Indications for removal of uterine fibroids by size in weeks or centimeters - how the operation is performed. Dimensions of uterine fibroids Complete removal of the uterus with fibroids

Many women, having come once for a preventive examination to a gynecologist, unexpectedly find out for themselves what they have. The reaction is usually the same: “How? Where? Nothing hurt me! .. And what should I do now? Misconceptions about this disease plunge some women into difficult experiences, anxiety and anxiety. Sleep, appetite disappears, and treacherous imagination paints terrible pictures. Let's try to figure out what is myoma(from Greek mys, myos - muscle) uterus.Fibroids (or fibromyomas) of the uterus - These are benign tumors from the elements of muscle and connective tissue. The tumor occurs first between the muscle fibers, then, depending on the direction of growth, the nodes develop in the thickness of the uterine wall, grow towards the abdominal cavity or towards the uterine mucosa. A capsule is formed around the myomatous node from the muscular and connective tissue of the uterine wall.

uterine fibroid occurs, usually during puberty. The reproductive function is reduced. Patients either suffer from infertility, or pregnancies in the past ended in miscarriages. Clinical manifestations of uterine fibroids depend on its anatomical condition. Tumors growing towards the abdominal cavity, usually small in size, often do not cause any disorders in women and do not affect menstrual function. In a large number of patients, even with a significant tumor size, there are no symptoms of the disease, but sometimes they appear quite early. There are several options for its location. Myoma can be located inside the uterus or on the outside under the membrane that separates the uterus from the rest of the abdominal organs. It also occurs in the thickness of the muscular wall of the uterus. It happens that myoma grows on a thin base connecting it to the wall. Doctors determine the size of the tumor in the same way as during pregnancy, the size of the uterus: 5-6 weeks, 7-8 weeks, etc.

It used to be thought that it occurs in 30% of women over 35 years of age. Currently, experts tend to believe that this disease is found in more than 80% of women, but in many it is asymptomatic.

WHAT PROMOTES THE APPEARANCE?

There are many hypothesized causes of this tumor. It is difficult to say which of them is the most probable. The factors provoking the occurrence and development of uterine fibroids include: Hormonal disorders. More precisely, the level of female sex hormones (estrogens) in the body of a young woman is too high. Yes! It's young! That is why this disease appears only in childbearing age. And during the onset of menopause, fibroids can disappear without a trace due to a sharp decrease in the level of estrogen hormones.

Overweight. Thin women are much less susceptible to the disease than women weighing more than 70 kg. This is due to the fact that subcutaneous fatty tissue has the ability to convert androgens (a group of male hormones) into estrogens, which significantly increases their number in the body.

Uterine damage. Traumatic childbirth, curettage, operations on the uterus, abortions and prolonged inflammatory processes of the reproductive system - all this already causes enormous damage to a woman's health, and in the future can also provoke the appearance of fibroids.

Heredity. Many experts believe that predisposition to uterine fibroids can be inherited. If the mother has uterine fibroids, then there is a high probability of detecting this disease in her daughter. Therefore, for those who know about their bad heredity, experts recommend visiting a gynecologist at least 2 times a year.

Sexual dissatisfaction. During excitation, a large amount of blood flows to the pelvic organs. With difficulty with orgasm, the outflow of blood does not occur immediately. Blood stagnates, causing prolonged vascular tension. Therefore, if a woman does not experience an orgasm over and over again, from year to year, this can provoke a hormonal imbalance in the body and uterine fibroids.

Number of periods. Some experts attribute the increase in the number of diseases to the fact that women began to give birth to fewer children. Nature has laid down that we give birth and breastfeed more often than it happens in modern life. Accordingly, menstruation would occur less frequently, and the load on the uterus would be less. Today, women, as a rule, calm down on one or two babies and stop breastfeeding after six months. And every menstruation is a stress for the uterus. The body can not cope, and a tumor appears.

WHAT IS THE DANGER OF MYOMA?

Myoma- This is a benign tumor, which degenerates into a malignant extremely rarely. According to statistics, this happens in only 1% of all sick women.

Myoma, located next to the fallopian tubes or on the inner wall of the uterus, greatly reduces the chance of becoming pregnant. It prevents the embryo from gaining a foothold in the uterine cavity. If pregnancy does occur, then the risk of miscarriage or premature birth increases, since the tumor takes up a lot of space and interferes with the normal development of the fetus. In this case, the woman throughout the pregnancy is under the close attention of gynecologists.

When a woman leaves the tumor uncontrolled and it begins to grow, there is a high probability of losing the uterus. The uterus is necessary not only for bearing offspring. It is connected with the entire reproductive system of a woman. Removal of the uterus can lead to such serious consequences as breast cancer and serious disorders in the thyroid gland.

ALARM SYMPTOMS

It's no secret that any disease, detected in time, is much easier to treat than a neglected one. However, at an early stage of development, fibroids practically do not give themselves away or the symptoms are smoothed out. But still, there are some alarming signals in which you should immediately contact a gynecologist.

