What is dangerous multiple uterine fibroids. Multiple uterine fibroids: types, causes, methods of diagnosis and treatment

Article last updated 07.12.2019

One of the most common types of cancer reproductive system in women is fibroids. The disease is characterized by a benign abnormal growth of the tissues of the uterine organ. There are single formations and multiple uterine fibroids. The multiple form occurs much more frequently and can lead to severe complications.

Several myoma nodes will grow on the uterus at once, which differ different sizes and types.

Science divides the uterine nodes into several categories.

Depending on the size, they are as follows:

• Small forms not exceeding 20 mm
• Medium no more than 60 mm
• And large from 60 mm and above

According to the location of the tumor in the uterus, the following types are distinguished:

• - myometrium nodes are formed under the mucous layer of the organ. They are adjacent to the body of the uterus.
• Interstitial fibroids nodes are located in muscle layer walls of the uterus.
• Subserous myoma- nodes cover the outer side of the organ and are attached to the uterus with the help of legs. They are also called subperitoneal, as they grow towards the abdominal cavity.
• Intraligamentary fibroids- such nodes appear in the interconnective space.
• cervical fibroids- develops on the cervix.

As a rule, the multiple form of uterine fibroids entails a violation of the functions of the entire reproductive system. The menstrual cycle gets off, there are pains in the abdomen, it becomes difficult for a woman to conceive a child.

Causes

A multiple tumor on the uterus develops for a number of reasons:

• Violation of the processes of cell division in the tissues of smooth muscle fibers.
• Spasm of the arteries during menstruation, leading to ischemia.
• Inflammatory diseases of the pelvic organs: endometriosis, metroendometritis, adenomyosis, etc.
• Hormonal failure, causing a high concentration of estrogens - female sex hormones.
• Low levels of progesterone in the blood.
• Injury to the inner layer of the uterus as a result of several abortions, operations.
• Long-term use of hormonal contraceptives and wearing an IUD.

In addition to the main causes, there are also risk factors that can trigger the development of the disease:

• hereditary predisposition
• Chronic fatigue and stress
• Hypothyroidism and obesity
• Prolonged lack of sexual activity and dissatisfaction in the sexual sphere
• Permanently postponing pregnancy

If you have found any items from the above list, do not rush to panic, fibroids do not always occur for obvious reasons. A completely healthy woman can also develop a tumor, and such cases are not rare. But still, it is better to visit a specialist in order to undergo an examination to exclude the disease or its early detection.

Symptoms of the disease

With small sizes of myomatous nodes and at an early stage of the pathological process, the tumor does not manifest itself in any way. Only a doctor on ultrasound can detect a neoplasm on the uterus.

But if you have a large multiple uterine fibroids, and even with submucosal or intramural types of nodes, then you will certainly feel the following symptoms:

• Acyclic bleeding that occurs in the middle of the menstrual cycle and leads to large blood loss.
• Cyclical haemorrhages with large volume of blood and sensitive pains.
• As a result, anemia and pallor of the skin develop.
• Pay attention to the nature of the pain. If they are pulling, long-lasting and do not depend on the cycle, then most likely you have muscle type fibroids. When the pain is cramping, sharp and occurs during menstruation, this indicates a submucosal type of tumor.

• If the number of nodes is significant and their size is constantly increasing, then the work of organs close in location to the uterus is disrupted. There are problems with urination and the act of defecation.

Due to the multiple form of oncology, the mucous layer of the uterus is gradually deformed and may completely cease to perform its function.

If you do not detect the disease in time, you can get serious complications. For example, torsion of the pedicle of fibroids with subserous formations leads to tissue necrosis and the development of a purulent process in the peritoneal region.

Multiple fibroids and pregnancy

Numerous nodes on the uterus affect both the process of fertilization itself and the period of pregnancy in a woman. A separate type of oncology, such as a small subserous node, will not adversely affect the function reproductive organ. However, during childbearing, myomatous formations can behave differently. Some fibroids begin to increase in size, others, on the contrary, fade away or freeze.

