Nodular fibroids of the uterus. Uterine fibroids dimensions for surgery

Antipyretics for children are prescribed by a pediatrician. But there are emergency situations with fever when the child needs to be given medicine immediately. Then the parents take responsibility and use antipyretic drugs. What is allowed to be given to infants? How can you lower the temperature in older children? What medications are the safest?

Tumor diseases of the genital organs are widespread in gynecology. And one of the most common formations is uterine fibroids. This benign tumor is detected in every sixth woman of reproductive age. Therefore, utmost importance is given to its timely diagnosis and subsequent active treatment.

Causes and mechanisms

To understand the essence of the pathological process, it is necessary to become familiar with its origin. The development of fibroids is mediated by general and local disorders. The main concept of the occurrence of a benign neoplasm is considered to be hormonal. Regulatory disorders in the hypothalamic-ovarian system give rise to proliferative processes in the uterus. In the muscle layer, hyperplasia and hypertrophy of fibers are observed, but the cells do not lose their differentiation.

A key role in maintaining tumor growth is played by increasing the concentration of estrogen - both absolute and relative. These substances are natural stimulators of cell growth. In addition, the metabolism of sex hormones changes in the tumor and the sensitivity of receptors to them increases. Of no small importance is given to cytokines and growth factors, immunological disorders and tissue hypoxia. It should also be remembered that the following conditions contribute to the development of fibroids:

Infectious and inflammatory diseases.
Menstrual cycle disorders.
Endocrine metabolic pathology.
Invasive interventions, including abortions.
Genetic predisposition.
Disturbances in the neuropsychic sphere.

All these factors must be taken into account when correcting the disease, because the basis of treatment, especially in the early stages, consists of eliminating the cause and mechanisms of development of fibroids. Without this, it is difficult to talk about further recovery.

Classification

There are several classification criteria for a diagnosis such as uterine fibroids. The doctor must take into account the location of the tumor, the direction of its growth, size, spread and morphological structure. The pathological process in most cases develops in the body of the uterus, including the fundus, and only in some cases affects the cervix. The most important influence on the nature of symptoms is the direction of fibroid growth. Based on this, the following node options are distinguished:

Submucosal (in the submucosal layer).
Intramural (in the thickness of the myometrium).
Subserous (in the outer membrane).

Fibroids growing between the uterine ligaments (interligamentous) can also be observed. In turn, the size of the nodes varies very widely: from clinically asymptomatic to those that are comparable to pregnancy for more than 12 weeks. Despite the fact that the tumor grows from the myometrium, it can have a different histological structure:

Mainly muscle - leiomyoma.
Mixed connective tissue-muscular fibromyoma.
Mostly connective tissue - fibroma.

And based on the rate of growth and cellular changes, fibroids can be simple or proliferating. The first is called muscle hyperplasia, and the second is a true tumor with rapid development. In addition, the size of the intramural component in the structure of fibroids and the direction of its growth allow us to form another classification, according to which there are the following types of pathological process:

0 – superficial nodes on the pedicle.
I – having a wide base and embedded in the wall of the uterus (less than half the thickness).
II – the intramural component is allocated more than 50% of the tumor volume.

In terms of prevalence, there is a single uterine fibroid, but most often it is necessary to detect multiple nodular formations. The lesions are located randomly throughout the entire plane of the organ wall.

Each tumor feature indicated in the classification is necessary to make a clinical diagnosis.

Symptoms

The clinical picture of the pathology is very variable. With small sizes, intramural and subserous tumors do not manifest themselves at all. But submucosal lesions, even small ones, can give rise to certain symptoms, which intensify as the fibroids grow. The most common signs include:

Heavy and prolonged periods.
Intermenstrual bleeding.
Pain in the lower abdomen.
Problems conceiving a child.

Submucosal nodes disrupt the functioning of the endometrium, which creates such a picture. Due to severe menometrorrhagia, a woman experiences chronic blood loss, which causes anemia. Characterized by general weakness and fatigue, pale skin and mucous membranes, changes in taste, dizziness, brittle hair and nails. Infertility is caused by both hormonal disorders and local disorders in the uterine wall (tumor nodes prevent normal implantation).

If a large uterine fibroid is diagnosed, symptoms will include disorders of neighboring organs. Women urinate more frequently, develop constipation and chronic pelvic pain. Sometimes shortness of breath and tachycardia occur when lying down - this is the so-called inferior vena cava syndrome, which appears due to compression of the vascular bundle.

As the tumor grows, the risk of complications increases: pedicle torsion and node necrosis. In both cases, signs develop acute abdomen", in particular sharp pain, irritation of the peritoneum, reflex muscle tension and deterioration general condition. This situation requires an urgent response.

During a gynecological examination, the picture also varies. Small submucosal and intramural nodes cannot be palpated. But external tumors manifest themselves in the form of moderately dense, round and inactive foci, which give the impression of a “lumpy uterus”. With large nodes, the organ increases significantly in size, and with complications, diffuse pain appears.

Additional diagnostics

Uterine fibroids must be confirmed using additional diagnostics, because based on clinical data, a tumor can only be assumed. And its characteristics will become known based on the results of instrumental studies:

Ultrasound of the pelvis.
Metrosalpingography.
Hysteroscopy with biopsy.
Diagnostic curettage.
Histological analysis.