You can suspect the presence of uterine fibroids by the following symptoms:

Painful menses with copious discharge. This suggests that with the development of the tumor, the muscles of the uterus begin to contract worse and worse. Also, you should be wary if the monthly began to go longer than usual. Due to prolonged and heavy bleeding, the amount of hemoglobin and red blood cells (anemia) may decrease. As a result, headache, pallor, weakness, dizziness.

Aching pains in the lower abdomen and in the lumbar region. Myoma does not bring a feeling of discomfort at an early stage, but when it reaches a large size, the pain is sudden and sharp. There may be pain during intercourse. The pain syndrome is caused by the tension of the ligamentous apparatus of the uterus, the stretching of its walls, as well as the pressure of the growing tumor on the surrounding organs.

Bloody discharge between periods and cycle failure. Under the influence of estrogens, hyperplasia (an increase in the layer) of the endometrium occurs, which causes spotting or even bleeding. Irregular bleeding is often due to concomitant ovarian dysfunction. Chronic anemia associated with constant blood loss causes disruption of the cardiovascular system, dizziness, shortness of breath, general weakness, palpitations, fatigue, decreased performance. The skin becomes pale yellow, the visible mucous membranes become pale, the face is puffy, edema is determined on the lower extremities, the pulse quickens, the amount of hemoglobin decreases, the number of red blood cells decreases, their immature forms appear.

An increase in the circumference of the abdomen without weight gain. When the stomach begins to grow sharply, and the rest of the body remains in the same pore, this means that the tumor is progressing, and quite quickly. Fortunately, this doesn't happen very often. However, this is a very disturbing symptom! You should immediately consult a doctor! And it can also be considered a great success if it is really a fibroid, because rapid growth always causes oncological alertness.

Failure of other organs. There may be: pain in the heart, a feeling of hot flashes, headaches, constipation, or frequent urination. Increasing in size, fibroids begin to put pressure on neighboring organs, making it difficult for them to fully function. The compression of neighboring organs depends on the location and direction of growth of the nodes. The nodes emanating from the anterior wall of the uterus put pressure on the bladder, causing various urinary disorders. Sometimes tumors compress the ureters with subsequent development of complications from the kidneys. Pressure on the rectum impairs the function of the gastrointestinal tract.

fibromyoma tends to grow slowly. A rapid increase in the tumor in some cases may be a sign of a malignant process (uterine sarcoma). Therefore, it is important to consult a gynecologist at the first signs of the disease to rule out cancer.

In the process of neoplasm growth, complications may arise: torsion of the tumor stem, necrosis and infection of nodes, malignant degeneration, acute bleeding, in which the general condition of patients worsens, clinical symptoms corresponding to the complication appear, which often requires emergency care in a hospital.

The doctor performs a two-handed examination of the uterus, an X-ray examination of the uterus with appendages, a histological examination of the scraping of the mucous membrane of the uterus, an ultrasound examination of the pelvic organs. In unclear cases, to establish an accurate diagnosis, computed tomography, instrumental and endoscopic examination of the uterus is prescribed.

FIMOMA TREATMENT

First of all, so that there are no unpleasant surprises, you need at least. If there are suspicions of uterine fibroids, the first thing to do is an ultrasound examination. Ultrasound is necessary in order to find out what size the tumor is, where it is located and whether it is alone there (sometimes several at once). The method of treatment will also depend on the results of the ultrasound.

If the fibroids are less than 12 weeks pregnant and does not progress in growth, then conservative, i.e. non-surgical, treatment is most often prescribed. Its main goal is to contain the growth of the tumor through diet therapy, herbal medicine, physiotherapy, taking vitamins and hormonal drugs. Some experts even recommend that with a slight increase in fibroids (no more than 1 cm in 3 months), wait for menopause.

Women with so-called asymptomatic fibroids uterus and with fibromyomas of small size (less than 12 weeks of pregnancy) need dispensary observation by a gynecologist (examination once every 3 months).

A woman's daily diet should be dominated by protein foods with a limited amount of fats and carbohydrates. The daily use of freshly squeezed juices of carrots, beets, apples, plums, apricots is welcomed. It is necessary to have foods rich in iodine in the diet: seaweed, shrimp, iodized salt, etc. Foods rich in B vitamins, such as sunflower or soybean oil, will also be useful.

Comprehensive vitamin therapy is mandatory (certain vitamins should be taken in different phases of the cycle).

With herbal medicine, the doctor can prescribe various fees that have an immunomodulatory effect and normalize the functioning of the reproductive system.

At home with fibromyoma of the uterus various phytotherapeutic agents can be used. For example, fresh juice of a shepherd's bag, which is drunk in 1 tbsp, has a very good effect. l. 3 times a day.

A decoction of wild strawberries, collected during flowering with roots, flowers and leaves, use as follows: 5 tbsp. l. herbs, pour 1 liter of water, boil for 5-6 minutes on low heat, leave for 1 hour, take 1/2 cup 3 times a day.

Of the physiotherapy procedures, radon and iodine-bromine baths, vaginal irrigation, and electrophoresis are often advised.

To all of the above, treatment with hormonal drugs can also be added. But their purpose in each case is individual.

