See what uterine fibroids are. What is uterine fibroid, why is it dangerous, its symptoms and treatment methods

Uterine fibroids are a benign neoplasm in a woman’s reproductive organ.

Myoma is recognized as the most common gynecological pathology developing in women after 30 years of age. Although not life-threatening, the tumor can develop unpleasant consequences.

However, many women, upon hearing such a diagnosis, are often scared and do not know what to do.

In this article you will learn what this disease is, what causes it, and also about methods of treating uterine fibroids.

What is fibroid

Myoma is a benign growth of tissue formed in the middle myometrial layer of the uterus. The neoplasm is myomatous nodes consisting of intertwined muscle fibers.

Fibroids differ in the type of node growth and their number - in rare cases, the tumor is single, more often multiple formations with different locations are found.

Also, depending on the cellular structure, two types of fibroids are distinguished:

• fibroids. Consists of connective tissue;
• leiomyoma. The cellular structure of this species has a muscle-fibrous structure.

The image below shows the main types of fibroids by location in the uterus.

There are the following sizes of fibroids:

• the tumor is considered small for periods of no more than 6 weeks, the approximate size is 2 cm. As a rule, small fibroids do not detect themselves and are diagnosed by chance;
• medium tumor determined with parameters from 3 to 5-6 cm, a period of 10-11 weeks is set. At this stage, signs of the disease begin to appear;
• tumor size exceeding 7 cm, recognized as large and corresponds to 12-16 weeks. Large dimensions of the tumor are an indication for surgical treatment.

The size of the tumor is of no small importance - it is subject to drug treatment, but a large tumor requires surgical intervention.

At what size of fibroids surgery is required, read.

Tumor size is of particular importance during pregnancy. Fibroids that are more than 12 weeks old can cause preterm labor.

A rapidly growing tumor is a bad sign and requires careful investigation.

In certain cases, it is possible to independently .

In medical practice, there have been cases where a single small nodule dissolved during pregnancy or after birth. Since the tumor is hormone-dependent, reduced estrogen levels during pregnancy can reduce fibroids to a minimum.

A benign tumor often resolves also during menopause. During the premenopausal period, the production of hormones is reduced to a minimum, which guarantees if not complete disappearance, then a significant reduction in fibroids.

The location of the tumor and its size are also important - nodes located in the uterine cavity have a greater chance of spontaneous disappearance. Myoma that has grown into the muscle wall may also decrease in size, but will not completely resolve.

Below is a photo of an ultrasound scan of small fibroids (12 mm).

Conservative treatment

• – a procedure that stops the nutrition of myomatous nodes by blocking the uterine arteries. During a simple operation, emboli are introduced into the arteries - small balls that close the vascular lumen. As a result, the fibroid, deprived of blood supply, is reduced by half. The procedure is performed under local anesthesia, without further additional treatment;
• — laparoscopic myomectomy is prescribed to patients of reproductive age. In this case, myomotic nodes are removed through punctures-incisions in the abdominal wall under general anesthesia. The operation is carried out using inserted special instruments under the supervision of a video camera. This operation received good reviews from women due to the rapid recovery after it and the low chance of complications;
• – a method of isolated thermal influence of focused ultrasonic waves on a myomatous node. During the procedure, the formation tissues are evaporated under the influence of temperature. The bloodless and painless operation is well tolerated by patients and has no relapses.

Read also about gentle removal of fibroids.

In what cases is hysterectomy required?

Hysterectomy – surgical , carried out at:

• rapid tumor growth;
• the size of fibroids exceeding 13 weeks;
• severe prolapse or prolapse of the uterus;
• a large number of formations;
• constant bleeding;
• cervical isthmus nodes;
• severe endometriosis;
• risk of malignancy

The uterus is removed while preserving the cervix, or extirpation is performed - removal of the uterus along with the cervix.

Panhysterectomy involves removal of the uterus, cervix and appendages.

The choice of operation option is determined during examinations. The planned operation is performed under general anesthesia.

Consequences of surgery to remove fibroids

Complications and consequences of surgery to remove fibroids can be expressed as:

• inflammation and divergence of the applied suture;
• impaired urination;
• internal or external bleeding;
• severe pain syndrome;
• thrombophlebitis.

PLEASE NOTE!

Removal of the uterus increases the risk of tumor formation in the mammary gland if the ovaries are preserved.

It is also possible to develop coronary heart disease.

Recovery period

The postoperative recovery period lasts from 3-10 days depending on the chosen method of removing uterine fibroids. In the first days after surgery, pain will persist.

During this period, antibiotics and anticoagulants are prescribed, and lost blood is replaced if necessary. In order to prevent vascular pathology, infusion therapy is carried out.

During rehabilitation it is necessary:

• restoration of motor activity;
• wearing compression garments and bandages;
• following a diet, limiting foods that cause flatulence, foods rich in fiber are recommended;
• In the first month it is forbidden to take a bath, visit the sauna, or lift weights.

What not to do if you are sick

• warming up the pelvic area - bathhouse, sauna, hot bath is prohibited;
• lumbar area, lower abdomen;
• heavy physical labor, including sports activities;
• lifting weights

You cannot sunbathe in open sunlight or in a solarium; you must limit your use of physiotherapeutic procedures.

Read more about contraindications for uterine fibroids.

Conclusion

Modern medicine offers effective methods for treating fibroids.

Gynecologists recognize embolization of uterine fibroids and the use of selective progesterone receptor modulators as an important discovery in this area.

Early diagnosis increases the chances of a full recovery.

Useful video

The video explains the dangers of uterine fibroids:

Article outline

Fibroids (uterine fibroids) are a common disease that occurs due to rapid cell division. Most often, the pathology affects people between 30 and 50 years of age, but now cases of the disease developing during reproductive age have become more frequent. Every woman should understand what it is, how to treat it and whether it is dangerous, in order to quickly recognize the disorder and consult a gynecologist.

Today there are many methods of therapy and diagnosis, so there is no need to panic, get upset, or sound the alarm. This is not a malignant formation, the disease responds well to therapy and is accurately detected by hardware methods. Below you will learn everything about uterine fibroids, what causes them, symptoms and treatment, types and causes.

What is it

A benign tumor consists of connective tissue of the uterine wall. Education grows quickly, and it is extremely difficult to control the process. Multiple fibroids are often diagnosed when a woman develops more than 2 nodes. Pathology develops due to increased production of sex hormones - estrogens.

Usually the tumor is located inside the cervix or its cavity. The nodules vary in size, reaching several centimeters. For some, the disease develops very quickly, while for others it does not make itself known for many years, remaining on the uterus in the form of a small nodule.

Some people mistakenly believe that if left untreated, malignant fibroids occur. Studies have been conducted in gynecology, the results of which refute this theory. Oncology appears only as a consequence of a previous illness, but the phenomenon is rare.

Myoma of the uterine body develops for various reasons: the woman’s age, concomitant diseases, hormonal imbalance. The main symptom is periodic, heavy or constant bleeding, sometimes accompanied by pain in the uterus. In extreme cases, anemia occurs, causing increased heart rate, dry, pale skin, and severe weakness.