• The neoplasm itself does not allow the egg to enter the uterus due to the high pressure on the fallopian tubes.
• Also, in the presence of a tumor, the patency of the cervical canal is impaired. This prevents normal fertilization.
• Various concomitant pathologies of the endometrium do not allow the egg to attach to the body of the uterus and interfere with the onset of pregnancy.

If pregnancy does occur, then there are certain risks and complications in the course of its course:

• High uterine tone contributes to arbitrary miscarriage in the early stages.
• When the nodes are located close to the placenta, its detachment or early aging may occur.
• There is a high probability of premature birth, sudden bleeding.
• In the worst cases, fetal malnutrition and the development of anatomical defects occur.
• The very process of delivery can be weakened in the presence of fibroids.

It is important to know that after surgery to remove multiple fibroids, you should not plan to conceive for at least a year so that the body and its hormonal levels can recover properly.

Diagnosis of the disease

First, the doctor examines the patient on the gynecological chair. The specialist can determine how much the uterus is enlarged in size, examine the surface of the organ, the mobility of the nodes and their number.

The main diagnosis of the disease is carried out by instrumental methods:

• Doppler ultrasound helps to determine the exact number of nodes, their position on the uterus, the nature of the blood flow.
• Hysteroscopy and MRI of the reproductive organs clarify some of the nuances of the course of fibroids, especially of the submucosal type.

• The method of diagnostic laparoscopy is aimed at distinguishing subserous fibroids from severe pathology of the ovaries and peritoneal tumors.
• Histological biopsy determines the nature of tumor tissues and their possible malignancy.

In addition to the above diagnostic methods, the doctor prescribes blood tests for the hormonal composition to the woman, examines the discharge and takes a smear.

And only after receiving all the information about the pathological process, the gynecologist decides which treatment is better to choose in a particular case.

Treatment of multiple fibroids

Treatment of fibroids is always selected individually. The choice of method depends on many factors: the behavior and nature of the neoplasm, the symptoms of the disease, the patient's well-being, the age of the woman and her desire to have a baby in the future.

conservative method

This treatment is prescribed in the absence of complications and the mild course of the disease. It consists in taking special medications that can affect the hormonal background of the body. These drugs include:

• Gonadoliberin agonists - Diferelin, Buserelin.
• Antigonadotropic drugs - Danazol, Gestrinone.

• Gestagen preparations - Norkolut, Dydrogesterone.
• Antiestrogen drugs - Tamoxifen.
• Progesterone antagonists - mifepristone, etc.
• Patients who are of reproductive age are prescribed combined oral contraceptives with low doses of active ingredients.
• Mirena has a good effect on the treatment of fibroids.

The intake of any hormonal drug should be monitored by a doctor. Women must strictly follow all specialist instructions and medication regimens.

Operational method

Surgical treatment of multiple forms of fibroids is indicated in cases of severe disease.

1. If a woman has severe uterine bleeding.
2. The large size of the uterus with a myomatous node and the accelerated development of the process.
3. Infertility and difficulty bearing a fetus.
4. Severe pain and too low hemoglobin levels.
5. Violation of the work of neighboring organs.
6. Necrosis of tumor tissues and the development of an inflammatory-infectious process.

The type of surgical intervention is determined individually. When a woman plans future pregnancy, then doctors perform organ-preserving operations:

1. Myomectomy
2. Hysteroresectoscopy
3. Embolization of the uterine arteries

If the pathology is complicated by other diseases, when a woman is already in the menopause period or when fibroids degenerate into cancer, it is recommended that the uterus be completely removed along with the tumor from the body or its supravaginal amputation.

All women who are seen by a specialist with a diagnosis of multiple fibroids are supposed to have regular ultrasound scans, at least once every 6 months.

It is forbidden to stay in the sun for a long time and any warming procedures in the form of baths, a solarium, as well as massage in the lumbar region.

Services table

Multiple nodular uterine fibroids: what is it?

Multiple (multiple) uterine fibroids is the presence in the reproductive organ of two or more benign nodes, consisting of hypertrophied cells of the middle layer of the uterus - myometrium.

Uterine fibroids mixed form: what is it?

Multiple nodes of uterine fibroids can be located completely in its various layers: both in the subserous, in the myometrium and intramurally.