Currently, there are 2 methods of treating patients with uterine myoma: conservative and surgical. , and each of them has its own indications and contraindications. Patients with small (up to 12 weeks of pregnancy) dense fibromyomas located in the thickness of the uterine wall, accompanied by small bleeding such as cyclic, as well as those women who have small, so-called low-symptomatic tumors, are subject to conservative treatment. In some cases, conservative drug therapy is carried out when patients refuse surgery.

If the fibroids are larger than 12 weeks pregnant, while its active growth is observed or myoma combined with other diseases of the uterus or appendages, most often surgical treatment is required. A woman can also be operated on if, due to a tumor, the functions of neighboring organs are seriously impaired, or if anemia progresses due to bleeding.

The degree of surgical intervention varies. Such indicators as the age and general physical health of the patient, the condition of the cervix, ovaries and endometrium (the lining of the uterus), the desire to have a baby are taken into account. In a nulliparous woman, surgery will be as minimal as possible. In this case, they try to do curettage by the traditional method (as with an abortion or some types of diagnostics). If a woman is no longer going to give birth, and the fibroid progresses very quickly (for 4 or more weeks a year), then the uterus is definitely removed.

Purpose of surgical treatment - radical removal of the tumor or the affected organ - the uterus (in whole or in part).

Operations about uterine fibroids produced in an emergency and planned manner. Emergency operations are required in case of bleeding associated with a danger to the life of the patient, torsion of the legs of the myomatous node, necrosis or suppuration of the myomatous node, the emerging submucosal node. In other situations, operations are planned.

Surgical treatment is prescribed in the following situations:

1. With heavy prolonged menstruation or irregular bleeding, leading to the development of anemia.
2. With large tumor sizes (over 14 weeks of pregnancy), even in the absence of complaints.
3. With intensive growth of the tumor to the size of pregnancy 12-13 weeks.
4. With necrosis of the myomatous node due to malnutrition of the tumor.
5. With submucosal uterine fibroids. Such fibroids cause profuse bleeding, leading to a sharp blood loss.
6. With a combination of uterine fibroids with other pathological changes in the genital organs: progressive endometriosis, ovarian tumor, prolapse and prolapse of the uterus.
7. With infertility.

However, there are some contraindications:

1. General serious condition and severe blood loss.
2. Myoma recurrence.
3. The age of the woman. If it does not allow you to count on the preservation of reproductive function, then a conservative operation is not indicated.
4. Concomitant inflammatory process in the pelvis.
5. Malignant tumor.

At the age of over 45, surgical removal of the uterus is indicated - the so-called supravaginal amputation, or extirpation of the uterus with appendages(with pathological changes in the cervix). In women under 45 years of age, the appendages are not removed if there are no pathological changes in them. In addition, a histological examination of the removed formations for the presence of malignant tumors must be carried out.

Forecast after removal uterine fibroids favorable. After conservative surgical treatment, patients need dispensary observation for the timely detection of tumor recurrences. In addition, cancer may occur in the remaining part of the organ. After the removal of the entire uterus, the function of the preserved ovaries often occurs. Therefore, it is very important to see a gynecologist regularly after the operation.

Embolization of the uterine arteries. This method of treating uterine fibroids began to be used only in the 90s of the last century. Its essence lies in blocking the blood flow through the uterine arteries to the myoma. Through the catheter, microscopic particles of the embolization preparation are introduced into the uterine arteries, which clog the vessels that feed the myoma with blood. Many experts believe that this is the safest and most effective organ-preserving method of treatment. However, today it is quite an expensive procedure.

So, uterine fibroids is not a sentence. It is treatable if diagnosed in the early stages of development. Although, of course, it is much better to prevent its occurrence. A healthy lifestyle, proper nutrition, prevention of abortion, diseases of the genitourinary system and long breastfeeding will help. A visit to the gynecologist at least twice a year is not a formality, but a necessity associated with the timely identification of risk factors for many diseases.

Uterine fibroids are among the most common female diseases. According to medical statistics, this pathology accounts for up to 27% of cases, it affects every fourth woman. Myoma, despite its benign nature, is not so harmless - it significantly worsens the quality of a woman's life and often leads to infertility. Therefore, the main task of diagnosticians is to identify a tumor in the initial stages of development in order to get rid of it and preserve reproductive function.

Please note that this text was prepared without the support of our.

As a rule, uterine fibroids are formed in women in the late reproductive period and before menopause, but there are cases when it is diagnosed in younger patients. The treatment of this pathology is selected in accordance with the size of the tumor and the localization of the myomatous nodes.

Determining the size of uterine fibroids

It has been proven that the size of uterine fibroids depends on the hormonal balance and the amount of estrogen in the blood. An increased level of female sex hormones can provoke the growth of myoma formation and at the same time the uterus itself. It is customary to compare the size of the fibroids with the size of the uterus corresponding to the weeks of pregnancy. To clarify the size of myomatous nodes in centimeters, an ultrasound examination (ultrasound) is performed.

Based on their size, fibroids fall into three main categories:

• small sizes - if the size of the uterus corresponds to the 5th week of pregnancy (from 2 to 2.5 cm);
• medium size - if the size of the uterus corresponds to 10-12 weeks of pregnancy (myoma 7-8cm);
• large sizes - with an increase in the uterus up to 12-15 weeks of pregnancy (myoma 8 cm or more).