The diagnosis is made at any age, in 20% the disease is detected at 30 years of age, in 10% in virgins, and in 50% in women over 50 years of age. To avoid negative consequences, it is recommended to undergo examination by a gynecologist at least once a year. In addition, it is important to pay attention to any irregularities in the menstrual cycle - an increase in the amount of blood, lack of pregnancy and ovulation, pain, etc.

Types of uterine fibroids

Fibroids in women can be of several types and large or small sizes. Classification is determined by the number of nodes, the nature of growth, and the place of origin. Based on the specific location, the following types of nodes are distinguished:

1. Interstitial.
2. Intraligamentary.

There are cases when a woman is found to have 2-3 types at once. In addition, in medicine there are “pedunculated” fibroids, which connect to the walls of the organ. The complications and consequences of this type are sad in cases where torsion occurs. Depending on the classification of fibroids, the doctor decides what to do and what treatment to choose.

Interstitial

Occurs most often. It usually affects the uterus, but can develop in the cervix. It grows inside the organ, towards the abdominal cavity, protrudes outwards or develops in the myometrial area. The disease is diagnosed at 30-45 years of age. Nodes can be single or multiple. Some formations reach more than 10 cm and are removed surgically.

While the knot is small, the woman does not feel much discomfort. At the beginning of the inflammatory process, pain in the lower abdomen and mucous discharge in copious amounts are observed. When the size of the formation exceeds 4 cm, compression of the bladder and intestines occurs, resulting in symptoms such as frequent trips to the toilet, urination with pain, and dyspeptic disorder.

Intraligamentary

The internal organs of the pelvis are held in place by ligaments, which are responsible for their normal position. In the presence of fibroids, serious disorders may occur, characterized by changes in the anatomical structure of organs. Intraligamentary fibroids are usually not accompanied by disruptions in menstruation, but cause problems with conception and pregnancy.

This type of disease is accompanied by pain in the abdomen or back, urinary disturbances, and enlargement of the kidneys and ureter. The nature of the manifestations is influenced by the size of the node, their location, and quantity. Interligamentous fibroids are rare. To determine this, ultrasound of the uterine cavity is used, then tomography or magnetic resonance imaging. The optimal treatment is removal of fibroid tissue if the nodes are actively growing.

Subserosal

A benign tumor is located outside the uterus and grows into the abdominal cavity. Large nodes are easy to identify during examination, small ones are detected using ultrasound. During the period of active growth, the pathology is accompanied by frequent constipation, frequent urination, and hemorrhoids.

After the onset of menopause, the tumor may decrease in size on its own (more details in). In other circumstances, it is removed surgically. Most often, subserous uterine fibroids in women are activated after performed or spontaneous abortions.

Submucosal

The nodes are located in the endometrium. The formations progress rapidly and grow outside the cervix, causing severe gripping pain. During the period of active growth, nodes cause the following complications:

• Miscarriage;
• Inability to bear a child;
• Heavy bleeding;
• Severe pain, spasms.

The submucosal type of fibroids can be caused by an excess of estrogen, frequent abortions, difficult childbirth, inflammatory diseases, etc. Treatment occurs surgically after hormone therapy.

Why are uterine fibroids dangerous?

Having heard the terrible diagnosis, the girl begins to panic and find out how fibroids can be dangerous for a woman’s life. It should be noted right away that the occurrence of cancer is minimal.

The main risk is the subsequent development of complications, but following the doctor’s recommendations and constant monitoring will eliminate adverse reactions.

If fibroids are not treated, the following consequences occur:

1. Severe uterine bleeding is a dangerous process due to the development of anemia and can threaten the patient’s life.
2. Purulent inflammation in the nodes and nearby tissues - without modern treatment, septic complications arise.
3. Torsion of the node “on the pedicle” - possible rupture of the pedicle, internal bleeding, or “acute abdomen” syndrome.
4. Inability to have children - pregnancy outside the uterus, miscarriage, infertility, difficult childbirth may develop.
5. Necrosis is the death of nodes.
6. Birth of a mass with uterine inversion.
7. Malignancy is when a benign tumor turns into a malignant one. The phenomenon is extremely rare, but it’s not worth the risk.

The development of pathology is accompanied by severe, sometimes unbearable pain. The main danger of uterine fibroids is possible complications, including death.

Causes

The appearance of pathology is due to various circumstances, which have not yet been fully studied. The main factor is hormonal imbalance that occurs due to illness, stress, poor diet, etc. Let’s look at what causes fibroids below:

• Hereditary causes;
• Hormonal imbalance – that is, a violation of the amount of estrogen and progesterone;
• Lack of orgasm;
• Adenomyosis;
• Diabetes, hypertension;
• Gynecological diseases, inflammation, diabetes, slow metabolism;
• Frequent abortions - the probability increases by 2 times;
• Stress that has a bad effect on the thyroid gland, adrenal glands, etc.;
• Obesity, lack of exercise;
• Installed intrauterine device.

Doctors have proven that women who have given birth are less susceptible to developing fibroids. The disease often appears during pregnancy, in particular if it is late.

Excess estrogen and excess progesterone

Fibroma is considered a hormonal disease, since growths form due to hormonal imbalances. That is why neoplasms do not occur in girls who are not of childbearing age.

When problems with the menstrual cycle occur, an imbalance in the production of progesterone and the hormone estrogen occurs. Hormonal imbalances provoke the growth of tumors, so suspicion of fibroids (first of all) needs to be confirmed by studying the hormonal status.

Diabetes and hypertension

Women suffering from such diseases are susceptible to developing fibroids at an early age. If there is a strong accumulation of fat deposits in the waist area, this indicates a tendency for formations to grow. Girls living in cities get sick more often. Their metabolism is disturbed due to stress or poor lifestyle, which provokes the occurrence of gynecological pathologies.

Women's nutrition

Diet plays an important role. Excessive amounts of trans fats or refined foods eaten, as well as a lack of fiber, provoke an imbalance of sex hormones. Poor nutrition causes obesity.

If a woman eats a balanced diet, eats cereals, seafood and plant foods, and avoids sugars and fats, the risk of fibroids is minimal. A person who eats right looks young and healthy.

Pregnancy, childbirth and abortion

Abortion, miscarriage, difficult childbirth with injuries, curettage are common causes of gynecological diseases. A woman who has given birth is less susceptible to the appearance of fibroids.

Lack of orgasm

Rare, irregular sex, as well as lack of orgasm, leads to stagnation in the pelvis. Chronic stagnation causes hormonal imbalance and, as a consequence, the development of fibroids.

Diagnostics

In modern medicine, diagnosing pathology is not difficult. A recently appeared tumor is identified during examination by a gynecologist. The patient has an increased size of the uterus, deformation of the walls and thickening are observed.

To confirm the diagnosis, the following additional studies are performed:

1. MRI, CT - rarely used.
2. Hysteroscopy is the removal of uterine tissue in order to subsequently transfer the resulting material for research.
3. Laparoscopy.

The scope of research is determined individually for each woman. An examination and ultrasound examination are usually sufficient.

Symptoms of fibroids

The early stages proceed unnoticed. Tumor formation can be detected as it grows.