Such a pathological condition is sometimes called mixed uterine fibroids, since the nodes are localized in different places of the organ and can give completely versatile symptoms, mixed, characteristic of both subserous localization of the neoplasm and submucous. This pathology is not uncommon, but rather, on the contrary, about 70% of uterine fibroids encountered in women are multiple. It was previously believed that this disease is more pathognomonic for women in the age group after 35 years, but at present, the incidence statistics are inexorably growing and indicate a rejuvenation of the incidence. So now and at the age of 20, doctors make such diagnoses.

Multiple fibroids in one uterus can be characterized by both different localization and size: small ones have dimensions not exceeding two centimeters, medium ones - from two to six centimeters, and large ones - more than 6 centimeters, respectively.

Etiological factors that affect the hypersensitivity of myocytes can be both inflammatory processes, traumatic factors, medical interventions on the organs of the female reproductive system, and genetic factors.

The pathogenesis of such neoplasms also has a hormonal character, which consists in influencing compromised muscle cells uterus of increased estrogen background.

In myomatous nodes, two stages of development are distinguished, characterized by different sources of estrogenic effects: so at the initial stage, the growth of nodes occurs due to a general altered hormonal background with a component of hyperestrogenism, when subsequently such formations become independent of the general hormonal background, and autonomously synthesize estrogens, which support the development of these nodes.

The clinical picture of this pathological condition depends on the size of the formation, as well as the anatomical location of the myomatous nodes.

Multiple small uterine fibroids

If the size of the nodes of even multiple fibroids is insignificant, then there may be no clinical symptoms at all. Such a fibroid may be an accidental finding during a routine examination by a gynecologist or a preventive examination. ultrasound.

The symptoms mainly depend on where the nodes are located: if there is a submucosal node, then the symptoms can manifest themselves in the form of heavy menstruation, uncharacteristic for a particular woman, cramping pains in the lower abdomen. Such blood loss leads to increased blood loss, which is not physiological, but pathological. And as a result, complications such as posthemorrhagic anemia develop, that is, a decrease in the level of hemoglobin in a clinical blood test.

Complaints of fatigue join, fatigue, decreased performance.

What is the danger of multiple uterine fibroids of large sizes?

A striking manifestation of myomatous nodes is pain syndrome, which can be both slightly pronounced and quite intense. Pain can be given both by multiple uterine fibroids with a subserous node, which compress nearby organs and nerve plexuses, and submucosal fibroids, especially on a thin stalk, which turn into newborns over time. With this type of myomatous neoplasms, pain acquires a cramping character, sometimes dagger-like, penetrating. Treatment of such fibroids should be carried out as soon as possible in an operative way to prevent malnutrition of the node, and in the future its necrosis. there are also signs of compression of neighboring organs, which have clinical symptoms of constipation, intestinal colic, intestinal obstruction, cystitis, frequent urination, on the contrary, lack of urination, also with large tumors, the outflow of urine from the kidneys can be disturbed, thereby appearing a clinic of pyelonephritis, hydronephrosis, accompanied by hyperthermic reactions, pain in the lumbar region from the affected organ.

What is multiple uterine fibroids and pregnancy: can it occur?

One of the frequent complaints of women in the presence of uterine fibroids is infertility, despite repeated attempts to conceive a child, none of them are successful.
Of course, this situation requires urgent treatment, since the more the process is started, the worse the consequences will be for the woman's reproductive system and her reproductive function.

To identify such a pathological process, a complex of clinical and laboratory examinations should be prescribed to confirm or refute this pathological process. These include a gynecological examination by an obstetrician-gynecologist, ultrasound examination with both abdominal and vaginal probes, ultrasound Doppler blood flow in the nodes, and magnetic resonance imaging. minimally invasive technologies such as hysteroscopy and laparoscopy are also used, which, in turn, can be both diagnostic and therapeutic.

Treatment also depends on many parameters of myoma formations.

With the diagnosis of multiple uterine fibroids, treatment without surgery can be carried out with a small size of fibroids. With significant size, compression of adjacent organs, symptomatic fibroids, surgical treatment is indicated.