Uterine fibroids of small size can proceed for a long time without clinical manifestations, without causing discomfort to the woman. However, as they grow, unpleasant symptoms join.

With the onset of conception, myomatous nodes can interfere with the normal process of bearing a child, provoke the development of bleeding during labor and disrupt it. In addition, with fibroids in a pregnant woman, infectious and inflammatory diseases can develop, the risk of early miscarriages, premature births and weak labor activity increases.

Large fibroids (myoma 7 cm or more) can compress the inferior vena cava, which causes severe shortness of breath and disorders in the cardiovascular system. With an average size of the myomatous node (uterine fibroids 7 weeks, uterine fibroids 8 weeks, uterine fibroids 9 weeks or more), a woman should be constantly monitored by a doctor and undergo a course of treatment.

Possible complications of uterine fibroids

Especially dangerous is the presence in a woman of multiple uterine fibroids of large sizes. In such a situation, the gynecologist is forced to monitor several myoma nodes at once, the number of which can sometimes reach more than a dozen. With large myomatous nodes, compression of the internal organs occurs, preventing the normal functioning of the kidneys, contributing to the development of urolithiasis and the development of infectious and inflammatory processes. In addition, in a woman with a large uterine fibroids (myoma 8-9 weeks), the activity of the digestive tract is disrupted, constipation is noted.

It is also important how intensively the uterine fibroids grow: the rapid growth of the tumor can be assumed with an increase in the myomatous node for a year by more than 5 weeks. For example, if a 7-week fibroid reached a size corresponding to 12 weeks of pregnancy in a year, an 8-week fibroid - 13 weeks, a 9-week fibroid - 14 weeks, etc.

If the blood supply is disturbed due to torsion of the fibroid stem, tumor necrosis may occur, requiring emergency surgical intervention. Sometimes there is a prolapse of the myomatous node from the uterus into the vagina, while the woman has a pronounced pain syndrome and bleeding.

The risk of degeneration of uterine fibroids into a malignant tumor is not excluded, which can occur in 1-2% of cases.

Methods for diagnosing uterine fibroids

Given the asymptomatic form of the course of fibroids in the early stages of development, it is often first detected during a scheduled visit to the gynecologist. To determine the exact localization of the myomatous node, a woman is assigned an ultrasound examination of the pelvic organs.

As additional diagnostic measures appoint:

• hysteroscopy;
• hysterosalpingoscopy (ultrasound of the uterus and fallopian tubes);
• tests to detect sexually transmitted infections.

Treatment methods for uterine fibroids

With small and medium-sized fibroids (for example, if the fibroids are 7-8 weeks old), treatment can be carried out by a conservative method, the basis of which is hormone therapy. With a larger size of the tumor, its rapid increase, combined with endometriosis, disruption of the activity of adjacent organs and the presence of a pronounced pain syndrome, it is recommended to remove the myomatous nodes surgically.

Surgical intervention is also indicated for torsion of the pedicle of the node, problems with conception and gestation, and if there is a suspicion of a malignant pathology. Often, to reduce the size of uterine fibroids, a woman is prescribed hormonal drugs before surgery.

Previously, long-term dynamic monitoring of the growth of the myomatous node was prescribed, with periodic ultrasound examination. After the myoma reached an impressive size, it was proposed to perform a surgical intervention aimed at removing the tumor or the uterus as a whole.

Modern gynecologists consider the removal of the uterus as a last resort. More preference today is given to minimally invasive techniques, for example, the EMA method.

In some cases, dynamic monitoring of uterine myoma is allowed, which does not require therapeutic measures.

There are four factors that determine the feasibility of treating fibroids:

• the presence of clinical manifestations that lead to a decrease in the quality of life of a woman: anemia, impaired urination, prolonged constipation associated with compression of the bladder or rectum;
• reproductive plans of a woman in the long term;
• intensive growth of fibroids, recorded by several consecutive ultrasound of the pelvic organs;
• the patient's age.

Often, in women who have entered the post-menopausal period, there is a halt in the growth of myomatous nodes, and sometimes complete regression of fibroids.

Currently, three methods are used to effectively treat uterine fibroids:

• surgical intervention;
• drug treatment with drugs from the group of progesterone receptor blockers;
• embolization of the uterine arteries.

Surgical treatment of uterine fibroids

Surgical removal of uterine fibroids - myomectomy - is performed using the classical method (through incisions) or. Nodes, the growth of which is directed into the uterine cavity, are removed with a special endoscopic instrument equipped with a loop (resectoscope) directly through the vagina.

The main advantage and at the same time disadvantage of this intervention is that it is a surgical method. On the one hand, this is an effective way to remove a benign tumor, and on the other hand, there are significant risks that accompany any surgical intervention and the use of anesthesia. Unfortunately, after myomectomy, there is a high probability of recurrence, which occurs in almost every second operated woman, and is an indication for repeated surgical treatment.

To reduce the risk of relapse, patients are prescribed hormonal drugs.

