - the treatment of uterine fibroids is no exception. Therefore, even if a woman accidentally discovers small myomatous nodes (no more than 2-2.5 cm) during ultrasound, let such a patient go with the words: “we will observe, if fibroids grow, we will treat” - it is equivalent to a situation when a patient goes to a doctor with complaints of coughing, and instead of treatment, the doctor says: “we will observe, pneumonia will develop, then we will treat.” Absurd, isn't it?

It has long been known that modern hormonal contraceptives are able to inhibit the growth of small myomatous nodes, the size of which does not exceed 2-2.5 cm. body).

Thus, when small myomatous nodes are detected, even in the absence of symptoms of the disease, the patient should be offered to take modern monophasic contraceptives. In the same case, if they are contraindicated to her, or the patient categorically objects to taking them, dynamic monitoring of the growth of myomatous nodes can be allowed, but ultrasound should be performed at least 1 time per year. If the nodes began to grow, then treatment should be started immediately and not wait for their further increase, even if there are no symptoms of the disease.

Reception of oral contraceptives can be replaced with a special intrauterine hormonal system "Mirena". This is actually an ordinary intrauterine device, but containing a container with a hormone that is released into the uterine cavity in small doses for 5-6 years. It is for this period that this system is put. She, as well as oral contraceptives, inhibits the growth of myomatous nodes.

In what other cases can you observe myoma and do nothing?

There is no single answer here, the decision must be made individually. Too many criteria should be taken into account when making such a decision (and the localization of the node, its size, the age of the patient, the degree of blood supply, the presence of reproductive plans, the presence of other diseases, etc.)

Thus, it is possible to allow dynamic monitoring of uterine fibroids only by evaluating many facts.

Before proceeding to describe the methods of treating uterine fibroids, it is necessary to tell what nodes are and what is the main idea of treating this disease.

What are uterine fibroids?

Myoma nodes can be located in different parts of the uterus.

Actually outside the uterus, "grow on a stalk"
Part of the node outside the uterus, and part in the wall
In the wall of the uterus
In the wall of the uterus, but grow towards the cavity
And nodes that protrude into the uterine cavity to varying degrees, some nodes can be completely in the uterine cavity "on a leg"

There are also other localizations, but they are extremely rare.

The closer the node is to the uterine cavity, the more likely it is to cause symptoms of the disease in the form of heavy long periods, pain and interfere with the development of pregnancy. Accordingly, the more external the node, the less it manifests itself, except when the node is large enough and squeezes neighboring organs (bladder or rectum)

Further, the closer the node is to the uterine cavity, the more significant its size. To clarify, even a small nodule in the uterine cavity can cause prolonged heavy menstruation, while a large nodule outside the uterus can remain asymptomatic for a long time.

Therefore, the choice of treatment method depends not only on the size and number of nodes, but also on their localization.

What is the main idea of the treatment of uterine fibroids

The uterine fibroid nodule can be reduced, fixed in size, and removed.

Reduces the size of fibroids Two types of treatment - drugs and uterine artery embolization (indirect, focused ultrasound)

Each node has its own limit, below which it cannot decrease. In other words, "dry residue". I often give the example of an apple that is turned into a dried fruit - the larger the apple initially, the more dried fruit it will turn out, the juicier it was, the more it will decrease when dried.

With a myomatous node also. Large nodes, as a rule, decrease worse and mainly due to the fact that the content of connective tissue begins to prevail in their structure, which is practically not amenable to regression. However, there are also small nodes, almost entirely consisting of connective tissue - fibromyomas. Fibromyomas also shrink poorly, with juicy large ones regressing to more than 80% of their original size.

On average, after the treatment, the myomatous node decreases by 40%. When choosing a treatment method, this should be taken into account. It is not rational to medically reduce the size of the 8 cm node, since the remainder will be a 5 cm node, which will also remain clinically significant, especially if this node grows towards the uterine cavity.

Medical treatment of uterine fibroids

Important! Uterine fibroids cannot be treated with Duphaston. Progesterone (duphaston is its analogue) is the main factor in the growth of fibroids (this has been proven more than 10 years ago) - who does not believe, see Western scientific publications.

Despite this, Duphaston continues to be prescribed everywhere for patients with uterine myoma - well, how can you? Below it will be said about the drug Mifepristone (progesterone receptor blocker) - this drug reduces the size of uterine fibroids only due to the fact that it does not allow progesterone to exercise its effect on uterine fibroids. That is, no progesterone - no growth of fibroids.

Duphaston is categorically contraindicated for the treatment of uterine fibroids! Duphaston grows fibroids, and after you are sent for an operation under the sauce “treatment did not help, the nodes grow, it is necessary to cut it off, no matter how bad it is.”
Some Paleolithic...