First signs:

• Menstruation irregularities;
• Bleeding;
• Constipation, frequent urination;
• Miscarriages;
• Infertility;
• Anemia;
• Sudden enlargement of the abdomen without any justification;
• Bloody discharge during sex;
• Pain in the lower abdomen and lower back, heaviness;

With growth, constant bleeding, cramping pain, anemia, and a large belly are observed. The growth of fibroids during pregnancy is dangerous due to premature, protracted labor, fetal hypoxia, and delayed fetal development.

Echo signs of uterine fibroids are important for the doctor. With their help, the location and type of growth is calculated.

The nature of pain in various forms

As the pathology develops, the pain becomes stronger and more unbearable. In the interstitial form, the tumor puts pressure on surrounding organs, causing a feeling of heaviness and pressure. The subserous form is accompanied by debilitating back pain, the submucous form is accompanied by cramping, which is constant.

Bleeding and the menstrual cycle

The submucosal form, developing, causes constant, incessant bleeding, which provokes the occurrence of iron deficiency anemia and other complications. The woman quickly gets tired, headaches and weakness appear, as well as dystrophic changes in the myocardium.

Is it curable or not?

Since the disease is common, new treatment methods are being actively developed throughout the world. There are a lot of them, ranging from taking hormonal medications to surgery. After diagnosis, a woman does not know what to do with uterine fibroids.

First of all, you need to visit a good gynecologist who will tell you exactly whether there is a disease or not, and how it can be cured. Then individual treatment is prescribed, which differs depending on the size and location of the tumor, as well as the woman’s age.

Knot dimensions

Myoma nodes can be both small and large, reaching sizes of more than 10 centimeters. Small formation - up to 2.5 cm, medium - up to 13 weeks, large - more than 12-15 weeks of pregnancy. The larger the nodes, the greater the risk of complications and bleeding.

How to treat uterine fibroids

There are 2 main methods of therapy:

1. Conservative treatment of uterine fibroids is the mandatory use of hormonal drugs, symptomatic treatment with painkillers.
2. The main thing is surgical intervention, which is effective in severe stages.

The method is prescribed based on symptoms, tumor size, patient’s age, intention to give birth, and growth rate of uterine fibroids. It is best to treat early, when surgery is not yet necessary. Conservatism is most effective during reproductive age.

Having discovered a tumor during menopause, the doctor restrains its development until it completely resolves or decreases in size.

Gonadotropin-releasing hormone agonists

This method initiates a temporary menopause, which leads to a reduction in the size of the tumor by 52%. The group includes drugs containing triptorelin, goserelin, buserrelin and leuprorelin. The course of therapy is 4-6 months. The size of the nodes is reduced by 50%, but the risk of relapse cannot be excluded. This group is often used before surgery to reduce bleeding by reducing the growth.

Antigonadotropins

The drugs are rarely used as they cause some adverse reactions. It should be taken only when other methods are powerless even with long-term use. The group consists of such active ingredients as Gestrinone and Danazol. The drug eliminates symptoms, but does not affect the size of fibroids, so it is often prescribed in the preoperative period.

Gestagens

Effective, inexpensive drugs that block estrogen synthesis. Unfortunately, fibroids are not completely cured with the use of this product. There were cases when the patient's condition worsened. Typically, drugs in this group are prescribed for concomitant diseases, for example, endometrial hyperplasia, since the cause of pathologies may be a hormonal disorder.

Antiprogestogens

Mifepristone - binds to progestogen receptors, blocking the effect of progesterone. The substances reduce the size of the tumor, reducing symptoms. The drug is available in the form of tablets of 3-6 pieces, and is often used before operations.

Operations

Surgery for uterine fibroids is performed in several ways. The most popular are hysteroscopy and laparoscopy. This is due to the absence of scars, preservation of reproduction, and rapid recovery. The doctor focuses on the woman’s age, the size of the formation, its location and quantity.

A laser is mainly used, which cuts off the tumor without causing bleeding and does not leave deep scars. Today, the UAE method is actively used - embolization of the uterine arteries. During the procedure, the doctor injects a special drug into the vessels to stop the flow of blood to the affected tissues.

They begin to die off as they are deprived of oxygen, gradually decreasing in size. The method is used for any number of nodes and their location. Gentle surgery is powerless in cases where it is impossible to stop the growth of the tumor. Then the doctor removes the uterus completely.

When is surgery prescribed?

The operation is prescribed in several cases:

• The nodes are more than 12 weeks old and put pressure on the internal organs;
• Combination of fibroids with other gynecological diseases;
• Severe uterine bleeding;
• Active growth of nodes or their necrosis;
• Birth of a node or necrosis.

Intervention is also necessary (surgery is needed) for suppuration in the area of ​​the fibroid.

Popular methods of treating uterine fibroids surgically will be described below.

Embolization

– a unique method used to stop the blood supply to fibroids. After the operation, the growth shrinks and resolves, as blood stops flowing into it. Doctors give positive prognoses; some are confident that the woman undergoing surgery remains able to bear and give birth to a healthy child. This depends on the size and type of fibroids, as well as the correctness of the operation.

Advantages of the operation:

1. Normalization of menstruation.
2. Disappearance of problems with urination.
3. No risk. The operation does not require anesthesia, takes no more than 15 minutes, rehabilitation lasts up to 7 days.
4. Good efficiency.

The method eliminates relapses and additional treatment; it is enough to perform one operation, and the pathology disappears forever. If the rules of rehabilitation or prevention are not followed, sometimes the disease reappears.

Hysteroscopy

A popular method that is carried out through the vagina, removing the growth with a special instrument. As a rule, after removal, no adverse reactions or complications arise, the risk of relapse is minimal, and the woman can give birth.

Often before surgery, the doctor prescribes preoperative preparation, which consists of taking hormonal medications. The method is more necessary to normalize the size of the uterus, but the tumor also decreases.

Myomectomy

The laparoscopic method is performed using special punctures in the abdomen. Removal of fibroids by myomectomy is low-traumatic; after extraction, the material is sent for research. With the help of myomectomy, uterine fibroids can be cured, preserving the woman’s ability to give birth to a healthy child, and without leaving visible marks on the body. The disadvantages of the method include possible relapse and the need for repeated intervention.

Fuse ablation

The nodes are removed under MRI control, the procedure is safe and convenient for the doctor. The cells are heated by an ultrasonic pulse until they are destroyed. The entire process may take 4 hours as it consists of several stages. After the operation, the symptoms of the pathology disappear, relapses are excluded, and the size of the growth decreases. Unfortunately, the method is not suitable for all women and is selected individually.

Uterine fibroids (called leiomyoma and fibromyoma) are a type of benign tumor, not classified as cancer, that grow in the cavity of the walls of the cervix and or in the uterus itself. Tumor growth can reach different sizes, from microscopic to large, and several fibroids may appear simultaneously. To understand the growth force of the tumor and what causes fibroids, doctors draw an analogy with the growth of the uterus when carrying a child (that is, 3 weeks, 6 weeks, 10 weeks, and so on). According to the location of fibroids, experts divide them into types.