Surgery to remove uterine fibroids is not the best solution for women who plan to become a mother in the future. Surgical interventions are often accompanied by the development of an adhesive process in the small pelvis, which leads to tubal-peritoneal infertility: a violation of the patency of the fallopian tubes prevents the fertilized egg from entering the uterine cavity.

An extreme measure, which is resorted to in the absence of the possibility of treatment by other methods, is a hysterectomy. However, this surgical intervention, which involves the removal of the uterus along with fibroids, threatens with very serious consequences, even if the woman is not going to become pregnant.

Medical treatment of uterine fibroids

To date, for the treatment of fibroids, the expediency of using a progesterone receptor blocker, ulipristal acetate, has been proven. To achieve maximum effectiveness, the drug should be taken in two or three cycles, assessing the dynamics of treatment using ultrasound. In more than half of the cases, regression of fibroids is observed.

The advantage of this tactic is the good tolerability of the drug. However, it also has disadvantages:

• it is impossible to predict the duration of the preservation of the result and the likelihood of relapses;
• there are no data on the response to the effect of the drug of different myomatous nodes: some of them decrease, others do not change in size.

Drug therapy is prescribed for young patients with myomatous nodes, the size of which does not exceed 3 cm.

It must also be understood that hormonal drugs have a temporary or preventive effect. Even less efficiency should be expected from taking all kinds of dietary supplements, herbal remedies and homeopathic remedies. There is no need to waste time on self-treatment, since myomatous nodes, having increased significantly, will require more complex treatment. The method of treatment of uterine fibroids should be selected by a qualified specialist.

Uterine artery embolization (UAE)

The essence of the UAE procedure is the introduction of an embolizing drug through a catheter into the blood vessels responsible for the nutrition of uterine fibroids. With the help of special particles - the embolus, the blood flow in the vessels of the myomatous node is blocked, due to which oxygen ceases to flow into the pathologically overgrown tissue. There is a death of fibroids, its replacement with connective tissue and a significant decrease in size.

A video about the EMA scheme can be viewed .

The EMA method has the following advantages:

• high efficiency, no relapses and no need for additional treatment;
• the possibility of normalizing the menstrual cycle and eliminating problems with urination caused by compression of the bladder by large uterine fibroids;
• absolute safety, lack of risks associated with surgical interventions and the use of anesthesia;
• a short rehabilitation period: on average, it lasts from 5 to 7 days.

The UAE procedure is indicated for women with the following problems:

• heavy menstruation, syndrome of compression of adjacent organs, frequent urination (disappearance of symptoms is observed already 1.5 months after UAE);
• intensive growth of myomatous nodes, confirmed by dynamic ultrasound (even in the absence of symptoms and the woman's plans for pregnancy);
• if a woman has a desire to preserve her reproductive function;
• with multiple uterine fibroids of medium and large sizes (uterine fibroids 7 weeks or more) with any localization and direction of growth.

Given all of the above, we can conclude that uterine artery embolization has virtually no limitations. It is indicated for women of any age, with any localization of uterine fibroids, regardless of whether it is single or multiple.

The UMA procedure can be performed at any of the leading clinics in Moscow, a list of which is presented.

Our coordinators will help you with the choice of a qualified doctor who has a fine command of the UAE technique. You can ask questions and make an appointment with a specialist.

Bibliography

• Savitsky G. A., Ivanova R. D., Svechnikova F. A. The role of local hyperhormonemia in the pathogenesis of the growth rate of the mass of tumor nodes in uterine myoma // Obstetrics and gynecology. - 1983. - T. 4. - S. 13-16.
• Sidorova I.S. Uterine fibroids (modern aspects of etiology, pathogenesis, classification and prevention). In: Uterine fibroids. Ed. I.S. Sidorova. M: MIA 2003; 5-66.
• Meriakri A.V. Epidemiology and pathogenesis of uterine fibroids. Sib honey journal 1998; 2:8-13.

Uterine fibroids is a benign tumor that appears in the reproductive organ. Affected age - women 20-70 years. This disease occurs due to hormonal failure. At the initial stage, the disease has no symptoms, only when pain and bleeding occur, the woman decides to be examined. The size of uterine fibroids in weeks is diagnosed using ultrasound. Treatment depends on its size.

The size of a benign tumor is determined by weeks and centimeters. This completely coincides with the obstetric period (fetal growth during pregnancy). Therefore, the size of fibroids is considered to be weekly.

• A small tumor (about 2 cm), its duration is 4-6 weeks, no more. The reasons for surgery are only in case of torsion of the fibroid stem. May be removed due to profuse bleeding, leading to anemia. Also, if a woman has been diagnosed with infertility;
• Medium (from 4 to 6 cm) period 10-11 weeks. If the nodes do not grow actively and there are no pronounced symptoms, then the operation can be omitted. Formations that are located on the outside of the uterus can disrupt the functioning of organs located closest. With an average myoma, infertility or miscarriage may occur;
• A fibroid exceeding 6 cm in diameter is considered large, its term is equal to 12-16 obstetric weeks of pregnancy. Such a fibroid is removed only in an operable way and drug treatment, to eliminate neoplasms.