GnRH agonites

These drugs (Zoladex, Buserelin, Diferelin, Lucrin-depot, etc.) introduce a woman into artificial menopause, against which a decrease in myomatous nodes occurs. In addition, they have a direct effect on uterine fibroids. GnRH agonists block the local production of hormones in the nodes (supporting the growth of nodes) and the synthesis of connective tissue (the accumulation of which also leads to an increase in size).

The drugs are administered intramuscularly once every 28 days. Usually the course of treatment is from 3 to 6-7 months. Side effects develop differently for everyone - from mild "hot flashes" to relatively severe conditions. After the end of treatment, the myomatous nodes may begin to grow again, therefore, such drugs should not be prescribed in isolation. To stabilize the results achieved after a course of therapy with GnRH agonists, hormonal contraceptives are prescribed or the Mirena spiral is introduced.

It is advisable to use GnRH agonists for only small myoma nodes up to 3-5 cm, then after reduction, the size of the nodes will remain clinically insignificant, and it will be easier to stabilize them with the help of contraceptives or Mirena. Prescribing GnRH agonists to large nodes is not rational; there are other treatments for such nodes.

GnRH agonists should not be given at all before surgery to remove fibroids. It is believed that after such preparation, the volume of surgical blood loss decreases and the reduced node is easier to remove. In fact, the volume of blood loss is indeed reduced, but at the same time, the myomatous node seems to be “soldered” into the surrounding muscle tissue of the uterus, which makes it difficult to exfoliate. The most negative consequence of the preoperative administration of GnRH agonists is that, during treatment, small myoma nodes become even smaller and cannot be detected during surgery and, accordingly, removed. It is from these left small nodules that new nodes are subsequently formed and the disease recurs.

GnRH agonists should be given after fibroid surgery to allow the uterus to fully recover and suppress any remaining fibroid buds.

Progesterone receptor blockers

Currently, there is only one drug from this group - mifepristone. It is known that it is the female sex hormone progesterone that is the most powerful factor in the growth of uterine fibroids. Mifepristone blocks all binding sites of this hormone on uterine fibroid cells, thus preventing it from realizing its effect.

Against the background of taking this drug, the size of myomatous nodes decreases in the same way as with the use of GnRH agonists. The drug is better tolerated. It is also advisable to prescribe mifepristone only in the presence of small myomatous nodes.

Embolization of the uterine arteries

In fact, a unique method of treating uterine fibroids. His appearance actually gave rise to a new era in the treatment of this disease.

What is uterine artery embolization?

The term "embolization" means blockage of the blood vessels that feed the organ, which leads to the cessation of its blood supply.

The essence of the technique of uterine artery embolization (UAE) is as follows: the uterus is mainly supplied with blood by four arteries: the right and left uterine arteries and the right and left ovarian arteries.

The share of uterine arteries in the supply of the uterus with blood is the main one. Now imagine that you drastically reduce the watering of your favorite ficus to a minimum - it is obvious that very soon it will simply dry out. Similarly, an organ that has lost a significant share of its blood supply gradually begins to decrease in size, only there is one nuance here. Uterine fibroids also feed from the uterine arteries, but since it was formed later than the uterus grew, the system of blood vessels in it is not perfect and vicious (“made hastily and not thought out in case of any violations”).

Thus, the cessation of blood supply to the uterus through the uterine arteries becomes “lethal” for fibroids, but not for healthy uterine tissue, since the presence of a normal circulatory network in it allows it to “exist” due to blood flow through the ovarian and other small arteries. In other words, the cessation of blood flow in the uterine arteries leads to the “shrinkage” of fibroids, but practically does not affect the functioning of healthy uterine tissue.

As a result of this procedure, already after three months, the volume of fibroids decreases by an average of 43%, and in a year - by 65%. Abundant long painful menstruation with clots by the second or third month after UAE in 90% turn into short moderate or even meager, painless periods. Most importantly, after this procedure, uterine fibroids rarely recur. EMA is a self-sufficient method. After this procedure, there is no need to take any medications and procedures - you solve the problem of uterine fibroids once and for all.

How does this procedure take place?

It is interesting!

How uterine artery embolization works in the Perinatal Medical Center (video from the operating room). Now you can see everything with your own eyes.

Under local anesthesia (this is more than enough), the right femoral artery is punctured (the same as an intravenous injection only on the leg), and a catheter is inserted.

Then, under the control of a special X-ray machine, they alternately enter the right and left uterine arteries, and a suspension of microparticles (balls with a size of 300-700 microns) is injected into each of them. These particles will block the blood flow in the uterine arteries.

This procedure usually takes from 15 to 40 minutes and occurs without anesthesia - as it is simply not needed. Throughout the procedure, the patient does not experience any pain.