Multiple uterine fibroids: symptoms

Symptoms or clinical manifestations multiple uterine fibroids can be:

• Menorrhagia - increased uterine bleeding;
• Acyclic uterine bleeding - bleeding that did not start according to the cycle schedule;
• Pain in the lower abdomen from slight discomfort in the lower abdomen to dagger piercing pains;
• Posthemorrhagic iron deficiency anemia;

Signs of impaired function of adjacent organs as a result of their compression of large uterine fibroids: constipation, impaired defecation, impaired urine outflow and dysuric manifestations.

Signs of multiple uterine fibroids

All signs of uterine fibroids depend on its location in the uterus, where exactly the tumor is localized: in the body or neck, intramural or subserous. And also the size of fibroids plays a huge role in the appearance of its signs.

So large subserous fibroids begin to manifest themselves with significant pain in the lower abdomen, pressure on anus, constipation, and frequent urination.

Submucosal fibroids can be suspected on such a basis as an increase in menstrual blood loss, that is, a woman’s periods become more abundant and after they end, the woman feels significant weakness and fatigue.

How to treat multiple uterine fibroids?

Treatment of such a diagnosis as multiple uterine fibroids can be of three types:

1. conservative therapy;
2. Operative treatment;
3. combination therapy;

Conservative therapy consists in the use of medications such as:

• Combined oral contraceptives, drugs that combine in their composition an estrogen and a progestogen drug;
• Gonadotropin-releasing hormone agonists;
• Antagonists of gonadotropin-releasing hormones;
• Gestagens both in the form of capsules and in the form of intrauterine devices;
• Antiestrogenic drugs;

Surgical treatment can be performed in three ways: laparotomically, laparoscopically, hysteroscopically, and operations are divided into:

Organ-preserving - surgical interventions that make up the organ itself - the uterus. These include myomectomy - the removal of only myoma formation.

Radical - involve the removal of the uterus or part of it (defundation, supravaginal amputation or extirpation of the uterus).

Only a doctor should prescribe therapy in each case, individually approaching, with a diagnosis of multiple uterine fibroids, treatment with folk remedies only delays the process and aggravates the patient's condition.

Multiple uterine fibroids: operation, reviews

Removal of multiple uterine fibroids is indicated for small neoplasms and the presence of an expected effect after such an operation. To remove a separate myomatous node, a conservative myomectomy is chosen, accesses are also selected depending on the size of the tumor. With its impressive size, of course, the doctor chooses a laparotomy access, and with minor - laparoscopy. With submucosal localization, hysteroresectoscopy is performed.

However, the opinion of doctors coincides with multiple uterine fibroids - removal of the uterus is effective. Such surgical interventions can be performed laparotomically or vaginally. There are combined surgical interventions that involve the implementation of the laparoscopic part of the removal of the uterus, followed by the vaginal stage.

In modern medical technologies, an innovation has appeared in the tactics of treating fibroids - embolization of the uterine arteries. The meaning of this procedure is the introduction of emboli (in other words, blood clots) into the vessels that feed the tumors. As a result of the cessation of blood circulation in them, necrotization and a decrease in this myomatous formation occur.

Also, a non-invasive method for removing fibroids is currently FUS-ablation - the use of an ultrasonic wave of a certain frequency, which is aimed at myoma formation, as a result of which the tissues are heated to a temperature of 60 degrees and the tumor tissue is simply necrotic. Due to the non-invasiveness of this method, doctors are increasingly giving preference to this method.

But we repeat that only a doctor can adequately evaluate all the data of objective research methods and choose the tactics of surgical intervention in each case, taking into account all the nuances of a particular woman.

Can you get pregnant with multiple uterine fibroids?

Of course, you can, however, it is worth noting that it all depends on the size of the myomatous tumor and its location. These characteristics of the neoplasm appear in all matters relating to this diagnosis.

With a small uterine myoma, its subserous location, albeit a few nodes, pregnancy is quite real. However, if we are talking about a large submucosal fibroid that deforms the uterine cavity, as well as a fibroid that is located in the cervix or close to the internal uterine os, then the chances of pregnancy in this case are very small. The large sizes of tumors also negatively affect the gestational period, as they can cause complications such as placental abruption, placental dysfunction, chronic fetal hypoxia, which ultimately leads to intrauterine growth retardation syndrome and fetal distress. In the most deplorable cases, there may be a threat of termination of pregnancy, the threat of premature birth, as well as antenatal death of the fetus.