Varieties:

1. – when it occurs, a tumor develops along the walls of the surface of the uterus, under the membrane that separates the uterus from the organs in the abdomen.
2. Intramuscular (interstitial) - appears on the inner wall of the uterus.
3. Submucosal (submucosal) - develops in the area of ​​the mucous membrane and extends into its lumen.
4. Pedunculated uterine fibroids are not a separate type; they can appear either subserous or on the submucosa. The width of the pedicle varies (the pedicle is the base of the fibroid).

Reasons for appearance:

• Genetic predisposition;
• Hormonal imbalances;
• Inflammation of the genital organs;
• Metabolism problems;
• Pathologies of other organs;
• Stable stress state;
• Large excess weight;
• Sedentary lifestyle;
• Stable abortions;
• Spiral;
• Lack of orgasm during sexual intercourse;

Uterine fibroids-video

Consideration of some causes of illness

Hormonal imbalances

The tumor depends on the hormonal balance, so it does not appear until puberty in girls and in women who have crossed the threshold of menopause. When there is a disruption in the stable functioning of hormones, with an increase in estrogen, tumor growth increases. The resulting estrogen imbalance is diagnosed by taking several forms of tests, because it is impossible to establish it with a single study. Also, xenoestrogens can act on the appearance of neoplasms such as endometriosis and fibroids.

Poor nutrition

The active growth of estrogens in the body is promoted by: metabolic problems, excess weight, a diet overfilled with refined foods, lack of fiber in the body, and an excess of fatty acids in the diet. Experts constantly say that it is excess weight that provokes the appearance of excess sex hormones in a woman’s body, because it is fatty tissue that contributes to the appearance of estrogen.

Women who adhere to a vegetarian diet, which mainly includes only healthy foods filled with vitamins from vegetables and fruits, low-fat lactic acids, and cereals, have a much lower risk of getting this disease.

With every ten kilograms gained, the risk of developing a tumor increases by 20 percent.

Lack of orgasm during sexual intercourse

When excited, there is a rush of blood to the pelvic organs and if the body does not receive proper discharge, the blood does not leave and begins to stagnate, this leads to great tension in the blood vessels. Such stagnation leads to painful sensations during sexual intercourse. With prolonged abstinence from orgasms, a failure occurs in the hormonal system, which can lead to the formation of a tumor.

Symptoms:

• Disruptions in the menstrual cycle, acyclicity of menstruation, possible appearance of blood in the middle of the cycle;
• Stable constipation, increased daily urination rate (indicates that fibroids are compressing the intestines and bladder);
• Heavy menstruation, increasing by day, leads to chronic anemia;
• Nagging pain, pressure in the lower abdominal cavity, which are not associated with menstruation;
• Infertility;
• Growth of the abdominal cavity, without increasing the entire body weight.

Almost always, when the size of the fibroids is still small, there are no symptoms of the disease. Most often, the disease is diagnosed during a routine examination by a gynecologist. Also, with the development of subserous and intramuscular fibroids, symptoms may be absent.

If symptoms do appear, they do not necessarily indicate the appearance of fibroids; they can also signal endometriosis, uterine and ovarian cancer. Therefore, before making a diagnosis, you should definitely consult a doctor.

Why is fibroid dangerous?

Uterine fibroids and why they are dangerous are important to know for every patient facing this disease.

Possible complications:

• Termination of pregnancy, hypoxia and fetal malnutrition;
• Hemorrhages, which can lead to anemia;
• Transformation of a benign tumor into a malignant one;
• Increased fibroid growth;
• Bleeding after childbirth caused by low uterine tone;
• The appearance of hydronephrosis or pyelonephritis;

Diagnostics

It will not be difficult for any specialist to make such a diagnosis, because with a simple gynecological examination one can determine an unhealthy enlargement of the uterus and understand what to do next. To confirm the diagnosis, use the following methods:

How serious the diagnostic tests will be is determined by the attending physician, but in most cases a routine gynecological examination and ultrasound are enough to understand how to treat uterine fibroids and whether uterine fibroids can be cured.

Treatment

Uterine fibroids are treated in three ways:

• Conservative;
• Surgical;
• Combined;

Conservative treatment

Such treatment is aimed at stopping the growth of the tumor and the occurrence of complications. Appointed:

• If the growth of fibroids does not exceed 12 weeks;
• If fibroids have intramuscular and submucosal nodes;
• If there is no occurrence of metrorrhagia and severe pain in the pelvic organs;
• If there are contraindications to surgery;

Directions of conservative treatment:

• Elimination of diseases of the genital tract;
• Restoration of the immune system;
• Changing a woman's diet;
• Restoration of metabolism;
• Restoration of a woman’s psycho-emotional state;
• Restoration of the menstrual cycle;
• Increased hemoglobin levels;

The basis of this treatment is the patient’s prescription of hormonal medications:

Combined oral contraceptives (COCs)

Medicines in this group are used to reduce the symptoms of the tumor, such as pain in the abdominal cavity and heavy blood loss. But in order to reduce the size of fibroid growth, such tablets are not prescribed, because only in rare cases do they help to reduce nodes, and then only very small ones.

Drugs: Mercilon, Novelon, Marvelon, Ovedon, Rigevidon.

Gonadotropin-releasing hormone agonists

When treated with such tablets for six months, it is possible to reduce the size of fibroids by 50 percent and reduce the symptoms of the disease. But these means have their drawbacks. After their use, it is possible to restore the size of the nodes they affected. Also, they should not be taken for a long time in order to avoid side effects such as osteoporosis and other diseases that arise due to a lack of necessary hormones in the body.

Often used before operations to reduce blood loss during surgery.

Drugs: Decapetil, Diferelin, Dicapep-til depot, Zoladex, Lucrin depot.

Antiprogestogens

One of the most popular hormones for the treatment of benign uterine tumors in women. Eliminates the symptoms of fibroids and reduces the size of nodes.

Drug: Mifepristone.

Antigonodotropins

They are used in rare cases because they do not affect the reduction of nodes, but only reduce symptoms. They cause many side effects: growth of unwanted hair, acne, change in voice. Taken if other medications do not help.

Drugs: Vero-danazol, Danazol, Danoval, Danol, Danogen, Nemestran.

Gestagens

Medicines are controversial among experts. The first claim that the use of these drugs for uterine fibroids is unacceptable, the next say that it is progesterone in insufficient quantities that can lead to unwanted formations. Therefore, the use of these funds is prescribed only for appropriate indicators.

Drugs: Duphaston, Primolut-Nor, Norkolut, Depo-Provera, Provera, Exluton, Ogometril.

In conjunction with the use of hormones, the patient is also prescribed a diet, immunomodulating agents, and herbal medicine.

Surgical treatment

Unfortunately, quite often the disease takes such a form that it is impossible to avoid surgical intervention.