To establish the mechanisms of development of fibroids and predisposing factors for their occurrence, laboratory tests should also be performed. The most important is a blood test for the hormonal spectrum (gonadotropins, estrogens, progesterone) and an immunogram. The attending physician may prescribe other tests necessary to identify concomitant disorders.

Additional diagnostic methods make it possible to obtain reliable information about the nature of the tumor process in the uterus and the prerequisites for its development.

Treatment

Treatment measures are determined by how uterine fibroids behave in a particular patient, depend on the size and number of tumor foci, clinical symptoms, and are also carried out taking into account the patient’s age and her reproductive characteristics. Based on the diagnostic results, the doctor creates an individual program for each woman.

Conservative correction

Until now, the question of the advisability of treating asymptomatic tumors remains open. Such patients are most often recommended to undergo ultrasound monitoring every six months to monitor fibroids. If its size increases, then therapeutic correction will have to be carried out.

In the early stages, when the nodes are still small, drug treatment is actively used. Hormone therapy becomes the basis of conservative correction. Considering the important role of regulatory disorders in the origin of the tumor, the following drugs are used to eliminate it:

Progestins (Norkolut, Duphaston).
Gonadotropin antagonists (Danoval).
Agonists of hypothalamic releasing hormones (Triptorelin).

In addition to drugs for systemic use, gynecologists also have in their arsenal local forms hormonal medications. We are talking about an intrauterine pharmacological system called Mirena. It contains the progestin levonorgestrel, which has a local effect directly on tumor nodes in the uterus. If fibroids are accompanied by heavy menstruation and bleeding, then symptomatic correction with the help of hemostatic agents (Dicinone, Vikasol, aminocaproic acid) is necessary.

Operation

Any pathological process, even of a benign nature, must be eliminated. If conservative correction does not help and the tumor continues to develop, then it is necessary to involve surgeons in the treatment of uterine fibroids. Surgery is indicated for large tumor sizes (exceeding 14 weeks), its rapid growth, submucosal localization, complications (pedicle torsion and necrosis), infertility and dysfunction of adjacent organs.

Uterine fibroids are removed in various ways. Recently, preference has been given to organ-preserving operations, which allow the woman to become pregnant in the future. Such interventions include myomectomy or node enucleation (enucleation), hysteroscopic or laparoscopic resection. The choice of technique and access is determined by the location of the tumor, its size and direction of growth. But in advanced cases, when the above methods are no longer effective, radical operations have to be done:

Supravaginal amputation.
Defundation (removal of the uterine fundus).
Extirpation (hysterectomy).

Such interventions are more often performed in women of late reproductive and menopausal age, since they do not make it possible to carry a child to term. But low-traumatic techniques completely preserve menstrual and reproductive functions. After surgery, hormonal drugs are often prescribed to normalize the regulatory processes of the female body.

Modern treatment of fibroids consists of drug correction and surgical interventions aimed at eliminating the tumor.

Traditional methods

Some patients with traditional therapy prefer treatment folk remedies.

Indeed, there are a number of natural components used to suppress the tumor process in the uterus and normalize menstrual function. But, unfortunately, they do not have proven effectiveness and safety, which makes taking such medications not entirely justified. In addition, independent use traditional methods can result in serious consequences, ranging from allergic reactions and ending with disease progression.

Therefore, you should first consult with your doctor and not refuse the traditional therapy prescribed by him. And as a supplement, you can try treatment with the following means:

Tinctures of propolis, marina root, walnuts, celandine.
Infusions of chamomile, St. John's wort, calendula, boron uterus.
A decoction of flaxseeds.
Aloe juice.

Any disease is easier to prevent than to treat. Therefore, it is important for women to undergo regular gynecological examinations. Early detection of a tumor will provide greater effectiveness from conservative therapy. And late stages, unfortunately, will be almost impossible to cure without surgery. But in any case, the doctor will try to do everything possible to restore the impaired functions of the female body.

Fibroids are among the benign tumors of the uterus. The tumor develops from the muscle layer. Let's look at the main causes and symptoms of fibroids, as well as methods for diagnosing and treating the disease.

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

What is uterine fibroid

Uterine fibroids – chronic illness. According to statistics, the tumor is most often diagnosed in women aged 30-40 years. Doctors note that fibroids do not interfere with the normal course of pregnancy. However, there are some features that need to be taken into account when planning it. Problems with conception arise if the tumor is localized in the area of the fallopian tubes, blocking their entrance. In addition, education big size may cause miscarriage or early labor. Therefore, doctors advise identifying and treating fibroids for pregnancy.

Causes of uterine fibroids

The exact reasons for the formation of uterine fibroids have not yet been studied. It has been established that benign neoplasms do not occur in girls before puberty, as well as in women during menopause. Pregnancy provokes an increase in the size of fibroids. After childbirth, the size of the formation returns to its original size. Among the predisposing factors to the development of a tumor are:

obesity;
excessive psycho-emotional stress;
too early or late onset of the menstrual cycle;
a large number of abortions or miscarriages in history;
absence of childbirth before age 30;
chronic diseases of the pelvic organs;
diabetes;
uncontrolled arterial hypertension.

If you have at least one of the above precipitating conditions, it is recommended to undergo regular preventive examination by a doctor.

Symptoms of uterine fibroids

In 70% of cases, fibroids are asymptomatic and only 30% require treatment. Among the main pathological symptoms of uterine fibroids are:

heaviness in the lower abdomen;
heavy menstrual flow;
constipation due to compression of the rectum by the tumor;
painful periods;
increase in abdominal size;
infertility (tubal factor).