A very important point is the monitoring of Doppler parameters of blood flow in the vessels feeding the tumor. Since there may be complications associated with malnutrition of the node and their necrosis.

Who gave birth with multiple uterine fibroids, reviews?

With this diagnosis, the birth plan can be chosen both through the natural birth canal and by caesarean section. If the tumors are small in size and do not interfere with the process of childbirth, then natural delivery is quite indicated. And if the tumor is located in the area of ​​\u200b\u200bthe internal pharynx and cervix, then such childbirth is impossible and the woman must be delivered by caesarean section.

Multiple uterine fibroids is a tumor-like disease that occurs in the muscular layer of the uterus (myometrium) and is characterized by the appearance of two or more myomatous nodes.

The severity of the disease lies in the fact that the nodes in the thickness of the uterus have a different structure, origin, and from this each specific node will require an individual and, accordingly.

The disease often debuts at the age of 32 - 33 years. During the period of late reproductive age and at the beginning of menopause, the growth of multiple fibroids increases. According to WHO, multiple uterine fibroids are 24 - 26% all cases of tumor processes of the reproductive system.

Prognosis for the disease adverse. In most cases, with this pathology, the uterus is removed, which in the reproductive period deprives a woman of having children, and in more advanced forms of the disease, it can be fatal.

The severity of the course of the pathological process in the uterus can be determined by the following criteria:

• Localization of nodes, which depends on their location in the thickness of the myometrium.
• The age of the woman.
• Node sizes.
• Myoma growth rates.

Causes of the disease

Multiple uterine fibroids are mutations of 2 or more smooth muscle cells in the thickness of the myometrium and further their uncontrolled and relatively rapid division.

These disorders in the body of a woman occur due to hormonal imbalance. It has been proven that the development and growth of multiple fibroids is affected by high level estrogen in the blood. And another, less studied factor is heredity.

Can be distinguished risk group- women who may be more prone to developing the disease:

• the presence of 2 or more abortions in history;
• late first birth - 35 years or more;
• women who are overweight or obese;
• women who have endocrinological disorders in the pancreas ( diabetes), thyroid gland (hypothyroidism) or pituitary gland (brain tumor, a consequence of TBI (traumatic brain injury));
• women suffering from frequent inflammatory diseases reproductive system, as well as having a history of benign or malignant ovarian tumors.

Classification

Divided by size:

• Multiple - the diameter of such nodes does not exceed 20 mm, and the total size of the uterus is typical for the 8th week of pregnancy.
• Multiple - the diameter of the nodes is from 20 mm to 6 cm, the total size of the uterus does not exceed the 12th week of pregnancy.
• Multiple - the diameter of the nodes exceeds 6 cm, the total size of the uterus corresponds to 13 or more weeks of pregnancy.

Depending on the location of nodes in the thickness of the myometrium allocate:

• located on the border of the muscle layer and the endometrium (the inner lining of the uterus).
• located in the middle of the myometrium.
• located between the myometrium and perimetrium (outer or serous membrane of the uterus).

The classification of multiple uterine fibroids is only conditional, as it can combine several items at once.

Symptoms

• headache;
• dizziness;
• impaired memory and attention;
• general weakness;
• loss of appetite;
• nausea;
• drowsiness;
• irritability;
• depression;
• pallor of the skin;
• increased heart rate;
• pain in the lower abdomen, aggravated before the onset of menstruation or during physical exertion;
• heavy and prolonged bleeding during menstruation;
• bleeding from the vagina between menstrual cycles;
• difficulty urinating;
• frequent urge to urinate;
• the occurrence of constipation;
• edema lower extremities.

Diagnostics

• Examination by a gynecologist.
  The examination consists in taking complaints, interviewing the patient and conducting an internal gynecological examination in the mirrors. With multiple uterine fibroids and sizes, the doctor can palpate the nodes on the surface of the uterus through the anterior abdominal wall by palpation.