Size of uterine fibroids in weeks and centimeters

At an early stage, fibroids is 4 weeks. It has no symptoms and does not disturb the woman. The main thing is to determine this disease before the period of 7 weeks. It will bring much less problems than in the later stages of detection.

With its increase to 5 cm and a period of about 10 weeks of obstetric pregnancy, the first symptoms begin to appear.

• Menstruation with pain that does not help with pain medication.
• Upon reaching 12 weeks, the cervix increases, which causes bloating.
• If there is a diagnosis of fibroids on the leg, then the appearance of a sharp pain in the abdomen.
• With a large fibroid, its increase leads to squeezing of neighboring organs, which interferes with normal urination and defecation. Pain begins in the lower back and near the rectum.

Fibroids, the size of which is more than 12 weeks, entail the formation of adhesive processes in the tissues of the body and nearby organs.

When a patient complains, an ultrasound examination is performed, and appropriate tests are given. Ultrasound is the most accurate detection of this disease, as well as the timing of its occurrence. Thanks to the examination, it is possible to accurately identify a benign tumor or not. The possibility of transition of a tumor from benign to malignant depends on the time of its detection. It is necessary for every woman to take as a rule an ultrasound scan regularly.

After examination and further diagnosis, the doctor decides on the operability of this tumor. For this, the following indicators are available:

• Uterine fibroids have a size of 6 cm and its duration is more than 12 weeks. This size of the tumor is life-threatening for the patient. Fibroids that are more than 12 weeks old should be urgently removed.
• Stable intense pain. A feature inherent in medium and large fibroids. The myoma node leads to squeezing of nearby organs, and also puts pressure on the rectum. Defecation is impaired, which can lead to inflammation of the intestines and intoxication of the body.
• There was bleeding. Basically, it leads to fibroids for a period of 15 weeks or more.
• Planning for pregnancy. If a woman is unable to conceive or carry a fetus, a medium-sized fibroid is often the cause. The hormonal background during pregnancy changes, which leads to the growth of the tumor and poses a threat to the child.

If uterine fibroids are more than 12 weeks old and are located on the back wall of the uterus, then this can provoke premature birth. Oxygen starvation of the fetus may occur.

• There is a risk of a benign fibroid to develop into a malignant one. This possibility appears with the rapid growth of fibroids.

Small or medium fibroids can be treated without surgery, provided there are no complications. If the tumor is benign and equal to even a few millimeters, you still should not relax and start its treatment, because it can be located in a harmful area.

tumor growth

For the treatment of fibroids, it is important how quickly it grows. If within a year the uterus has increased to 5 weeks or more, then this tumor is progressing. Her growth is affected by hormonal failure of the body. There are also the following reasons for the rapid development of this disease:

• before the age of 30, a woman did not give birth
• gynecological pathologies
• a sufficient number of abortions
• taking hormonal drugs
• long-term effect of ultraviolet radiation on the body.

Sometimes uterine fibroids grow to enormous sizes, the weight can be about 5 kg and 40 cm in diameter. At the same time, it looks like a late pregnancy.

Effect of fibroid size on pregnancy

With fibroids of small or medium size, pregnancy can proceed normally. If the tumor is large, then pregnancy, as well as the bearing of the child, is not possible. Even conception does not occur due to the fact that the nodes block the fallopian tubes.

If a woman during pregnancy found out that she had a large fibroid, then complications may arise during childbirth. It can be bleeding, infections of internal organs, as well as unforeseen situations.

The most serious is considered a fibroid located in the vagina. It causes infertility, as well as spontaneous miscarriages. If the onset of pregnancy occurred with a benign tumor, then the patient is under the supervision of doctors all the time to prevent miscarriage. If the growth of the myoma node increases rapidly, then the pregnancy has to be terminated.

In some pregnant women, fibroids stop growing altogether, in 10% it decreases, and in only 20% it can begin to grow at a progressive rate.

Removal of fibroids

When examining an ultrasound, it was revealed that the nodes are increasing, the doctor prescribes a complete examination of the patient to begin with. Then the operation is performed. There are the following types of operable intervention: laparoscopy, laparotomy, strip operation, hysteroscopy, hysterectomy.

With hard-to-reach and large nodes, hysteroscopy is done - making incisions through the vagina.

Removal of fibroids 10 weeks. Deletion cannot be delayed. The operation is performed through an incision in the anterior wall of the abdominal cavity. This rather serious operation to remove a benign tumor is called a laparotomy. After it, a long rehabilitation is required.

Removal of fibroids 12 weeks. When a tumor of this size is diagnosed, surgery is performed immediately. In extreme cases, a hysterectomy is used - the complete removal of the uterus. This operation is performed if no other treatment is more effective. The rehabilitation period is about 2 months.

In a difficult case, as well as common foci of the disease, a strip operation is performed.

Complete removal of the uterus for fibroids

The entire genital organ can be removed: if the size of the tumor has reached unacceptable norms, also if the removal of the nodes is not possible. The main indicators for this are:

• late identified nodule formation,
• uterine prolapse,
• prolonged blood loss
• suspected malignancy,
• increasing anemia.