Diagnosis of uterine fibroids

Diagnosis of fibroids requires an integrated approach. The further prognosis for life and recovery depends on how timely and accurate the examination is. The diagnostic scope is determined individually depending on the characteristics of the disease.

Gynecological examination

Bimanual examination of the uterus is the initial stage of diagnosing fibroids. The examination allows you to determine the increase in size reproductive organ, as well as the presence of tumor formations. Unfortunately, small tumor volumes are not diagnosed by bimanual examination. Other methods are prescribed for this.

Ultrasound of the pelvic organs

Ultrasound examination is included in the gold standard for diagnosing formations of the pelvic organs. This method is considered one of the safest and most informative. Can be performed via transabdominal, transrectal and transvaginal access.

Transvaginal ultrasound

Transvaginal ultrasound of the pelvic organs allows you to determine the location of fibroids and its size. If necessary after ultrasound examination the doctor prescribes additional instrumental examination methods.

Hysteroscopy

Hysteroscopy is an endoscopic method for examining the uterine cavity. For this purpose, a special device is used - a hysteroscope, which is inserted into the uterine cavity. Hysteroscopy allows you to assess the condition of the uterine mucosa, determine the location of the formation and its size. Not included in the mandatory diagnostic list.

Laparoscopy

Laparoscopy can be performed for both diagnostic and therapeutic purposes. For research, punctures are made in the anterior abdominal wall. Laparoscopic instruments are inserted through them. During diagnosis, it is possible to remove the formations (myomectomy).

CT and MRI of uterine fibroids

CT and MRI are used both to diagnose fibroids and to monitor the tumor over time after treatment. Contrasting enhances the information content of the method. CT and MRI make it possible to determine the size of the formation and its location. Tomography is considered additional method research.

Laboratory research

To detect the presence of blood loss during menstruation, it is necessary to perform general analysis blood, determination of ferritin and iron concentrations.

Treatment of uterine fibroids

An integrated approach is used to treat uterine fibroids. The volume of therapy is determined depending on various factors. These include the size and location of the tumor, the woman’s age, and concomitant diseases. When developing a treatment program, the woman’s desire to preserve reproductive function is taken into account.

Treatment in Moscow

You can undergo diagnosis and treatment of fibroids in our gynecological clinics. Medical centers equipped with modern equipment. It allows you to quickly and accurately determine the location of the tumor formation and its size. Treatment is selected in accordance with the data obtained. An individual program is developed for each patient. This allows you to reduce treatment time and achieve positive results for a minimum period.

Drug treatment

Indications for drug therapy for uterine fibroids are the following conditions:

the size of the formation is no more than 3 cm in diameter;
presence of contraindications for surgical intervention;
menopause

Task drug treatment– reducing the severity of pain, eliminating uterine bleeding, which results in anemia. Main pharmacological groups Treatments prescribed to reduce the symptoms of fibroids include:

hormones;
painkillers;
iron supplements;
anti-inflammatory.

Fibroids form in a hormone-dependent organ. For drug treatment of symptoms, use:

Gestagens. Stabilizes the menstrual cycle. Prescribed for small tumors.
Antigonadotropins. Reduce the production of gonadotropic hormones and estrogen.
Analogues of gonadotropin releasing hormones. Reduce estrogen concentrations.

All of the above drugs have a temporary effect, so after stopping treatment, relapses of the disease often occur.

Surgery

Surgical removal of uterine fibroids is carried out when conservative therapy is ineffective, the size of the tumor increases, infertility occurs due to blockage of the fallopian tubes and deformation of the uterine cavity. Surgery is performed in several ways. Among them are:

Hysterectomy. The most common method. It involves resection of the tumor along with the reproductive organ.
Myomectomy. Involves removal of a pathological benign formation while preserving the uterus
Embolization of the uterine arteries. It is a minimally invasive intervention. The purpose of the procedure is to block blood circulation in the tumor area. As a result, the nodes die and become smaller.

Disease prognosis

The prognosis for life and recovery depends on many factors. These include the size of the fibroids, its location, the woman’s age, and concomitant diseases. Education can be asymptomatic for a long time. In this regard, diagnosis is carried out at the stage when fibroids reach large sizes. With timely detection and high-quality treatment, the prognosis for life and recovery is considered favorable.

Prevention of uterine fibroids

regular gynecological examinations;
weight control;
maintaining an active lifestyle;
eating food rich in vitamins and microelements;
exclusion of abortion.

You can undergo examination and treatment of uterine fibroids in our gynecological clinics. Diagnosis is carried out using modern medical equipment. It allows you to quickly and accurately determine the location and size of a benign neoplasm. An individual treatment plan is developed for each patient. You can make an appointment by phone. Calls are accepted 24 hours a day.

Bibliography

Lipsky A. A.,. Gynecology // Encyclopedic Dictionary of Brockhaus and Efron: in 86 volumes (82 volumes and 4 additional). - St. Petersburg. 1890-1907.
Bodyazhina, V.I. Textbook of gynecology / V.I. Bodyazhina, K.N. Zhmakin. - M.: State Publishing House of Medical Literature, 2010. - 368 p.
Braude, I. L. Operative gynecology / I. L. Braude. - M.: State Publishing House of Medical Literature, 2008. - 728 p.

- a benign tumor, manifested by the appearance of nodules and compactions in the body of the uterus, which can grow in all directions: inward, outward, or directly in the thickness of the uterine body.