  In the event of a large “nascent” node that grows into the thickness of the uterus and descends into the vagina through the cervix, the gynecologist will determine during an internal gynecological examination.

  After the first stage of diagnosis of the disease are appointed additional methods examinations, which include laboratory and instrumental tests.

• Lab tests.
  Deciphering the results general analysis blood and urine (normal values ​​​​of indicators and changes in nodular myoma uterus) are given in the tables below. A general blood test will indicate the degree of anemia in bleeding that provokes a general disease. Table 1. Complete blood count

  Table 2. Urinalysis

Instrumental Methods:

• Ultrasound of the uterus with which you can identify the number of myomatous nodes, determine their size and shape. This method of examination is quite informative, fast and relatively cheap.
• MRI (magnetic resonance imaging) of the uterus allows you to identify the structure, shape, number and size of fibroids, as well as to determine their blood supply and the presence of complications that have arisen during the course of the disease. The method is more informative than ultrasound diagnostics but more expensive. An MRI is mandatory for this disease.
• Hysteroscopy- examination of the cavity of the vagina and uterus with a special device - a hysteroscope, which consists of a fiber optic tube and a light source. This method of examination is resorted to after ultrasound or MRI, in the presence of submucosal myomatous nodes.
• Diagnostic laparoscopy- examination of the pelvic cavity using an endoscope - a tube made of optical fiber, which has a camera that displays an image on a monitor screen and a light source. This method is the most accurate, but invasive (penetrating into the body). The study is resorted to in case of doubt after ultrasound and MRI or in the presence of complications.

Treatment of multiple fibroids

Treatment of multiple uterine fibroids, depending on the complexity of the course, can be conservative or surgical. (medication) methods combine the reception hormonal drugs as well as vitamin therapy. (surgical) methods are used for complicated forms of the disease, as well as for the growth of myomatous nodes. Usually methods such as:, myomectomy or hysterectomy are used.

Conservative treatment

When multiple small fibroids occur, it is used expectant tactics, which involves the passage of an ultrasound examination of the uterus 2-3 times a year and, in the event of a mild or moderate degree of anemia, the intake of vitamins and iron preparations:

• vitamins B1, B2 and B12(neurorubin, neuromidin, milgama) intramuscularly at 2.0 - 3.0 ml or inside 1 - 2 tablets per day (depending on the severity of anemia);
• iron(totem, gynotardiferon, sorbifer) inside 1-2 times a day;
• vitamin C 500 mg 2 times a day;
• folic acid 1 capsule 3 times a day.

These medications are taken under the control of a general blood test every 7 - 10 days.

With and multiple uterine fibroids, which differ rapid growth, drugs are prescribed that block their increase - gonadotropin releasing hormone antagonists (goserelin, leuprorelin, buserelin).

Dosages and frequency of taking these drugs are individual in each case and are decided by your doctor.

Surgery

Surgical treatment of multiple uterine fibroids is divided into two types:

• radical- removal of multiple fibroids together in the entire uterus.
• functional- removal of all nodes of the uterus while maintaining the integrity of the organ.

Indications to surgical treatment:

• multiple uterine fibroids of large sizes;
• severe anemia;
• rapid growth of fibroids - an increase in growth of more than 3 weeks in 1 year;
• the presence that provoked this disease.

Methods of surgical treatment

• Myomectomy- removal of multiple fibroids, which is performed in an operating room under general anesthesia. This type of surgical intervention is performed only in the presence of intermuscular and abdominal myomatous nodes.
  The operation can be carried out two accesses:
• Median laparotomy- an incision of the abdominal wall is made, the myoma is removed into the area of ​​the surgical field and excised, the surgical wound is sutured, drainage is placed. Hospitalization period - 10 - 14 days.
• Laparoscopy- 3-4 incisions are made in the lower abdomen, an endoscope, a camera and an electrocoagulator are inserted inside. With the help of an electrocoagulator, the fibroid is cut off and removed through one of the incisions. Postoperative wounds are sutured, drainage is placed. Hospitalization period - 5 - 7 days.
• Hysterectomy- complete removal of the uterus, which is performed in the operating room under general anesthesia. This method is used in almost 90% of cases in the event of multiple uterine fibroids. Access and terms of hospitalization are indicated above.