Reasons for surgery:

• The size of the tumor and nodes exceeds 10 weeks and puts pressure on other organs;
• The appearance of heavy bleeding;
• Rapid growth of tumors;
• Necrosis of the fibroid node;
• The appearance of a submucosal node and its necrosis;
• A set of diseases: adenomyosis and fibroids;

Methods of surgical intervention:

1. Uterine artery embolization is a new modern method of tumor removal. The operation is performed with a probe that helps determine which vessels send blood to the fibroids, after which doctors inject substances that lead to blockage of these vessels. As a result of the operation, the fibroid is eliminated. Whether the woman will be able to perform her reproductive functions in the future or not depends on how successful the operation is.
2. Laparoscopy - the procedure is performed using small holes in the abdomen. It is completely painless and brings fairly good results, but in advanced forms of uterine fibroids, it may not help to completely get rid of the disease.
3. Hysteroscopy – performed for submucosal nodes. Instruments are inserted into the cavity to remove them.
4. Strip surgery - a cut is made in the abdomen. It is used extremely rarely.
5. Hysterectomy – performed in extreme cases if the growth of fibroids cannot be prevented otherwise. The uterus is completely removed from the body.

Combined method

The method in which some type of gentle operation is performed, without eliminating the pelvic organs, and then hormonal medications are prescribed. To avoid the return of the disease.

The method is often used because it is highly effective.

Treatment with folk remedies

The use of herbal medicine when uterine fibroids appear is quite individual. Therefore, before using folk remedies, you should definitely consult a doctor.

With increased tumor growth, the use of folk remedies can be harmful and lead to complications. Therefore, herbal medicine is prescribed to women with small fibroids. Infusions of nettle, hawthorn, celandine and mint will be useful.

Benefits of herbal treatment:

• Elimination of the cause of the disease;
• There are no contraindications other than individual intolerance;
• No side effects;
• Has a good effect on other organs;
• Affordable price of herbs;
• Prevention of uterine fibroids:

Prevention

In order not to encounter this disease again, you need to follow a number of rules that will help:

1. Consistent visits to the gynecologist twice a year.
2. Ultrasound of the pelvic organs once a year;
3. Stable sexual activity;
4. Refusal of such a method of ending pregnancy as abortion;
5. Physical activity;
6. Stable intake of vitamins;

Is it possible to get pregnant with uterine fibroids?

It is possible to get pregnant with uterine fibroids, however, if the tumor presses on the fallopian tubes, the sperm will not be able to enter the uterus. Therefore, doctors recommend that you first undergo full treatment and then plan a pregnancy.

Pregnancy with myomatous processes in almost any case is accompanied by the threat of miscarriage, the possibility of placental abruption and heavy hemorrhages.

At the initial stage, uterine fibroids are often confused with pregnancy. Therefore, in order to be confident in the doctor’s testimony, you should undergo additional tests.

Frequently Asked Questions

What does uterine fibroid look like and what is it? The doctor explained to me and said that an operation to remove the uterus is required, can it be avoided? Irina, 23 years old

It is possible to avoid surgery in such a complex form of the disease with the help of medications, but not for long. This way you will only delay the inevitable. Pay attention to what fibroids look like on an ultrasound, whether they interfere too much with your body, and then evaluate the timing of inactivity.

Is it necessary and when to do an ultrasound for uterine fibroids? Can cancer appear with fibroids? Anastasia, 37 years old

An ultrasound should be done for diagnosis; this procedure does not harm anyone. Myoma can develop into cancer. How to treat it depends on what cancer diagnosis you have.

Is everything really happening as creepy as in the photos on the Internet? It describes in detail what fibroids are and how to treat them, but no matter what women’s forum you open, the photo in which fibroids form is terrifying. Christina, 18 years old

In order to avoid stress, do not scare yourself! You don't need to know what this looks like because you won't have to deal with it during treatment. If you find symptoms, consult your doctor.

Every woman should understand how dangerous uterine fibroids are. It is absolutely impossible to get rid of it by self-medication, so you should definitely contact a specialist who will understand what causes uterine fibroids in your body and why it could have formed. The doctor will help you do all the necessary tests, prescribe treatment and prevent fibroids from appearing again.

When a doctor diagnoses a woman with uterine fibroids, she certainly panics.

What is this? What is the threat? Why is fibroid so scary? Could it burst? What to do? These questions run through almost everyone’s head.

There is no need to despair and be upset; uterine fibroids are no longer a death sentence, but a disease that can be treated in various ways.

It is not at all necessary to remove the uterus - doctors practiced this method of treatment several decades ago. Now doctors have at their disposal a lot of minimally invasive and conservative ways to combat myomatous formation, which allow them to preserve the woman’s reproductive organ.

What is fibroid

Uterine fibroids are certainly not oncology, and even calling this formation a tumor is not entirely correct.

Uterine fibroids are a benign tumor formation that develops in the walls of the reproductive organ or in its cervix.

As a rule, fibroids are multiple in nature, but a single form of the disease often develops.

A tumor-like myomatous formation develops from connective and muscle tissue cells. Many doctors attribute this disease to hyperplastic changes in the endometrium.

There is a theory that the rudiment of fibroids is formed during the development of the embryo, and at the moment of hormone imbalance it begins to grow. When hormonal regulation is disrupted, the process of active division of muscle fibers starts, and some cells are destroyed.

The immune system reacts to this by provoking hyperplasia. This is how the tumor begins to grow.

In addition, the growth of fibroids is influenced by the structure of the uterine arteries, near which the tumor grows.

A number of provoking factors, which will be discussed below, also have a negative effect on the walls of the uterus, which leads to the growth of the myomatous node.

After the doctor has made the initial diagnosis, it is recommended to undergo an ultrasound examination with a vaginal probe to ensure that the previous examination is correct.

Myoma develops in three stages:

• the beginning of education– formation of the active zone;
• microscopic volume of the node. If at this moment a histological analysis is carried out, then it is still impossible to distinguish normal myometrial cells from pathological ones. As already mentioned, this process occurs during the period of embryonic development, and if there is no impetus for the development of the tumor, the fibroid remains in its infancy;
• appear clear boundaries of education, which means the growth of fibroids.

How quickly it happens depends on where exactly the fibroid is located.

Symptoms of the disease

What symptoms accompany this disease?

In the early stages of the development of a myomatous node, a woman in most cases does not feel any symptoms or signs of the disease. In rare cases, an attentive woman may notice heaviness in the lower abdomen and discomfort during intimacy.

A later sign of fibroids is the appearance of pain in the lumbar region. But they can be perceived as premenstrual pain.

• gynecological examination, during which the doctor can palpate the formation, or determine its presence using mirrors. The doctor also interviews the patient and draws up a general clinical picture, taking into account the woman’s medical history;
• . This is the most informative technique, the effectiveness of which is almost 100%. This study can be performed abdominally or transvaginally;
• hysteroscopy. It is carried out using special optical equipment, during which various surgical procedures can be performed. During hysteroscopic examination, the integrity of the organ is preserved. The equipment is inserted into the cervical canal and transmits an image to the monitor;
• colposcopy. With this study, the doctor can not only confirm the presence of a tumor, but also take biomaterial for examination under a microscope;
• laparoscopy. A small puncture is made in the abdominal cavity, where a special device is inserted, which provides detailed information about the condition of the organ and collects biomaterial for research;
• X-ray, CT, MRI;
• laboratory tests include a general blood and urine test. Curettage may also be prescribed, which provides information about the formation even when other methods turn out to be uninformative.

The photo below shows a transvaginal ultrasound of uterine fibroids.

What are the sizes?