After the procedure is over, the patient returns to her room, where she remains until the morning. Some time after the procedure, pain (drawing character) appears, resembling pain during menstruation. The severity of pain is different - from mild to moderate, sometimes quite strong. Painkillers are prescribed to relieve pain. By morning, the pain usually disappears completely. In the next 5-7 days, a condition resembling a mild cold may be observed, that is, fever, weakness, drowsiness. Most often, women spend this time at home and after it they can go to work. Already after one menstrual cycle, you can feel the effect of the procedure.

Embolization of the uterine arteries can be performed for any size and localization of myomatous nodes. It is advisable to perform this procedure even in the presence of small nodes, in fact, for a preventive purpose, so as not to take contraceptives and not worry that one day the nodes will begin to grow. For large nodules, embolization alone may be enough (the nodules in the uterus may remain large enough, but they will not grow further and there will be no profuse bleeding) or embolization will be the initial step before surgery to remove fibroids, especially in women planning a pregnancy.

The combination of uterine artery embolization with subsequent removal of the remaining nodes is an approach that allows you to restore reproductive function in women with the most complex variants of uterine fibroids.

These are situations when the uterus is actually “stuffed” with fibrous nodes of various sizes and it is not possible to remove all the nodes without risk for the uterus and the patient. 6-8 months after embolization of the uterine arteries, the number of nodes decreases, the remaining nodes are clearly delimited from the surrounding myometrium, the contour of a normal uterus begins to be drawn, and the cavity is leveled. It becomes easier to remove nodes from such a uterus, blood loss is sharply reduced, after removal of all nodes, the uterus quickly acquires its original size.

Is it possible to get pregnant after uterine artery embolization and is this procedure performed on nulliparous women?

Yes, you can! And this is proved by the increasing number of children around the world every year, born to women who have undergone uterine artery embolization.

Already within a few months after embolization, the blood flow in the uterus is restored in full. Ovarian function in young women does not suffer, despite the fact that during embolization, emboli enter the bloodstream of the ovary.

A decrease in ovarian function can be observed in women mainly over 45 years of age. The radiation dose during the procedure does not exceed the allowable values (this has been shown in large Western studies)

Of course, after embolization of the uterine arteries, not so many children are born, but this is due to the fact that the vast majority of women with uterine myoma are over 35 years old, and many have already given birth to children or by this age they have additional factors of infertility (for example, obstruction of the uterine tubal or male infertility).

Uterine artery embolization and submucosal uterine fibroids (submucosal)

The effect that uterine artery embolization has on submucosal myoma nodes can be called unique. Submucosal nodes are nodes that grow into the uterine cavity and deform it to varying degrees.

Before the advent of uterine artery embolization, such nodes were removed using hysteroresectoscopy (a large operation that is performed through the vagina - with a special tool, the myomatous node is cut off in small pieces from the wall of the cavity). This operation is still being carried out. The maximum node size for the possibility of this operation is 5 cm. For large sizes, they most often insist on removing the uterus. Hysteroresectoscopy is most justified in the presence of small nodules that grow in the uterine cavity, as if "on a leg".

After embolization of the uterine arteries, the myomatous node or nodes begin to gradually move into the uterine cavity, where it begins to disintegrate. The disintegrating myomatous node gradually flows out of the uterine cavity and then is completely pushed out of the uterus. Thus, the uterus, as it were, rejects the knot from itself, while already a few weeks after that it is impossible to find a single sign that this knot was in the uterus - complete healing occurs without a trace.

Against the background of such a disintegration of the node, a woman, as a rule, has an increase in temperature, weakness, malaise, periodic pulling pains in the abdomen. This condition can last for several weeks (depending on the size of the node or nodes), but in general it is relatively easy to tolerate. After removing the knot, the woman's condition becomes normal within one day. In my practice, the maximum size of a node that was cured in this way was 12 cm.
Who speaks badly about uterine artery embolization and why?

As a rule, bad reviews about uterine artery embolization are:

from doctors who have only heard about this method and have never seen it (well, rumors are different)
for doctors who are engaged in operations to remove the uterus and fibroids - this is their main income and embolization acts as a competing method
from extremely conservative doctors who like to treat "the old fashioned way"
in doctors who had to deal with complications after uterine artery embolization (they happen extremely rarely with the correct operation and proper management after)
in patients who underwent this procedure poorly or had complications (as you know, there is no medicine without complications, but more often they are silent about the successes of doctors, but I always talk about complications)

Thus, uterine artery embolization is a very successful self-sufficient method of treating uterine fibroids, which has already saved many women from hysterectomy and allowed them to give birth to full-fledged children.

Remember! Every time you are offered to remove the uterus for fibroids, do not rush to agree, you will always have time to remove the uterus. Embolization of the uterine arteries is a worthy alternative to this operation.