Complications

• necrosis of multiple uterine fibroids;
• degeneration of fibroids into a malignant tumor;
• infertility;
• compression of the inferior vena cava by multiple myoma, which manifests itself in increasing edema of the entire surface of the lower extremities and the anterior abdominal wall, a decrease blood pressure and pulse rate;
• compression of the aorta by myoma, which is manifested by fainting, shock, the onset of coma;
• compression of the ureters by fibroids, which is accompanied by anuria (lack of urine), vomiting and loss of consciousness.

Prevention

• balanced diet;
• fight against hypodynamia and excess weight;
• compliance with the regime of work and rest;
• rejection of bad habits;
• pregnancy planning;
• passing annual examinations at the gynecologist;
• sanitary and educational work among the population.

Multiple uterine fibroids imply the presence of fibroids of not very large sizes (from 2 cm). Often there is a disease with medium multiple fibroids, in this case there are several dominant nodes that do not exceed 7 cm in diameter. As for large formations, you should know that they are more difficult to treat.

Uterine fibroids is a benign type of tumor, the disease is one of the most common among women.

Multiple uterine fibroids

A few decades ago, the disease could be found in women 45-50 years old. To date, cases of fibroids have become more frequent, it is not uncommon to meet young women with a problem of this nature. The causes of the disease are numerous. One of them can be a hormonal failure in the body: a violation leads to the fact that the female reproductive system lacks the hormone progesterone. Treatment is complex. If the doctor has prescribed removal with the help of surgical intervention, you should know that in this case a relapse is possible. Fibroids in a woman's body will not stop appearing until the level of hormones is restored.

It is important to remember that one disease can provoke another. Multiple uterine fibroids can result from problems with thyroid gland, in this regard, a thorough examination of the thyroid gland is required. Women who have multiple uterine fibroids complain of soreness during the menstrual cycle, and blood clots may appear. During the course of the disease, a woman may experience. Multiple fibroids lead to the fact that the functions of the pelvic organs are violated, in connection with this, pregnancy is problematic.

The cause of the disease can be a gynecological infection or a disease of the reproductive system. Oddly enough, uterine fibroids can appear as a result of lack of sleep: in order to ensure prevention, you should lead a correct, moderately mobile lifestyle. It is important to exclude heavy physical exercise they have a negative impact on women's health. The disease can manifest itself if a woman often experiences sexual dissatisfaction, fibroids can be caused mental disorders. Often the disease is inherited: if there were relatives in the family who suffered from a similar disease, there is a high probability that it will be inherited. Treatment of multiple fibroids causes problems, the main one is the difficulty of identifying several nodes.

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Basic Treatments

The disease should be treated in stages, the course of therapy can be divided into 2 main stages: the first involves the use of conservative methods, in this case, efforts must be made to reduce the size of the tumor, hormonal drugs are prescribed for these purposes (drugs will help create the so-called pharmacological menopause) . If it is established that multiple fibroids have small nodes, it should be remembered that they may disappear. The conservative method of treatment should not last more than 6 months. If the patient is too young, the course of therapy lasts only 3 months. The second step is surgery. After establishing the diagnosis and performing conservative treatment, the doctor determines what type of surgical intervention will be. A few years ago it was necessary to completely remove the uterus, today medicine has become more developed, doctors have the opportunity to save the organ.

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What to do if the disease appeared during pregnancy?

Often, fibroids form during pregnancy. It is worth knowing that pregnancy with multiple fibroids is incompatible. During pregnancy, a certain restructuring of the body occurs: myomatous nodes begin to grow rapidly, this phenomenon can lead to miscarriage. At first, the fibroid begins to grow, and very quickly. In order for the birth to be successful, it is necessary to remove the existing nodes, thus avoiding complications. If a woman has multiple fibroids along with pregnancy, such a patient needs a special approach, she should be under the strict supervision of a doctor. In the case of fibroids with pregnancy, it is difficult to do without surgical intervention, the operation is performed by the traditional or laparoscopic method.