Experts say that uterine fibroids are benign education, which has virtually no chance of developing into malignant. However, fibroids create significant discomfort in a woman’s daily life, and therefore every second woman admitted to the department of operative gynecology is forced to undergo a planned operation to remove fibroids. This pathology develops in every fourth woman over thirty and in every third woman on the verge of menopause.

Causes. To date, the exact causes of uterine fibroids have not been fully elucidated, but experts say that malfunctions in the hypothalamus-pituitary-ovaries-uterus system play an important role in the development of this pathology. Despite the fact that there is very little data in this area, many doctors agree with the hypothesis that the root cause of the pathology is the level of the hormone estrogen in a woman’s blood, which increases almost three times during the period of puberty until the onset of menopause.

Genetic predisposition can also play a big role. It has been proven that in families where cases of polycystic ovary syndrome or fibroids have been observed, the risks of developing these pathologies are significantly increased due to increased susceptibility of hormones.

Symptoms

There are three main types:

. Subserous nodes. They develop under the outer lining of the uterine wall and grow outward, giving the uterus a nodular shape. As a rule, subserous nodes do not cause menstrual disorders, but can cause pain in the pelvis, back and put pressure on nearby organs (intestines, bladder, pelvic vessels), causing disruption of their function. Subserous fibroids may be pedunculated (peduncular fibroids), making them difficult to distinguish from the ovary.
. Intramural fibromatous nodes. They develop deep in the muscular wall of the uterus and grow inward, causing an increase in the size of the uterus. This type of uterine fibroid is the most common. Intramural fibromatous nodes can cause excessive uterine bleeding, manifested by pelvic pain and pain in the spine, as well as a feeling of general pressure on the internal organs.
. Submucosal fibromatous nodes develop inside the uterine cavity, under its mucous membrane. This is the least common type of uterine fibroids, however, and they are the most severe. Even a very small submucosal node can cause life-threatening bleeding.

The development of fibroids in most cases is characterized by the appearance of multiple nodules of very different sizes - from one to thirty centimeters, and in some cases more. A rare phenomenon occurs when, due to the growth of nodes, the uterus increases to the size of a five-month pregnancy, and, characteristically, the woman looks pregnant. Individual nodes are extremely rare; most often there are several of them, and they can be located in different layers of the uterine wall.

If the nodules grow slowly, then the disease may not manifest itself for years, despite the large size of the formation at the time of its discovery. Typically, women consult a doctor after discovering bleeding outside of menstruation, pain in the lower abdomen and associated anemia, as well as bladder discomfort, etc.

If the course of the disease is longer, then a dysfunction of the ovaries may be detected, up to the impossibility of ovulation or pathology of the function of the corpus luteum, and this entails an even greater hormonal imbalance. This imbalance can become a stimulus for the formation of cystic ovarian lesions and endometrial hyperplasia.

If the tumor grows quickly, then the symptoms are more pronounced, which is why such patients are treated only one to two years after the onset of fibroids. As a rule, the course of this disease becomes much easier upon the onset of menopause, since the amount of the female sex hormone estrogen becomes less. Despite this, if a woman is still taking synthetic sex hormones during menopause, tumor growth may continue.

Fibroids and pregnancy. There are frequent cases of normal pregnancy, despite the presence of fibroids; it is often detected on an ultrasound examination along with the diagnosis of pregnancy. In this situation, it is necessary to determine the size and location of the nodules, as well as their growth rate. If the doctor is sure that they will not interfere with the normal course of pregnancy and labor, then the woman will be able to give birth to healthy offspring. However, if concerns still arise, it is recommended to use a cesarean section, or, in extreme cases, termination of pregnancy or premature birth.

Diagnostics. Fibromyoma is primarily detected during an examination by a gynecologist.The diagnosis is confirmed using ultrasound. This is a painless procedure that allows specialists to see the size, shape and structure of the uterus.In some cases, transvaginal ultrasound may be necessary. In this case, a sensor is inserted into the vagina, allowing you to see the inside of the uterus more clearly. The slight discomfort associated with this procedure is compensated by its high information content.

Uterine fibroids can also be confirmed using computed tomography(CT) and magnetic resonance imaging (NMR) are also painless diagnostic procedures, providing accurate information about the number and location of fibromatous nodes.

Hysteroscopy - diagnostic method, allowing you to confirm the presence of small submucosal nodes that are difficult to distinguish using the above methods. A long, thin, probe-like instrument is inserted through the vagina and cervix into the uterus, after which the doctor can examine the inside of the uterus and take tissue samples. This procedure, which causes some discomfort, is performed by a gynecologist in a clinic or hospital under local anesthesia.

Treatment. Surgical and conservative techniques are used. Surgery

Initially, unconditional indications for surgical treatment:

submucosal localization of fibroids
large size of the node (the total size corresponds to the uterus of the 14th week of pregnancy)
uterine bleeding accompanied by chronic anemia
fast growth tumors
acute malnutrition of fibroids (torsion of the subserous node, tumor death)
combination of uterine fibroids, endometrial hyperplasia, ovarian tumor
compression of the ureter, bladder, rectum
the presence of a node in the area of the tubal angle of the uterus, which causes infertility
cervical and cervical-isthmus localization
non-regressive and growing uterine fibroids in postmenopausal age.

The extent of surgical intervention is largely determined by the age of the patient.