Removal of uterine fibroids or conservative myomectomy

This operation was proposed about a hundred years ago and so far the possibility of this operation is hushed up. Technically, this is a rather complicated operation, and not all gynecologists are proficient in it. Removing the uterus is much easier.

Most often, this operation is performed to realize the reproductive function. You can get pregnant 6 months after this operation. With a large number of nodes and a high risk of losing the uterus during the operation, embolization of the uterine arteries is performed six months before this operation. Then the outcome of the operation is almost always successful. In order to prevent recurrence of the disease and allow the uterus to recover better after surgery, a course of therapy with GnRH agonists is prescribed for 3-6 months.

What is the best method for removing fibroids?

There are two options for conservative myomectomy - laparoscopic and laparotomy. In the first case, the operation is performed using special instruments inserted into the abdominal cavity under the control of a video camera; in the second, the operation is performed by the surgeon's hands in the abdomen.

Laparoscopic myomectomy requires a very high skill of the surgeon, as he must sew the uterus well so that it can withstand pregnancy and childbirth. This is not an easy task. Many cases of uterine ruptures during pregnancy and childbirth after poorly performed operations have already been recorded. Laparoscopic access is most indicated in the presence of nodes growing outside the uterus "on a leg".

The advantages of laparoscopic access include a quick recovery period, less likelihood of adhesions, less blood loss during surgery. But I repeat once again, in Russia there are only a few dozen surgeons who have sufficient experience and qualifications to fully perform this operation in the presence of several nodes in the uterus and when they are located in the wall and closer to the cavity. The names of these surgeons are usually widely known. You may be offered to do such an operation in any clinic, but just remember that you can only check the quality during pregnancy and childbirth, and it may be too late there.

Still, the uterus must be sewn by hand. Neatly, layer by layer, matching all the layers. This allows you to do an abdominal operation. In addition, during abdominal surgery, there is a more complete opportunity to feel the entire uterus with your fingers and find small myomatous nodes and remove them. The tool doesn't work that well.

Therefore, I believe that the removal of myomatous nodes, if these nodes are located in the wall of the uterus, they are large or there are a lot of them, should be done with an open operation. This will allow with greater confidence to guarantee the complete removal of myomatous nodes and better and more reliable suturing of the uterus.

When should the uterus be removed for uterine fibroids?

Only in very advanced cases, when the size of the uterus is very large and the uterus is completely stuffed with knots, so that it is impossible to find healthy uterine tissue in the uterus. And a few more situations that do not occur so often.

It's a shame, because many women themselves run their disease to such an extent. They see that their belly is growing, they do not visit a gynecologist for 10 years, and some even more, and actually come when their disease reaches a stage when organ-preserving treatment is no longer possible. Some women avoid going to the doctor because they are offered to remove the uterus from the very beginning without being told about the available alternatives. Afraid of losing their uterus, these women grow fibroids for years and only come to an appointment when a huge uterus in their stomach does not allow them to lead a normal life. They come to surrender - doomed, sad and with a strong longing in their eyes. And the worst thing is that if they knew that there were other treatments, and came to the appointment a few years earlier, they could have used them and saved the uterus.

Why should you not remove the uterus and fight for it to the end?

The attitude to the uterus, as an organ that is intended only for childbearing, actually makes it so easy to make a decision to remove it. In fact, the uterus is an organ integrated into the entire reproductive system of the body and its removal does not go unnoticed.

It is known that after the removal of the uterus, the risk of breast and thyroid cancer increases. In addition, during the removal of the uterus, there is a violation of the blood supply to the ovaries, which entails the development of the so-called "posthysterectomy syndrome". This syndrome is similar to that observed in menopausal women. It often happens that after the removal of the uterus, a woman begins to “age” quickly, her body weight increases, and the quality of life changes for the worse.

Sexual life can also change. On this occasion, Western scientists have conducted a number of studies, and their results were controversial. It was noted as an improvement in sexual life after amputation of the uterus (apparently these are those women who were exhausted by the disease they had) and those who completely lost the pleasure of sexual activity. There is no reliable data and this is most likely due to the fact that the formation of sexual sensations in a woman is extremely complex and it is very difficult to evaluate it from all positions.

If you still decide to remove the uterus, then you need to remember that in order to prevent the development of post-hysterectomy syndrome (early aging), from the next day after the operation, you must start taking a special preparation Livial, which will level the development of this pathological condition.

Other treatments

High Frequency Focused Ultrasound

This method has appeared relatively recently. The meaning of this method lies in the fact that, under the control of MRI (tomography), a stream of ultrasound is aimed at the myomatous node. In the center of the node, tissues are heated to a high temperature and the node dies.