The size of the myomatous formation can be determined by ultrasound. The uterus also increases as fibroids grow, so the results often indicate the size of the fibroids in obstetric weeks.

The classification of fibroids by size looks like this:

• small – up to 2 cm, 4 or 5 obstetric weeks;
• average – up to 6 cm, 6-11 weeks;
• large – more than 6 cm, 12 weeks or more.

After the tumor reaches a large size, it begins to interfere with the functioning of other internal organs.

How to recognize a tumor at an early stage

Since myomatous formation is entwined with a large number of vessels, its first signs may be bleeding. Young girls may experience a disruption in their cycle.

Problems with the menstrual cycle are a very important symptom of the presence of fibroids, which is a good reason to contact a specialist.

Due to an increase in the amount of menstrual blood or intermenstrual bleeding, a woman experiences low hemoglobin, and also develops another early symptom of fibroids - iron deficiency anemia.

With the active growth of the formation, pain appears in the abdominal area, and the lower back and back also begin to ache.

In some cases, the temperature may rise, difficulty urinating, constipation, and infertility.

A persistent increase in temperature to subfebrile levels can be an extremely dangerous symptom of tumor malignancy.

Painful sensations

Pain from fibroids can be sharp or aching.

The intensity of pain depends on the location of the myomatous formation, its size, as well as the presence of possible complications.

With submucous fibroids, the lower abdomen constantly hurts. The cause of pain is compression of surrounding tissues by the tumor, which leads to disruption of their blood circulation. Cramping pain occurs before menstruation, and disappears after the end of menstruation.

With interstitial fibroids, pain occurs only when the formation reaches a large size. The pain intensifies before menstruation and can be paroxysmal.

Lumbar pain is not characteristic of all myomatous formations.

If you have any type of pain, you should consult your doctor.

Self-regression

Myoma regression is its reduction.

Since fibroids are a hormone-dependent tumor, regression is impossible without appropriate treatment.

During menopause, the level of estrogen in a woman’s body decreases, and this leads to the cessation of the growth of myomatous formation, as well as to its slight decrease, but we are not talking about the complete disappearance of fibroids during this period. In any case, hormonal treatment of the tumor will be required to completely get rid of the disease.

Conservative treatment methods

Goals of drug treatment:

• inhibition of educational growth;
• reduction in fibroid size;
• prevention of possible complications.

Appointed:

• oral contraceptives – Regulon, Janine etc.;
• gonadotropin agonists – Zoladex, Buserelin, Diferelin;
• antiprogestogens – Mifepristone;
• gestagens – Utrozhestan, Duphaston.

FUS ablation is also a conservative method of getting rid of fibroids - in this case, the tumor is destroyed using ultrasound waves.

Drugs, their dosage and duration of treatment can only be prescribed by a competent specialist in accordance with the patient’s age, clinical picture, type of fibroid, its size and the presence of underlying diseases.

Surgery

In cases where conservative treatment of the disease is impossible, surgical removal of the tumor is prescribed:

• uterine artery embolization– the formation degrades due to the cessation of blood supply to the tumor;
• myomectomy– organ-preserving surgery, in which only nodes are removed;
• hysterectomy– the myomatous node is removed along with the uterus.

Consequences of the disease

Once upon a time, fibroids were considered a precancerous condition, since experts believed that the risk of the formation degenerating into a malignant process was quite high. Today, this topic has ceased to be relevant, since studies have proven that the percentage of benign fibroids degenerating into cancer is extremely low.

Other risks:

• rapid growth of the tumor, as a result of which it begins to put pressure on tissues and organs located nearby. This leads to blocking of normal blood flow and decreased tissue nutrition;
• profuse bleeding that leads to anemia;
• development of hydronephrosis and pyelonephritis;
• termination of pregnancy;
• fetal malnutrition or hypoxia;
• infertility;
• endometrial hyperplasia.

Why uterine fibroids are dangerous, read also

Complications during pregnancy

If a woman with fibroids manages to become pregnant (a fairly rare occurrence), then the following risks are possible:

• leg torsion;
• impossibility of normal closure of the neck (if the node is located in the cervical region);
• rapid growth in education;
• fetoplacental insufficiency;
• thrombosis;
• uterine rupture;
• termination of pregnancy;
• low placentation;
• placental abruption;
• gestosis;
• anemia.

All pregnancy complications associated with myomatous formation are quite serious and must be treated in a hospital setting.

A woman must adhere to a diet prescribed by a doctor and undergo therapy aimed at improving placental-fetal blood flow.

In case of active growth of the formation, endoscopic surgery may be performed to remove the fibroids. Pregnancy in this case can be saved.

Uterine fibroids, or leiomyoma, is a benign hormone-dependent (estrogen- and progesterone-dependent) tumor of the myometrium (muscular lining of the uterus), which develops from smooth muscle cells and contains fibrous connective tissue in varying quantities. Despite significant progress in early diagnosis, removal of the uterus for fibroids (hysterectomy) still remains a fairly common treatment method.

Relevance of the topic

Myoma ranks 2nd in the structure of gynecological diseases. Its frequency in reproductive age averages 16%-20% of cases, and in premenopausal age it reaches 30-35%. Recently, due to the increase in the number of “aggressive” gynecological and obstetric treatment methods and the improvement in the quality of diagnosis, there has been an increase in the number of women with myomatosis under 30 years of age.

In general, leiomyoma growth occurs slowly - on average over 5 years. But sometimes rapid growth of the tumor is observed, in which within one year or less it increases by an amount corresponding to 5 weeks of pregnancy.

It can be the cause (if localized in the area of ​​the uterine part of the fallopian tube), spontaneous abortions, premature births, abnormal fetal position, heavy postpartum uterine bleeding and other complications during childbirth and the immediate postpartum period.

Significant sizes of fibroids, for which surgery is indicated, correspond to 14 weeks of pregnancy. But in most other cases, radicalism in treatment (hysterectomy) is unjustified. It is based on the traditionally prevailing opinion that the uterus performs only a reproductive function, after which it can be removed without consequences for the body.

This opinion is erroneous, since the risk of transformation of leiomyoma into a malignant tumor is practically absent, but after hysterectomy, menstrual and reproductive functions are lost, and many women develop pronounced vegetative-vascular, psycho-emotional disorders and accelerated decline in mineral bone density.

At the same time, conservative treatment of uterine fibroids, as well as the use of non-invasive and minimally invasive treatment methods in the early stages of tumor development, make it possible to stop its growth, cause reverse development and prevent disorders of the reproductive function of the uterus. But if the indications for surgical treatment are clearly developed and defined, then the issues of using conservative methods still remain controversial.

Causes of uterine fibroids and mechanisms of its development

Reasons

There are different theories about the causes of leiomyoma. For example:

1. Some scientists believe that this formation is not a tumor, but a consequence of focal hyperplasia (proliferation) of the myometrium. It can occur in areas where there is a complex interweaving of muscle fibers - along the lateral surfaces of the cervix, in the area where the fallopian tubes originate, along the miduterine line. These areas are called risk areas for the development of dystrophic disorders.