Up to 40 years of age, if there are indications for surgical treatment, if technical capabilities allow, conservative myomectomy is performed. It is especially advisable to remove medium-sized myomatous nodes (2 to 5 cm in diameter) before they rapidly increase in size. The preferred technique is laparoscopic. Relapses during conservative myomectomy for uterine fibroids occur in 15-37% of cases.

After 40 years and postmenopausal age, in the presence of surgical indications, surgery to remove the myomatous uterus is necessary, because if the fibroid does not regress in the first 2 years of postmenopause, its continued existence is accompanied by the risk of oncology (adenocarcinoma, sarcoma).

Conservative treatment

Conservative treatment, carried out immediately after the identification of small and medium-sized myomatous nodes, allows in some cases to slow down further growth tumors, prevent operations to remove the uterus, preserve the opportunity to give birth to a child.

Indications for conservative treatment:

young age of the patient
small size of the myomatous uterus (up to 10-12 weeks of pregnancy)
intermuscular location of myomatous nodes
relatively slow growth of fibroids
no deformation of the uterine cavity.

Conservative treatment consists of normalizing systemic disorders characteristic of patients with uterine fibroids, including:

chronic anemia,
inflammatory processes of the uterus and appendages,
impaired blood supply to the pelvic organs with a predominance of venous stagnation and a decrease in arterial blood supply,
functional impairment nervous system and vegetative balance.

Methods for correcting systemic disorders include the following:

compliance (normalization of sleep, balanced nutrition, physical activity, giving up bad habits, controlling body weight);
normalization of sex life;
periodic intake of vitamins and microelements in the winter-spring period;
treatment of anemia;
neurotropic effects if the patient exhibits traits of a disharmonious personality.

If pregnancy occurs, even if not planned, it is necessary to preserve it, because postpartum uterine reduction, breast-feeding a child of at least 4-6 months contribute to a change in the composition of fibroids, its transition to simple and, in some cases, the cessation of its further development.

To prevent the inevitable removal of the uterus when the tumor grows, the preservation and maintenance of reproductive function up to 40 years is of great importance.

The effectiveness of hormonal therapy varies greatly depending on the nature of hormonal disorders, the presence and density of receptors in myomatous nodes and myometrium. In fibroids, where connective tissue predominates, as well as in large nodes, hormonal receptors are usually absent. That's why hormone therapy in these patients it is of little effectiveness.

However, it is used to correct irregular menstrual cycles. For this purpose, progesterone and its derivatives (dydrogesterone, cyproterone acetate), as well as androgen derivatives, 19-norsteroids (levonorgestrel, norethisterone acetate) are used. The latter are undesirable at a young age, with obesity, diabetes, and cardiovascular diseases.

The most promising drugs in the treatment of patients with uterine fibroids are antigonadotropins (gestrinone, danazol), which have an antiestrogenic and antiprogesterone effect, causing temporary amenorrhea, as well as gonadotropin-releasing hormone agonists (triptorelin, goserelin, buserelin), which cause a state of reversible hypogonadism.

Registered in Russia the following drugs antigonadotropins:

Depot-goserelin 3.6 mg s.c.; triptorelin 3.75 mg IM and SC; leuprorelin 3.75 mg IM The drug is a ready-made kit with various methods of administration. Treatment begins on days 2-4 of the menstrual cycle: 1 injection every 28 days.
Endonasal spray - 0.2% solution of buserelin acetate 0.9 mg per day. Treatment begins on days 1-2 of the menstrual cycle: 0.15 mg in each nasal passage 3 times a day at equal intervals.

Preparation for surgery with the help of antigonadotropins in the presence of uterine fibroids allows for gentle organ-preserving operations using endoscopic techniques.

To date, several strategies for long-term therapy with antigonadotropins have been described to avoid severe side effects while maintaining high clinical effectiveness:

Add-back regimen - a combination of antigonadotropins with small doses of estradiol.
On-off mode - therapy with antigonadotropins in intermittent courses (three-month therapy with a three-month break for up to 2 years).
Drow-back - the use of high doses of antigonadotropins for 8 weeks with a transition to lower doses of the drug for 18 weeks.

The likely response to treatment can be predicted in most cases 4 weeks after the first injection.

The drugs are well tolerated, do not have antigenic properties, do not accumulate, and do not affect lipid spectrum blood. Side effects: hot flashes, sweating, vaginal dryness, headache, depression, nervousness, changes in libido, seborrhea, peripheral edema, deterioration of prospective memory, decreased bone density.

Discontinuation of therapy leads to the restoration of the normal menstrual cycle and estrogen status approximately 60-100 days after discontinuation of the drug and the rapid re-growth of uterine fibroids to their original size (during the first 3-4 menstrual cycles) with all clinical symptoms(although some authors note that these symptoms are less severe).

Uterine fibroids are a benign formation that grows in the muscular layer of the reproductive organ. The disease develops over many years, is asymptomatic for a long time and is accompanied by clinical manifestations mainly at the age of 30-50 years. The tumor grows throughout the reproductive period and regresses at menopause. The nature of the course of the disease is determined by the size and location of the nodes, their number and the presence of concomitant pathology.

The clinical course of fibroids is no different from uterine fibroids. The difference is known only to the doctor ultrasound diagnostics and a pathologist. These specialists can recognize fibroids and give a detailed description of the tumor. The special histological structure of the node has some influence on the course of the disease and prognosis, but is not a key factor in the choice of treatment method - both conservative and surgical.