On the one hand, this method is very good. The impact is through the skin, that is, generally contactless, but there are several nuances:

the method is very expensive (this is due to the fact that the equipment for its implementation costs many millions of euros and this must be paid back)
it is possible to act on one or at most several nodes of fibroids
at the same time, there should not be a lot of fat, scars and scars on the anterior abdominal wall
at the same time, the nodes should be well located - that is, there should not be large obstacles on the path between the node and the beam flow
uterine myoma nodes have different sensitivity to this effect, some nodes do not decrease at all after this procedure
During the procedure, the patient must lie motionless on her stomach for several hours.

Thus, the method has many limitations and inconveniences. At a time when there is uterine artery embolization, in which all myomatous nodes are affected at once, there are not so many restrictions and this method costs half as much - the use of focused ultrasound is only advisable for scientific purposes.

I don’t believe in homeopathy, dietary supplements, etc.…..

Conclusion

Can uterine fibroids cease to be one of the most urgent problems of gynecology? - MAYBE!!! How? - everything is very simple!

It is necessary from the earliest youth to regularly do an ultrasound scan - once a year, and if a myomatous node is detected - immediately take measures (take contraceptives, do embolization) It is absolutely unacceptable to observe how the fibroids grow.

Regular examination by a gynecologist with ultrasound is the best prevention of problems associated with uterine fibroids.

2013-03-23 07:51:57

Natalia asks:

I have uterine fibroids for 8 weeks. The dimensions of the uterus are 87X83X58. subserous node on the anterior-left side wall 4.7 mm. The shape of the uterus is pear-shaped, with uneven contours. A diagnosis of endometriosis is made. Endometrial hyperplasia 24 mm. The doctor says that a curettage is necessary. Are there other treatments for the disease. Menstruation is not heavy, 3-4 days. Pain before menstruation is small, does not interfere with performance. The ultrasound was done on the 25th day of the cycle, almost before menstruation.

Responsible Kondratyuk Vadim Anatolievich:

Ultrasound should be repeated in the first third of the cycle (5-7 days after menstruation). Curettage with a histological examination is mandatory - not for the treatment of fibroids, but to exclude oncology and precancers. The fibroid is relatively small, if it is somehow disturbing or has a tendency to grow, the possibility of embolization of the uterine arteries can be considered.

2015-04-02 08:02:23

Lydia asks:

I am 45 years old and my period is two weeks late. When examined on a chair, the gynecologist said that the uterus was enlarged. They took a smear for cytology and bacterial culture.
They wrote on the ultrasound: the left ovary is normal, and the right one is enlarged, has fluid inclusions, a cyst of the right ovary, and they issued a conclusion - "myomatosis of the uterus", and the doctor said that I have fibroids. What does this mean, please tell me? Why, if there is a suspicion of myoma, did not write its size and where is it located?

2013-04-23 07:33:58

Galina asks:

I did an ultrasound of the small pelvis .. the diagnosis was uterine fibroids for 15 weeks with an isthmus location of the node. endometrial polyp. So what's now? goodbye life? Examination of the pelvic organs: uterus 158 x 65 x 113 mm. located: usually contours: uneven, clear in the myometrium located: nodes located: along the back wall isthmus, intramurally, dimensions: 82 mm, clear contours. uterine cavity: defined, shape: correct, walls: clear in the uterine cavity located: heterogeneous. with the inclusion of increased echogenicity up to 9 mm in the m-echo circle: 6 mm. left ovary: 42 x 24 mm. contours: clear, follicles: up to 17 mm. right ovary: not pilot. mm, contours: shielded, follicles: nodular adhesive process: no mass formation: no free fluid in the pelvis: no cervix: b/o last date. menstr.-i: 04/16/13

Responsible Gritsko Marta Igorevna:

There is no need to say goodbye to life, but an operation is required, uterine fibroids 15 weeks. necessarily subject to surgical intervention.

2012-10-30 14:23:24

Jeanne asks:

Hello)) Please tell me which treatment is better for me: drug treatment or surgery? The doctor during the examination put uterine fibroids 7 weeks. Ultrasound result: the uterus is in the anteflexio versio position; dimensions are 8.1-6.7-9.6 cm; the contour is clear; the differential structure is heterogeneous; along the posterior interstitium, the subserogenous node is 5.6 cm. On the anterior, a similar node 1.8 cm. Endocervix cysts up to 0.7 cm. The cavity is not expanded, the endometrium is 1.0 cm. right 2.2-1.4 cm, with a yellow body 0.5 cm, with a foul. up to 0.5 cm. Left 2.9-1.8 cm, with foludo 0.8 cm. Thank you))

Responsible Kondratyuk Vadim Anatolievich:

Removal of the uterus is a mutilating operation, indicated only with reasonable suspicion of oncology. Removal of the node (myomectomy) is most effective with a single node along the anterior wall, in your case you need to decide individually, the location of the nodes and the skill of the surgeon is the decisive factor here. Embolization of the uterine arteries is the most gentle technique that allows you to irreversibly reduce all the nodes at the same time without damaging the surrounding tissues, the number and location of the nodes do not matter.