   Under the influence of any unfavorable factors, hypoxia (lack of oxygen) develops in the smooth muscle fibers of the myometrium. The areas mentioned above are especially affected. Hypoxia leads to impaired differentiation of muscle cells, as a result of which they acquire the ability to divide and grow against the background of normal synthesis and release of sex hormones. This constant unregulated proliferation of undifferentiated muscle fibers leads to the formation of fibroids.

2. Under the influence of growth factors and sex steroids, mutation of normal muscle cells occurs, followed by their neoplastic transformation in the presence of favorable conditions. At the same time, the molecular disorders that contribute to this transformation have not been fully established.
3. During the embryonic period, smooth muscle fibers undergo a long stage of development - from 14 to 30 weeks. Since during this time they are still poorly differentiated, they are easily subject to mutations under the influence of external causes (negative environmental influences) or maternal factors (growth factors, tropic hormones, sex steroids, etc.). Mutated tumor cells (progenitor cells) are located in the myometrium and begin to develop under the influence of estrogens after the first menstruation. Their development takes place over many years. This theory is currently the most substantiated.

Pathogenesis

Various concepts of tumor development mechanisms have also been proposed. Thus, the theory of peripheral hemodynamic disorders and water-electrolyte disturbances suggests that the basis for tumor development is a decrease in the sodium-potassium coefficient. The reason is a local decrease in the elasticity of the vascular wall, which leads to their overflow with blood, slower outflow and accumulation of potassium ions.

Another concept for the formation of fibroids is the influence of estrogens on the mechanisms of programmed cell death (apoptosis) through the BcI-2 protein, which inhibits them. Estradiol suppresses the effect of BcI-2, and in fibroids - to a much lesser extent than in normal myometrium.

In recent years, multiple interrelated mechanisms have been identified. The main ones:

1. Changes in sex hormones (estrogen and progesterone) affecting mutated smooth muscle cells.
2. Increased sensitivity of tissue receptors affected by sex hormones.
3. Changes in the formation of new blood vessels in the tumor area.

Their principle is as follows. Progesterone, acting on mutated cells, causes their proliferation. The conditions for the implementation of its action are created by estrogens. In addition, they inhibit the regulated processes of programmed cell death, which promotes cell proliferation.

The influence of sex hormones is not direct, but through the stimulation of certain protein growth factors, which include:

• epidermal (EGF);
• insulin-like-1 (IGF-1);
• transforming-beta (TGF-beta);
• heparin-binding epidermal (HSEFR);
• vascular endothelial (VEGF-A);
• fibroblast growth factor (FGF-2).

For the first four factors, a characteristic property is a pronounced stimulation of mitosis (division) of cells, for the rest and angiogenin - modulation of angiogenesis (formation of the vascular network) in the tumor, necessary for its development.

Recent results of studying the pathogenesis of the disease have made it possible to supplement the treatment of uterine fibroids with medications, with the help of which in many cases it is possible to avoid hysterectomy or prevent relapses after minimally invasive surgical treatment.

Provoking factors

As a result of epidemiological studies, the main risk factors that trigger the development of leiomyomas have been established:

1. Genetic - the likelihood of developing uterine fibroids is much higher in women whose immediate relatives (mother, sister) suffered from the same diseases. Moreover, their tumors appear at a younger age and become larger in size compared to others.
2. Early onset of menstruation.
3. No children. Increasing the number of full-term pregnancies correspondingly reduces the risk. For women with three children - by 50-90%.
4. Excess body weight due to low physical activity. Obesity in childhood and adolescence has significantly less impact than that after puberty.
5. Presence of arterial hypertension before the age of 35, accompanied by taking antihypertensive drugs for 5 years.
6. Long-term and chronic psycho-emotional stress, frequent and prolonged stressful conditions.
7. Repeated episodes of artificial termination of pregnancy, especially surgically, and frequent diagnostic and therapeutic curettage.

The factors listed in points 2-5 increase the risk of developing fibroids by 2 times or more.

Types of uterine fibroids

It arises and develops in the muscular layer of the uterus. There are 3 stages in its development:

• I - formation of a zone of active growth at the location of small vessels; These zones are characterized by high permeability of the vascular wall and tissues, as well as a high level of metabolic processes, which contributes to the further development of the tumor;
• II - the tumor is visible in the form of a nodule only microscopically; it consists of fibers that have no obvious signs of difference from neighboring tissues;
• III - it is already defined macroscopically in the form of a formed dense node with clear boundaries, the capsule of which is formed by the surrounding tissue elements; leiomyoma consists of muscle spindle cells collected in a bundle and oriented in different directions; They already differ from normal smooth muscle fibers of the myometrium in their significantly larger size, high density of nuclei and the content of individual thin muscle fibers (myofibrils) in the cytoplasm.

Classification

Depending on the number of nodes, multiple and single (in only 16% of cases) fibroids are distinguished.

Types of uterine fibroids depending on location

According to the nature of their growth, they are divided into 5 types:

1. Intermuscular, interstitial, or intramural uterine fibroids. It is completely located in the thickness of the muscular layer of the uterine wall (occurs in 60% of all cases of the disease).
2. , or submucosa - grows in the direction of the endometrium. If such a node is partially (more than 1/3) located in the myometrium, it is called intermuscular with centripetal growth (towards the uterine cavity).
3. Subserous, or subperitoneal fibroids - located completely or partially under the serous (outer) membrane of the uterine wall, that is, under the peritoneum. It is divided into three types: “type 0”, when the tumor is completely located under the serosa; “Type I” - more than half of the tumor is under the serous membrane, and the rest of its volume is in the thickness of the myometrium; “Type II” - more than half of the node is located interstitially. The zero type is divided into 2 subtypes - “0-A” (knot on a wide base) and “0-B” (knot on a leg).
4. Retroperitoneal tumor - the growth of the node occurs from the cervix or lower parts of the uterus outward, where the peritoneum is absent.
5. Intraligamentary, or interligamentous - between the leaves of the broad uterine ligament.

The first three species differ significantly in morphological structure and degree of ability to increase. Submucous tumor and interstitial uterine fibroids are true, since the ratio of parenchyma (functioning tissue) to stroma (connective tissue cells, nerves, vessels and extracellular substance) is 1:2, and in subserous nodes - 1:3. Therefore, the latter are called fibromyomas. The degree of activity of metabolic processes in a submucosal tumor is much higher, and therefore its growth rate is higher.

Depending on the location in relation to the uterus, a tumor is distinguished between corporal, or uterine body (94%), and cervical (16%).

Types of uterine fibroids according to cellular composition:

1. Simple - grows like a simple benign local growth of healthy muscle cells. There is no cell division (mitosis) in it.
2. Proliferating is also benign, but the number of muscle cells is significantly greater compared to the equivalent volume of simple leiomyoma. In addition, in the absence of atypia of cells in a proliferating formation, their mitotic activity is determined, but it constitutes no more than 25% of all tumor cells.
3. Presarcoma. This type of fibroid is characterized by the presence of multiple foci of growth in the node, in which the number of mitoses is up to 75%. The cells have signs of atypia, their nuclei are heterogeneous. In some areas of the node there are cells with multiple and large nuclei with intense coloring.