Such different uterine fibroids

The national manual for obstetricians and gynecologists states that fibroids are a benign hormone-sensitive proliferation consisting of altered smooth muscles of the myometrium. The terms "fibroma", "fibromyoma" and "leiomyoma" are stated as synonyms. By and large, this is true. In the routine practice of a local gynecologist, it does not really matter what kind of tumor is growing in the uterus - leiomyoma or fibromyoma. The causes, symptoms, diagnostic and treatment methods for each of these pathologies will be similar.

Since benign tumors have a lot in common, in everyday life both gynecologists and patients can call these pathologies fibroma, myoma, fibromyoma, and leiomyoma.

Histologists and pathologists do not agree with this interpretation and point out that fibroids are a tumor that contains both muscle and connective tissue fibers in approximately equal proportions. These specialists divide all benign uterine tumors into two types:

Leiomyoma is a node, mostly consisting of muscle tissue;
Fibroma is a tumor in which more than 50% is occupied by connective tissue fibers.

Fibroids of the uterine body is an intermediate condition in which the amount of muscle and connective tissue its composition is approximately equal. In the International Classification of Diseases (ICD-10), all these conditions come under one code - D25, since for a practicing gynecologist the difference between them is insignificant and is rather of research interest (in histology and pathological anatomy).

On a note

The term “fibroids” can hide any type of tumor, and only tissue analysis will show what kind of node is located in the uterus.

To determine the type of myomatous node, it is necessary to analyze the tumor tissue.

Causes of the disease and key risk factors

Fibromatosis is considered a condition preceding the appearance of a uterine tumor. This term refers to the diffuse proliferation of pathological foci. It is impossible to single out one node among the rudiments of fibroids. The uterus slightly increases in size, but does not become deformed. At this stage, the disease is usually asymptomatic and detected incidentally during ultrasound.

The appearance of a fibromatous node is preceded by the following conditions:

Early sexual development: the onset of the first menstruation before the age of 12, the appearance of secondary sexual characteristics before the age of 9;
Refusal to have a child. The likelihood of developing the disease increases in nulliparous women after the age of 30;
Late first birth (30-45 years);
Previous abortions or miscarriages. A single termination of pregnancy can also provoke the growth of a myomatous node, but more often we are talking about numerous curettages of the uterine cavity that accompany this process;
Instrumental interventions on the reproductive organs;
Previous operations on the uterus;
Traumatic and protracted labor;
Overweight and obesity;
Prolonged stressful situations.

Women who are obese are more likely to develop uterine fibroids.

All these conditions provoke an increase in the level of estrogen in the body and thereby trigger cell proliferation. During repeatedly repeated cycles of hyperplasia, phenotypically altered smooth muscle cells accumulate, from which the rudiment of fibroleiomyoma is subsequently formed. The medical history of a woman with a uterine tumor almost always contains data indicating a burdened gynecological history. Pathology is also detected in nulliparous young patients, but such cases are much less common.

On a note

Pelvic inflammatory disease is also considered a risk factor for the development of fibroids. Endometritis does not increase estrogen levels, but weakens the body's immune defense and contributes to the disruption of apoptosis - natural programmed cell death. Proliferation of myocytes leads to the appearance of fibromyoma rudiments and subsequently to its active growth.

In modern gynecology, attention is paid not only to estrogen, but also to progesterone - another female hormone. Studies have shown that the tumor grows during pregnancy, as well as when gestagens are prescribed (Duphaston, Utrozhestan). In this regard, the period of gestation, as well as the use of hormonal drugs, should be considered risk factors for the development of the disease.

Practice shows that fibroids continue to grow during pregnancy.

Other theories of the appearance of fibroids also deserve attention:

Frequent ovulation. A modern woman gives birth to a child once or twice. The rest of the time, her body undergoes monthly maturation of follicles, the formation of a dominant one among them, and ovulation. Each cycle, the uterus prepares for a possible pregnancy by growing the endometrial layer. Muscle tissues also proliferate, which provokes their uncontrolled growth and the appearance of a tumor;
Injuries and operations on the uterus. Damage to myometrial tissue can lead to improper restoration and activation of cell division, which also provokes the appearance of a myomatous node.

There is no difference in the development of leiomyoma and fibroma. The reasons for the appearance of each type of tumor are the same. At a certain stage of proliferation, more connective or muscle fibers accumulate in the tissues of the node, and this determines its type.

It is important to know

Benign tumors of the uterus grow during the reproductive period and are practically not detected in adolescents. Fibroids in a virgin are rare. In practice, such situations occur if the patient remains a virgin at the age of 25 years or older. Gynecologists call irregular sex life or its absence one of the risk factors for the development of uterine fibroids.

The photo below shows the types of fibroids:

Subserous - located close to the outer layer, can protrude beyond the uterus on a stalk;
Interstitial – located inside the walls of the organ;
Submucosal - exits into the uterine cavity.

Particularly distinguished are nodes located in the cervix or extending into the vagina.

Types of myomatous nodes depending on their location.

Clinical picture of the disease: how to understand that there is a tumor in the uterus?