Rehabilitation after removal

To quickly return to a normal lifestyle, you must adhere to the following recommendations:

• eliminate the load on the stomach, but try to move more;
• avoid constipation;
• do not lift weights;
• eliminate stress, often they lead to changes in hormonal levels.

To plan pregnancy, you need to consult with your doctor.

Take medicine to restore the vital activity of the uterus. Also, in case of any unpleasant symptoms, consult a doctor.

Every woman should systematically visit her gynecologist, monitor her reproductive system.

Content

Today, uterine fibroids are one of the most common diseases in gynecology. Not so long ago, her treatment was started only after reaching the size of the formation of 9 cm in diameter. In this case, an operation was performed, which consists in the complete amputation of the uterus (hysterectomy).

Today, doctors have a huge number of different methods of treating fibromyomas in their arsenal: from therapy with medications and minimally invasive methods of removing tumors, to safe and gentle surgical methods designed to preserve the reproductive function and health of women.

What

Myoma is a benign neoplasm in the uterus, which is formed primarily as a result of improper functioning of the hormonal system of a woman. Uterine fibroids may appear one or several at once. Most often, it has a regular rounded or oval shape, and sometimes a knot develops on the leg.

The size of fibroids can be both very small (only a few millimeters) and very impressive (up to 20 cm in diameter). It is customary to use the circumference of the uterus when determining its parameters, which, with an increase in fibroids, grows as during pregnancy. Thus, in the card, the doctor will write down the “age of the mime” in the number of weeks corresponding to the increase in the uterus during pregnancy.

"Age" of fibroids and symptoms

Most often, a small fibroid is found at a routine examination by a gynecologist or on an ultrasound examination of the pelvic organs. In this case, she does not bring any discomfort to the woman, because her size will be no more than three cm (8 weeks). Small neoplasms do not manifest themselves in any way and, most often, do not require urgent surgery.

When is uterine fibroids detected? on the leg, the operation is carried out without fail. Voluntary twisting of the stem can cause tissue necrosis and sepsis, both life-threatening conditions.

A medium-sized fibroid, equal to about five cm (11-12 weeks), a woman can even find herself. Suggest some symptoms of the disease:

• an increase in the abdomen with a negative pregnancy test;
• pain in the lower abdomen and sacrum;
• menstrual irregularities (failures, lack of menstruation, bleeding lasting more than six days);
• acyclic spotting or breakthrough bleeding;
• infertility;
• miscarriages;
• pain when urinating;
• constipation.

If there are still no symptoms of the disease, you can try to treat the middle myoma node in a conservative way. This is especially true in the period before the onset of menopause, when there are still chances for an independent regression of the disease.

A large fibroid, larger than 8 cm (from 12-15 weeks of pregnancy) is simply impossible not to notice. Such a fibroid always brings discomfort to the patient, and an increase in the abdomen due to its growth is already noticeable even with the naked eye.

Large fibroids, larger than 12 weeks, require mandatory urgent minimally invasive or full surgical intervention.

When do you need surgery for uterine fibroids 12 weeks (8 cm)

The main treatment for a large myomatous node or multiple neoplasms is a surgical operation - myomectomy. Myomectomy is performed in several ways.

• Laparotomy is a full abdominal surgical operation, which is performed through a fairly long incision on the lower part of the abdominal wall. Indications for laparotomy will be: large nodes, severe deformation of the walls of the uterus, multiple formations. During laparotomy, doctors, most often, manage to avoid bleeding, completely remove all diseased tissue areas and make the correct suture on the uterus, which will not interfere with the normal development of pregnancy and natural childbirth.
• Laparoscopy is a minimally invasive surgical procedure in which nodes are removed through several small incisions in the abdominal wall. Laparoscopy is performed if the formation is not more than 6 cm in diameter and only on nodes accessible to the laparoscope. Carrying out this type of operation in hard-to-reach areas is dangerous, since the uterus is densely supplied with blood vessels, and any damage to them can lead to extensive bleeding.
• Hysteroscopy is a method of removing fibroids without incisions. A thin tube is inserted through the vagina and cervical canal into its cavity, and under the control of a miniature video camera, neoplasms are removed.
• Hysterectomy is the complete or partial removal of the uterus. This is an extreme measure that doctors take in the most advanced cases of the disease, with severe tissue damage that cannot be restored, with severe concomitant diseases.

Myomectomy Helps not only completely remove the formation of almost any size, but also preserve the reproductive function of the female body. For quick recovery, drugs are used that normalize the condition of the uterus after surgery, accelerate tissue healing and prevent recurrence of the disease.

myomectomy

There are a number of absolutely clear indications when surgical treatment is necessary:

• when the size of the fibroids is more than 8 cm (12 weeks of pregnancy), surgery is the only way out;
• too rapid growth of fibroids (by 2-3 cm in 12 months);
• the appearance of multiple nodes;
• uterine bleeding (spotting or breakthrough);
• anemia;
• pain in the region of the lower back and lower back;
• uterine fibroids on the leg;
• "Birth" of fibroids (its germination outside the cervical canal).
• death of neoplasm tissues;
• infertility;
• miscarriage;
• violation of the functions of organs associated with the growth of the myomatous node (constipation, frequent or painful urination, impaired blood supply to neighboring organs);
• the danger of degeneration of fibromyoma into a cancerous tumor (sarcoma).