2012-07-29 06:36:46

Natalia asks:

Hello! I ask you to answer my question, according to the results of ultrasound (ultrasound was done on the 24th day of the cycle before menstruation). The uterus measures 5.6 * 5.0 * 5.5 cm, the myometrium is heterogeneous, in the anterior wall of the inter. M-node 1.0 cm in diameter, alternation of hyper- and anechoic structures in both walls. Endometrium 1.0 cm, uneven contour, proliferative type. 2 cm, follicles 0.2-0.9 cm, lion. ovary 3.4-1.2 mm, dominant follicle 2.1 cm in diameter. Conclusion: Uterine fibroids 5 weeks with signs of internal endometriosis. Assigned Janine for 3 months. The doctor says that I won't be able to get pregnant, but if I get pregnant it will allow me to "cure". I am 38 years old, I have 1 child, my husband and I planned the second. Can I get pregnant? Thank you in advance.

Responsible Danilenko Elena Grigorievna:

Natasha, adenomyosis of the uterus in the initial stage does not prevent pregnancy. It is only necessary to clearly understand with this pathology whether the fallopian tubes are passable. You have a dominant follicle, although according to your data it is on the 24th day of m / c. I recommend a metrosalpingography to clearly understand the condition of the uterus and tubes.

2012-07-10 17:07:29

Oksana asks:

Is there any cause for concern with the following ultrasound result:
number of fetuses 1 fetal position: higher
Overdue: smut. Heartbeat +
Heart rate 140 beats/min Rukhi +
4-carmeric rostin heart N nasolabial trikutnik used
brain structure N
BDP 7.16 DM 9.27 AC 5.78 OB 26.6
Cerebral index 77.3%
Quantity of natural waters: increased 27.6
Localization of the placenta: posterior. The thickness of the placenta is 3.6 cm
Number of ships 3
Pathology along the left rib, myomatous node d 6.4 cm, along the p / s myomatous node d 5.8 cm and d 2.8 cm and d 4.2 cm
VISNOVOK: The dimensions of the fetus correspond to 29 weeks and 3 days. Head presentation. Polyhydramnios.

Fibroids from the beginning of pregnancy, the size of the nodes is almost in the same condition as in the early stages. At week 12, the myomatous node d 6.7 cm, according to p / s the myomatous node d 5.8 cm and d 2.6 cm and d 3.9 cm
All tests taken during pregnancy are normal.

Responsible Danilenko Elena Grigorievna:

Oksana! according to the presented ultrasound, polyhydramnios and slight swelling of the placenta against the background of uterine fibroids can occur during infection (possibly viral, cytomegalovirus). I would recommend to conduct a study and be sure to treat polyhydramnios. In the absence of treatment, early aging of the placenta occurs, the development of fetal growth retardation and premature birth is possible.

2012-07-07 08:20:34

Irina asks:

Hello, I am 48 years old, I have a fibroid 12-13 weeks. The uterus is located typically, 9.7x9.8x7.2 cm in size, the contours are uneven, the structure is heterogeneous along the back wall on the left, a subserous-interstitial myomotous node is located with a size of 8.3x6.3, the echogenicity of myommetry is not changed , the cavity is not expanded, the endometrium is heterogeneous, the thickness of the M-echo is 0.9 cm (premenopause. The ovaries are not located. The free fluid in the retrouterine space is not located. I was scheduled for surgery. Please tell me if treatment is possible without surgery, but the nodes are sick.

Responsible Benevsky Alexey Viktorovich:

If you feel pain in the lower abdomen, then unfortunately there is no other method of treatment. An operation is necessary, only after it the pain will go away.

2012-07-06 13:51:51

Natalia asks:

I am 39 years old, I have an adult child in marriage, and there were also 2 abortions, 1 miscarriage at 5-6 weeks and missed pregnancies at 10 and 14 weeks.
Could the cause of frozen and miscarriage be myoma with intramural nodes measuring 28x20 mm and 32x22 mm along the posterior and anterior walls of the uterus?

Responsible Palyga Igor Evgenievich:

Hello, Natalia! Intramural nodes do not affect the course of pregnancy if they do not deform the uterine cavity and do not disrupt blood circulation in the endometrium, i.e. You need to see the conclusion of the ultrasound. If the influence of intramural nodes is excluded, then the cause of missed pregnancies may be genetic pathologies (then it is necessary to carry out karyotyping) or TORCH infections.

2011-12-30 11:46:16

Anna asks:

Hello, my mother had a fibroid removed, but now, 3 months after the operation, she started bleeding and headaches, please tell me what this means and what to do in a similar situation. .