The following diagnostic criteria help to suspect the development of the disease:

Changes in the nature of menstruation. If your periods become heavy and prolonged, you should undergo an ultrasound and find out if there is any benign tumor. Nodes located submucosally or intramurally change the nature of menstruation, increasing their duration and volume. Often there are nagging pains in the lower abdomen and lower back, which disappear after the bleeding is completed. Subserous tumors do not affect menstruation and remain asymptomatic for a long time;
Uterine bleeding. If heavy menstruation does not end, the amount of blood loss increases, the woman’s condition worsens, you should see a doctor (if there is heavy bleeding, call ambulance). This symptom occurs in many gynecological diseases, and fibroids are only one of the likely diagnoses;
Intermenstrual acyclic bleeding. Such a sign may indicate both fibroids and endometrial hyperplasia, so you cannot do without consulting a doctor. Acyclic bleeding occurs mainly with interstitial multiple formations, when almost all muscle layer the uterus is deformed and is not able to fully contract;
Chronic pain syndrome. Pain is not the main symptom of fibroids. This tumor often makes itself felt by menstrual irregularities. In the early stages there is no pain, and only as the node grows does an unpleasant pulling sensation appear in the lower abdomen. The pain can radiate to the sacrum and lumbar region, and be felt in the thigh and perineum. With large fibroids, tingling sensations are observed under the ribs, in the epigastric region;
Weight gain and belly growth. Occurs with large and giant tumors. Fibroids can reach significant sizes, up to the size of a full-term pregnancy, and it is impossible not to notice such a formation.

One of the signs of the presence of large fibroids in the uterine cavity is an increase in the size of a woman’s abdomen.

Fibroids are dangerous due to their complications that arise when the node grows rapidly and therapy is refused. A tumor in the uterus can provoke the development of the following conditions:

Feeling unwell, general weakness, tinnitus, rapid heartbeat and dizziness are all signs iron deficiency anemia. Iron deficiency occurs due to blood loss during menstruation or in the middle of the cycle, after heavy bleeding. This condition may be accompanied by a decrease blood pressure and fainting;
Frequent urination. Occurs with subserous tumors pressing on the bladder. Giant formations can block the lumen of the ureter or urethra and lead to acute urinary retention;
Constipation is another sign of subperitoneal fibroids pressing on the rectum. In advanced cases, the tumor can lead to intestinal obstruction;
Severe abdominal pain occurs when the fibroid stalk is torsioned and necrosis develops. The pain becomes cramping and may appear bloody discharge from the vagina, increased body temperature, nausea and vomiting;
Cramping pain radiating to the perineum indicates the birth of a submucosal node. Expulsion of the tumor is accompanied by bleeding.

The birth of a myomatous node and its exit into the vaginal cavity causes a woman severe pain, reminiscent of labor pains.

Pregnancy with fibroids: what does the prognosis depend on?

It is important for all women dreaming of motherhood to know:

Conceiving a child with uterine fibroids is possible. A small tumor does not interfere with fertilization and gestation;
The best prognosis is given for subserous formations. Myoma, located outside the uterus, practically does not interfere with the course of pregnancy;
Submucosal nodes are unfavorable for motherhood. A tumor extending into the uterine cavity deforms it, preventing fertilization and bearing a child. With submucosal formations, miscarriage often occurs for up to 12 weeks;
Fibroids can grow during pregnancy, increasing by a quarter of their original size. The maximum growth of the node is observed in the first half of gestation;
During pregnancy, the blood supply to fibroids is disrupted, which can lead to tumor necrosis and require urgent surgery.

It is important to know

Gynecologists advise undergoing a full examination before pregnancy in order not only to detect a tumor, but also to receive treatment before conceiving a child. Competent therapy will reduce the risk of complications and increase the chances of a favorable outcome.

Since fibroids can grow during pregnancy, it is better to do a full examination in advance and undergo the prescribed course of treatment.

Why does the tumor grow?

Fibroids have one peculiarity - they grow rather slowly. Connective tissue fibers do not proliferate too quickly, so such a tumor may not change for years. Only fibroma increases in size more slowly - a node consisting of more than 50% connective tissue. Leiomyomas are muscle formations that grow rapidly.

Changing the size of a node is affected by the following states:

Pregnancy and childbirth. Some fibroids grow during gestation, while others, on the contrary, shrink. It has been noticed that with small nodes the probability of their regression is slightly higher;
Abortions and miscarriages. Any hormonal changes and surgical interventions on the uterus there is a risk of uncontrolled growth of a node;
Climax. With the onset of menopause, the production of sex hormones decreases, which leads to natural regression of the tumor. If the formation increases after the onset of menopause and grows after the age of 50-60, you should immediately be examined by a gynecologist. Such symptoms occur during the formation of sarcoma - a malignant tumor of the uterus;

During menopause, benign neoplasms, as a rule, tend to decrease. If the tumor grows, this may be a sign of malignancy of the tumor.

Taking hormonal drugs. Some medications cause fibroids to shrink in size, while others promote their growth.

The effect of heat on the growth of fibroids has not been proven, but doctors do not advise their patients to get involved in procedures related to warming up the body. If rapid growth of education is noticed (more than 4 weeks per year), you should not play sports, stay on the beach for a long time, or visit the bathhouse, sauna, or solarium.

It is important to know

IN last years fibroids are no longer considered a precancerous condition, but oncological suspicion remains. Sarcoma and fibroids are accompanied by the appearance of similar symptoms, so it is possible to distinguish one condition from another only after a complete examination. Fibroma cannot degenerate into cancer, but the possibility of the simultaneous development of a malignant tumor in the altered or intact myometrium cannot be excluded.