The operation for these manifestations is performed regardless of the age of the patient.

Treatment of fibroids measuring 5 centimeters

For fibroids measuring 4.5.6 cm (age 8-12 weeks), there is an alternative treatment.

• Laser treatment (FUS-ablation) - elimination or reduction of fibroids without incisions and damage to healthy tissues. The procedure consists in “burning out” the tumor with a laser beam. The operation is carried out under the control of a magnetic resonance imaging device, which allows you to perform manipulations as accurately as possible and completely eliminate injury to the pelvic organs, and preserve reproductive function.
• The method of embolization of the uterine arteries is to block the blood flow to the fibromyoma. A small incision is made in the region of the right femoral artery, through which a catheter is inserted into the artery up to the very vessels of the uterus. With the help of a specially designed drug, the vessels are blocked, after which the blood supply to the neoplasm stops and its gradual death occurs. The uterine fibroids are then excreted from the body during menstrual bleeding.

How to treat fibroids 9 weeks

Most fibroids up to 12 weeks can be treated with medication.

• Analogues of gonadotropin-releasing hormone provoke the drug-induced onset of menopause by reducing the production of estrogen. Treatment can greatly reduce education, however, it is more appropriate to use it in women after 45 years, when it is not very long before the real menopause.
• Combined oral contraceptives are used in young women when fibromyomas up to two centimeters in diameter are detected. It is good to carry out such treatment in the period of preparation for pregnancy.
• The intrauterine hormonal coil helps with small and medium formations in the subserous (outer) layer of the uterus.
• Antiprogestin is the newest drug (synthetic steroid) to reduce knots.

It is important to remember that with the help of pills it will not be possible to completely get rid of fibroids. Such treatment is necessary in order to stop its growth or temporarily reduce it in size. Some time after the end of treatment, the fibroids will begin to grow again.

The doctor should decide on the method of treating fibroids. If you doubt your doctor's competence, consult with several specialists and listen carefully to why each of them recommends a particular treatment. Remember that the gynecologist always evaluates the situation as a whole: collects an anamnesis, studies the medical history and test results. Therefore, if several doctors recommend surgery, do not delay it. Timely treatment will protect you from complications.

uterine fibroids(synonyms: fibromyoma, fibroma) is a benign tumor that develops from the muscular tissue of the uterus, consisting mainly of connective tissue elements. The incidence of fibroids by the age of 35 is 35-45% among the total female population. The peak incidence falls on the age group of 35-50 years, however, recently, uterine fibroids have become “younger” and are often diagnosed in women of young reproductive age.

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

Causes of uterine fibroids

Possible reasons leading to the development of uterine fibroids include:

Hormonal disorders that are clinically manifested by menstrual cycle failures: late onset of menstruation, too heavy periods, which leads to sharp fluctuations in sex hormones - an increase or, conversely, a decrease in the level of estrogen and progesterone;
- irregular sex life, especially from the age of 25; disharmony in sexual life - an interesting fact is that women who experience problems with achieving orgasm are more likely to get uterine fibroids;
- mechanical factors: abortion, diagnostic curettage, traumatic childbirth;
- genetic predisposition;
- concomitant diseases: high blood pressure, obesity, diabetes mellitus, thyroid disease;
- sedentary lifestyle.

Symptoms of uterine fibroids

Often, uterine fibroids do not give any symptoms and are a find during a preventive examination by a gynecologist. Or it happens that the symptoms are quite smoothed and are often perceived as a variant of the norm. The most striking symptoms are observed with the submucosal location of the tumor and with large sizes of fibroids of any kind.

Possible symptoms of uterine fibroids that may alert you:

Abundant and prolonged menstruation (menorrhagia). Sometimes the bleeding is so profuse that the woman does not have time to change the pads. Often there are acyclic bleeding that is not associated with menstruation - “metrorrhagia”. Menorrhagia and metrorrhagia lead to iron deficiency anemia - the level of hemoglobin gradually decreases. There is weakness, pallor of the skin, which is not always noticeable and is perceived as a common malaise;
- Pain in the lower abdomen and lower back. If the blood circulation in the myomatous node is disturbed, then the pains are acute. However, more often the tumor grows gradually and the pains are rather aching in nature, even if the fibroid is large;
- violation of the function of neighboring organs - urinary and gastrointestinal tract, in particular, this applies to the bladder and rectum - the tumor compresses these organs. As a result, there may be difficulty with urination, chronic constipation.

For this reason, patients with uterine fibroids often turn to urologists and proctologists.

In the presence of the above symptoms, a consultation with a gynecologist is necessary.

Diagnosis of uterine fibroids

Diagnosis of fibroids is not difficult. At gynecological examination - the size of the uterus is increased. Additional research methods are used to confirm the diagnosis:

Obstetrician-gynecologist, Ph.D. Christina Frambos