Responsible Klochko Elvira Dmitrievna:

Hello. If the mother did not remove the uterus along with myoma - and uterine bleeding began - then it is better to inject Diferelin once a month. There are 3 injections. And then look - it may be necessary to remove the uterus.

What is myoma?

A fibroid is a tumor that forms in the muscle layer of a woman's uterus. The neoplasm often develops very slowly. The exact reasons why one muscle cell begins to divide and create new cells are not known, which form a kind of knot called fibroids. Depending on where the uterine fibroids are located, the following types are distinguished:

subserous (under the upper layer of the uterus, and development goes in the direction of the abdominal cavity);
interstitial (develops in the uterus inside the muscle layer);
intraligamentous (formed in the uterus between the broad ligaments);
submucous (formed in the body of the uterus under the mucous layer, development - in the area of its lumen);
cervical (develops in the muscles of the cervix).

In the case of an increase in the nodes, the fibroids become larger and the size of the uterus itself - in the same way as during pregnancy. Therefore, the size of fibroids is usually indicated in weeks (uterine fibroids 7-8 weeks, etc.) - similar to the gestational age, which corresponds to an increase in the size of the uterus. For example, uterine fibroids were detected at 8 weeks, that is, the size of the uterus increased to the size that happens at a gestational age of eight weeks. There are cases in which several nodes are detected at once, and their sizes may differ. This is called multiple uterine fibroids.

How is the size of uterine fibroids determined?

The size of uterine fibroids directly depends on the hormonal background of a woman, mainly on the amount of estrogen in the blood - female sex hormones. If their level increases, uterine fibroids become larger.

The size of the fibroids, as mentioned above, is compared by obstetricians-gynecologists with the size of the uterine body at a certain gestational age. During an ultrasound examination, the neoplasm can be measured in centimeters.

Depending on the size, uterine fibroids are conventionally divided into three main categories: small, medium and large:

uterine fibroids 8 weeks or less and up to 2.5 centimeters in size are small;
a medium-sized neoplasm corresponds to 10-12 weeks of pregnancy;
large fibroids correspond to more than 12-15 weeks of pregnancy.

Just as important as the size of the body of the neoplasm is the rate of its development. It is believed that if in a year a small or medium-sized fibroid has increased by more than five weeks (for example, uterine fibroids of 8-9 weeks - up to 13-14 weeks), then it is growing rapidly. The reasons for the rapid growth are the constant hormonal disorders in the patient.

The size of the fibroid is especially important if the patient is pregnant. When diagnosing small and small uterine fibroids (7-8 weeks - a maximum of 12), pregnancy often proceeds quite normally, without any deviations. In the case of large fibroids (12-15 weeks or more), fertilization and subsequent childbearing usually becomes impossible due to the overlap of the woman's fallopian tube, miscarriage or premature birth. When diagnosing fibroids at 12-15 weeks during childbirth, heavy bleeding may open, labor activity may be disrupted, an infectious-inflammatory process may develop, and so on.

How to identify uterine fibroids?

Uterine fibroids can be diagnosed through a gynecological examination, ultrasound examination of the uterus, as well as hysteroscopy and hysterography (if necessary).

1. Gynecological examination. During the examination, a gynecologist can detect an increase in the size of the uterus (an increase in the uterus will correspond to a certain gestational age: 4, 8, 12, 16 weeks, and so on.).

2. Ultrasound examination of the uterus is of two types: vaginal ultrasound, as well as ultrasound through the anterior abdominal wall. A similar study of the uterus demonstrates an increase in the organ, as well as the fibroid itself (large and small). Myoma can be detected already at the very initial stages, when its diameter is less than 1 centimeter, not to mention the rather large nodes of uterine fibroids 7-8 weeks or more.

3. If it is extremely difficult to identify fibroids, then such a diagnostic technique as hysterography can be applied. In this case, the doctor injects a contrast agent into the uterine cavity and takes an x-ray of it.

4. With hysteroscopy (another method for determining uterine fibroids), a hysteroscope will be inserted into the uterus, with which the doctor will examine the uterus from the inside.

5. To determine small and located in some unusual areas of fibroids (6-8 millimeters), computed tomography or diagnostic laparoscopy can be used.

How to cure uterine fibroids?

The method and duration of therapy for uterine fibroids is determined by many factors, the main of which are the following:

size (small uterine fibroids 8 weeks or less, small - size 10-12 and large - 12-15 weeks or more);
How are the symptoms expressed?
woman's age;
the desire of the patient to become pregnant and give birth.

Today, there are two main areas of treatment for uterine fibroids:

1. Medication. The goal of treatment is to control the increase in the size of uterine fibroids and the symptoms of the disease.