Clinical symptoms of uterine fibroids and contraindications for it

In half of women with fibroids, the disease develops without any symptoms and is detected by chance during an examination by a gynecologist or an ultrasound scan of the pelvic organs. Clinical signs are quite varied. The main ones:

1. Pain of varying nature and intensity in the lower abdomen. They can be aching or pulling (in 25-30%), which is associated with pressure on the nerve plexuses and/or stretching of the serous membrane (peritoneum). As the tumor grows rapidly, the pain becomes more pronounced and constant. Torsion of a subserous formation on a pedicle or acute disturbance of blood flow in myomatous nodes with the development of their necrosis (necrosis) causes acute paroxysmal pain, which may be accompanied by weakness, vomiting, and fever. Cramping pain during menstruation usually occurs when the node is located submucosally.
2. Acyclic bleeding, more characteristic of intramural or subserous localization, as well as prolonged and heavy menstruation, usually occurring in the presence of a submucosal node. Blood loss leads to the development of anemia, headaches, fatigue and weakness, and degenerative changes in the myocardium.
3. Disorders of the pelvic organs, which are manifested by frequent urge to urinate and constipation. These symptoms occur when the nodes are subserosal, cervical or interligamentous, as well as when the tumor volume is large.
4. The presence of a dense formation above the womb.
5. Miscarriage and infertility occur in 30% of women with multiple fibroids.

Principles of treatment

Despite the high prevalence of the disease, a clear algorithm for the management of such patients has not been developed. There are many different opinions and contradictions in treatment tactics, which boil down to 3 main areas:

1. Waiting tactics.
2. Conservative treatment of uterine fibroids.
3. Active patient management.

Waiting tactics

It can be applied to a small number of patients. These include women who have no manifestations of the disease, the size of the tumors corresponds to periods of less than 10 - 12 weeks of pregnancy, the reproductive function has already been realized and pregnancy is no longer planned in the future. In addition, such patients should be able to be under constant dynamic monitoring using ultrasound, cytological monitoring of the endometrium and cervical mucosa, as well as monitoring the content of tumor markers in the blood.

Contraindications for uterine fibroids:

1. Prolonged exposure to the sun and visiting a solarium.
2. Lifting weights of more than 3 kg, heavy physical activity, especially on the abdominals.
3. Any types of physiotherapeutic procedures for the pelvic area.
4. Wraps, abdominal massage.
5. Thermal baths, visits to baths and saunas.
6. Application of cosmetic hardware techniques to the abdominal area.
7. Load training on simulators.
8. Abortion and self-selection of oral contraceptives.

Conservative treatment of uterine fibroids

Taking hormonal medications

Conservative tactics consist in prescribing hormonal drugs, among which the most effective are analogues of gonadoliberin, or gonadotropin-releasing hormone (hypothalamic hormone). They are able to temporarily bind the corresponding receptors in the pituitary gland and over time suppress its gonadotropic function. As a result, the synthesis of estrogen and progesterone decreases, the tumor volume decreases to 55%, and bleeding and pain stop. However, these drugs, even with a short course of treatment (3-4 months), have side effects in the form of severe vascular reactions, feelings of flushing, nausea and decreased bone mineral density.

The relatively new drug Mifepristone is a synthetic steroid with a fundamentally different effect. It binds to the receptors that progesterone acts on, blocking their function. For this reason, there is no decrease in the production of progesterone itself, and the side effects characteristic of previous drugs are much less pronounced with approximately equal effectiveness.

Mifepristone is used at a dose of 50 mg daily for 2-3 months in preparation for surgery: it allows you to stop bleeding, relieve a woman of pain, normalize blood hemoglobin, and halve the volume of nodes, which makes them easier to remove with minimal blood loss. As an independent treatment, the drug is used rarely and over a longer course.

Currently, clinical trials are being conducted on 2 drugs that block the action of growth factors. One of them, Pirfenidone, causes fibrosis of the node; the action of the second, Interferon-alpha, is based on suppressing the growth of blood vessels in the tumor.

FUS – MRI ablation

Another conservative method is a non-invasive method of focused ultrasound ablation of a myomatous node under the control of magnetic resonance imaging (FUS - MRI ablation). It is based on the passage of ultrasonic waves through biological tissues without damaging them. Focused on the tumor, they cause heating of its individual zones to 55-90 o. Already at 60 o in 1 second, cell destruction occurs due to the evaporation of water from them, damage to the vascular network, local destruction of the structure of proteins and collagen fibers.

However, this technique is not yet perfect enough and is used mainly when fibroids are localized in the fundus of the uterus and along its anterior wall. The procedure is contraindicated for nodes smaller than 2 cm and larger than 9 cm, for pedunculated subserous fibroids, infertility, unrealized reproductive function, etc.

Active tactics

It distinguishes two directions:

• minimally invasive manipulations;
• surgical treatment.

EMA

Among minimally invasive manipulations, bilateral selective arterial embolization for uterine fibroids is mainly used. Its effectiveness is 98.5%, in contrast to surgical myomectomy, after which relapses are possible (up to 40%). The meaning of the procedure is to insert (under local anesthesia) a special microcatheter into the uterine artery through the femoral and internal iliac arteries. After this, polyvinyl alcohol is introduced in the form of very small particles. It leads to occlusion (blockade) of the vessels feeding the myomatous nodes, cessation of blood flow and their further shrinkage.

After the procedure, severe pain appears in the lower abdomen, lasting several hours. Sometimes vascular embolization (rarely) can be complicated by the development of infarctions in the uterus or abscesses, which will require removal of the organ. In addition, embolization is ineffective for subserosal nodes, the long-term results of its use are still unknown, and the effect on the possibility of subsequent pregnancy has not been fully studied. In 5% of cases, the onset occurs in women of childbearing age.

Surgical treatment

Currently, on average, in 80% of women, surgery for uterine fibroids remains the main method of treatment. Surgical treatment can be of two types:

• conservative - removal of only single or multiple nodes (myomectomy);
• radical - subtotal hysterectomy (supravaginal amputation with preservation of the cervix and appendages) or total hysterectomy (extirpation), that is, removal of the uterus and cervix.

Conservative removal of uterine fibroids using the laparoscopic method is preferable and is carried out for nodes smaller than 7-8 cm. However, the current availability of morcellators makes it possible to remove tumors up to 17 cm in size using the laparoscopic method. A morcellator is an electromechanical device that crushes a myomatous node in the abdominal cavity.

The absolute indications for surgery are:

1. The size of the tumor is more than 14 weeks of pregnancy or more than 10 cm (according to ultrasound).
2. Rapid growth during reproductive years or any growth during the postmenopausal period.
3. Submucosal location, accompanied by anemia as a result of prolonged and heavy menstruation.
4. Cervical localization.
5. Subserous tumor on a pedicle.
6. Negative effect on the function of the pelvic organs (bladder, intestines).
7. Combination of fibroids with diseases of other genital organs requiring surgical treatment.
8. Necrosis of the node, usually accompanied by pelvic pain syndrome.
9. Infertility, if fibroids are the cause.

The choice of the extent of surgical intervention depends on concomitant diseases, the woman’s age and planning a future pregnancy. The priority in the treatment of fibroids is the use of minimally invasive or conservative surgical organ-preserving methods.