Tactics for suspected fibroids

To identify a tumor, the following is carried out:

Examination by a gynecologist. During a bimanual examination of the uterus, the doctor pays attention to its enlargement and the presence of nodes. For small tumors, no significant changes are observed;
Laboratory examination for fibroids is not indicative. The doctor may recommend a blood test for hormones to identify concomitant pathologies, determine tumor markers if sarcoma is suspected;
Ultrasonography. On ultrasound, fibroids are visible as a hypoechoic formation. During the examination, areas of connective tissue occupying up to 50% of the tumor are determined;
Hysteroscopy. Allows you to identify submucosal nodes, distinguish them from polyps, take aspirate from the uterine cavity, and conduct diagnostic curettage;

One of the types of diagnostics of neoplasms in the uterus is hysteroscopy, with which you can see pathological changes and take a tissue sample.

Laparoscopy. Indicated for subserous formations, compression of the pelvic organs by a tumor;
Histological examination of macro- and microspecimens is carried out after removal of the node. Allows you to identify the type of tumor and distinguish malignant from benign.

On a note

Uterine fibroids are often accompanied by other pathologies reproductive organs(polyps and endometrial hyperplasia, adenomyosis, ovarian cysts). Also, examination often reveals mastopathy, pathology thyroid gland(hypothyroidism).

Principles of therapy: how to treat?

During reproductive age, fibroids cannot resolve on their own, so sooner or later a patient with fibroids will need therapy. The choice of treatment method depends on the size of the node. All formations are divided into several types:

Small: up to 2.5 cm and up to 5-6 weeks of uterine enlargement;
Average: 2.5-5 cm and 6-12 weeks;
Large: from 5 cm and from 12 weeks.

The ultrasound photo shows a large tumor.

The size of the tumor is important for selecting drug therapy, as well as determining the method of surgery. Characteristics of fibroids depending on their size are presented in the table.

Fibroids size	Clinical manifestations	Drug treatment	Surgery
Clinically insignificant fibroids (up to 2 cm)	There are no symptoms of the disease	Not carried out. Hormonal therapy may be prescribed for infertility due to fibroids, when other causes of this condition are excluded	Indicated only when the node is located in the cervix, when the tumor interferes with conception and pregnancy
Small fibroids (up to 2.5 cm)	Asymptomatic (interstitial and subserous tumors) or menstrual irregularities (submucosal nodes)	Gonadotropin-releasing hormone agonists, progesterone receptor modulators, antiprogesterone drugs, COCs	Performed only in case of infertility or miscarriage due to fibroids: UAE, conservative laparoscopic myomectomy
Medium-sized fibroids (up to 5 cm)	Menstrual irregularities, uterine bleeding, chronic pelvic pain		Uterine artery embolization, conservative laparoscopic myomectomy
Large fibroids (from 5 cm)	The entire clinical picture of the disease with the development of complications	Hormonal drugs as preparation for surgery to reduce the size of the node	Uterine artery embolization, conservative laparoscopic or abdominal myomectomy, hysterectomy

12 important questions about fibroids:

Do fibroids need to be stopped? Yes, if the tumor grows, is accompanied by the appearance of clinical symptoms, and interferes with a full life and the conception of a child;
Is it possible to cure the disease without surgery? If the tumor is less than 3 cm in diameter, hormonal drugs to reduce the size of the node. Medicines do not lead to complete regression of fibroids, but they inhibit their growth, help gain time for pregnancy and childbirth, or allow them to survive until menopause;

In certain cases, hormonal drugs can stop the growth of small fibroids.

Should fibroids be removed before pregnancy? Yes, if it is a tumor larger than 2.5 cm and it prevents conception and bearing a child;
Is surgery always necessary for a benign tumor? No, if the nodule is small, you can manage with conservative methods - taking hormones;
What is the best way to treat a tumor – with pills or injections? Priority is given to injectable depot forms - one injection is valid for 28 days;
Should fibroids be removed during menopause? Yes, if the tumor grows, provokes bleeding and leads to the development of other complications;
Can the disease be cured by outpatient radio wave surgery? No, this method is not used in the treatment of uterine tumors;
If fibroids are not removed, will they develop into cancer? No, a tumor of the muscular layer of the uterus almost never transforms into a sarcoma, and even the rapid growth of a node does not always indicate an oncological process;
Is it possible to cure fibroids with folk remedies (ASD-2, herbal decoctions - boron uterus, red brush, celandine, half-palm, etc.)? Non-hormonal drugs cannot make fibroids disappear, but they help strengthen the immune system and increase the chances of a favorable outcome of the disease;

Some means traditional medicine have a positive effect on immune system, however, they are not able to completely get rid of the tumor.

Are suppositories with antiseptics and antibiotics used for fibroids? No, such drugs do not affect the growth of the node, but can be used to treat concomitant pathologies;
How long is sick leave given after removal of a benign tumor? Depending on the type of surgery sick leave issued for a period from several days to 1.5-2 months;
Is disability allowed after removal of fibroids? If the outcome of the operation is favorable, only the tumor is removed, and after recovery the woman can return to her normal life. Disability can result from the development of serious complications, after which the patient’s ability to work is lost completely or partially.

Uterine fibroids are treated by an obstetrician-gynecologist. According to indications and when complications develop, other specialists are involved (proctologist, urologist). The earlier the disease is detected, the less the amount of medical intervention and the better the prognosis. For timely detection of fibroids, it is recommended to visit a gynecologist at least once every 6 months, even in the absence of complaints.