2. Surgical. Radical or organ-preserving operations aimed at eliminating fibroids.

how to treat fibroids and got the best answer

Answer from Larisa[guru]
at the gynecologist

Answer from 2 answers[guru]

Hello! Here is a selection of topics with answers to your question: how to treat fibroids

Answer from MARINA ZVYAGINTSEVA[guru]
I had a hemomyoma on my leg - it went away on its own, but in general I was offered to remove it with a special apparatus

Answer from Irina Vedeneeva (Burlutskaya)[guru]
The method of treatment with the help of medicinal herbs and medicinal leeches. Fibroids up to 7-8 weeks in size are almost one hundred percent treatable. Fibroids that are large (up to 12 weeks) can be corrected - in the form of a decrease in size and stop further tumor growth. Fibroids that have reached a size of 12 weeks or more should be operated on. Fast-growing tumors are also indications for surgical treatment - this is found out during dynamic observation; fibroids with submucosal localization of nodes. Surgical treatment is indicated for patients with severe anemia due to heavy menstruation and dysfunction of the bladder and intestines caused by fibroids. An important component of therapy is a diet - a strictly balanced diet and food intake. It is necessary to include sunflower, corn, soybean, olive oils containing unsaturated fatty acids, vitamins that provide cholesterol breakdown. Patients with uterine fibroids are advised to periodically take freshly squeezed vegetable and fruit juices. Non-specific antitumor plants are used. Under the name of non-specific means such antitumor plants that are aimed at destroying the tumor, regardless of its location. In other words, these plants are prescribed for any tumors, including uterine myoma. This category includes such plants as Dzungarian and Baikal wrestlers, speckled hemlock, marsh cinquefoil, white mistletoe, and red fly agaric. In most cases, alcohol (vodka) extracts from the listed plants are used. Dosed drip depending on the type of grass. As you can see, almost all of these plants (with the exception of cinquefoil) are poisonous. The use of such herbs should be extremely careful. Another type of antitumor herbs that are used in the treatment of fibroids are called mother liquors. Among such plants, it is necessary to mention the common shandra, the one-sided ortilia, the European zebra and some others. These herbs are non-poisonous and specifically act on uterine tumors. As antitumor plants used for uterine myoma, there are connective tissue trophic regulators: knotweed (highlander), field horsetail, medicinal lungwort. The use of immunomodulators and adaptogens acquires a certain relevance. These are: Eleutherococcus prickly, Rhodiola rosea and four private, Leuzea safrolovidnaya, Aralia Manchurian, Kopeck tea. In treatment, attention is paid to the regulation of the menstrual cycle (if any). With a delay in menstruation, they give a tincture of aristolochia, a decoction of tansy flowers, with painful periods - medicinal cuff, chamomile, common hops. With early menstruation - common lumbago (sleep-grass). With menstruation, accompanied by edema, fragrant woodruff helps, with an atonic uterus - field cloves, oregano. With heavy menstruation, plants are used that have long and firmly entered the gynecological and obstetric practice: stinging nettle, shepherd's purse, common yarrow, Amur barberry. Complex herbal medicine of the uterus includes local treatment, which aims to enhance the effect of herbs administered orally. The methods of carrying out are different: douching, tampons, poultices and others. Depending on what action is to be achieved, plants are selected. For an antitumor effect, douching is done with a decoction of horse sorrel root or tenacious bedstraw, to reduce pain, chamomile is used. Poultices are used externally, applying them to the lower abdomen. The basis of the poultice is any substance that retains heat for a long time and does not interfere with the absorption of the medicinal substance. It is customary for the people to use baked onions, undercooked barley porridge, hominy (corn porridge), decoctions of mucus-containing plants - flax seeds, marshmallow root, forest mallow, mallow, warm infusion of Icelandic cetraria thallus and others.

Uterine fibroids 6 8 weeks what to do. Influence of the size of uterine fibroids on the symptoms and choice of method of treatment of pathology. What is uterine artery embolization

Why everyone is offered to operate on myoma?

What is uterine fibroids and why is it so scary?

Diagnostic approaches

How to treat uterine fibroids?

Dimensions of uterine fibroids

Choice of treatment for uterine fibroids

What is the main idea of ​​the treatment of uterine fibroids

Medical treatment of uterine fibroids

GnRH agonites

Progesterone receptor blockers

Embolization of the uterine arteries

What is uterine artery embolization?

How does this procedure take place?

Is it possible to get pregnant after uterine artery embolization and is this procedure performed on nulliparous women?

Uterine artery embolization and submucosal uterine fibroids (submucosal)

Removal of uterine fibroids or conservative myomectomy

What is the best method for removing fibroids?

When should the uterus be removed for uterine fibroids?

Why should you not remove the uterus and fight for it to the end?

Other treatments

High Frequency Focused Ultrasound

Conclusion

Popular articles on the topic: fibroids 7 8 weeks size

What is myoma?

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How to identify uterine fibroids?

How to cure uterine fibroids?

What is the main idea of the treatment of uterine fibroids