If the myomatous nodes are located in the uterine cavity, doctors need to perform a laparotomy operation (the traditional method with an incision). In this case, the surgeon will be able to make a scar and match the ends of the tissues. With the use of laparoscopic surgery, this is very difficult to do. After the procedure, it is necessary that the patient is protected from pregnancy for a year. It is important to clearly understand that multiple uterine fibroids poses a threat to women's health, folk methods treatments will be ineffective. If you are planning a pregnancy, you need to get detailed advice from a gynecologist. As emphasized above, it is recommended. Multinodular uterine fibroids are quite common. The size of the formations in such a disease is estimated by weeks (as the size of the fetus of a pregnant woman). The main cause of the disease is hormonal imbalance.

If fibroids are treated before pregnancy, the conception period is delayed by 12 months, the woman may get a scar that will prevent her from having a natural birth. If fibroids are not removed, there is a possibility of miscarriage. The doctor's concerns arise when the fibroid is in the body during pregnancy, also if the size of the nodes exceeds 5 cm. Concerns also arise if signs of uterine deformity are visible. In some cases, the doctor doubts whether to prescribe surgical method treatment. In such a situation, additional diagnostics are necessary.

Formation of leiomyomatous nodes can be single, but multiple uterine fibroids are much more common. The predominant location of nodular formations is outside or inside the muscular wall of the uterine body, but it is quite possible to detect submucosal leiomyoma or cervical isthmus localization of nodes. A benign tumor can be large, but often multinodular uterine fibroids are formed from several small formations.

In each case, the examination and treatment is carried out according to an individual plan, especially in situations where a woman wants to conceive and endure a pregnancy. Multiple uterine fibroids with menstrual bleeding and large nodules may be a reason for surgery.

It is possible to treat folk remedies, but only after consulting a doctor and in the absence of indications for surgery.

Classification of multinodular leiomyoma

Myomatous nodes can be located anywhere in the uterus. Typical options:

• submucosal;
• interstitial;
• subserous;
• intraligamentary;
• isthmus.

Multiple uterine fibroids, depending on the number and size of nodes, there are 3 varieties, which are presented in the table.

Treatment and management tactics largely depend on the type of tumor: the doctor will choose only conservative methods of therapy for small forms of the tumor in a woman who wants to endure pregnancy.

Symptoms of pathology

With a small multiple leiomyoma, there may be no manifestations in the form uterine bleeding but the following symptoms are more common:

• profuse menstruation;
• intermenstrual spotting;
• violation of the cycle;
• infertility.

All these manifestations are possible with large fibroids and in the presence of a dominant node that does not exceed 6 cm. In addition, there will be the following symptoms:

• pain sensations of varying severity;
• troubles with functions Bladder and rectum;
• changes in the blood in the form of anemia.

Large leiomyoma always leads to pronounced changes in the rhythm and magnitude of menstruation, which becomes an indication for surgery. Drug treatment and therapy with folk remedies can be used with a small tumor size and minimal manifestations.

Diagnostics

During a routine gynecological examination, the doctor will detect a bumpy enlarged uterus with the help of palpation, which will become the basis for a preliminary diagnosis. On ultrasound, the specialist will count the number of nodes and the size of each tumor-like formation. In most cases, this is enough to start treatment. In difficult situations and when planning a surgical intervention, the doctor will prescribe tomography (MRI or CT).

If a woman is planning a pregnancy, then it is necessary to assess the condition of the ovaries and endometrium. Of great importance for the choice of tactics of therapy is the presence of the following pathology options:

• endometrial hyperplasia;
• polyp of the body of the uterus;
• polyp of the cervical canal;
• ovarian cyst;
• endometriosis of any localization.

Gynecological diseases associated with leiomyoma create difficulties for therapy. With uncomplicated myoma of small size against the background of therapy, the desired pregnancy will definitely occur. The larger the value benign tumor the less chance of successful conception.

Therapy

If multiple uterine fibroids are detected, then treatment is carried out individually, taking into account the age and desire of the woman to have a baby. The most favorable outcome of therapeutic measures and the prognosis for pregnancy in women with small leiomyoma is when the doctor uses the following complex treatment:

• hormone therapy with the use of drugs that create optimal conditions for conception;
• correction of menstrual disorders;
• reduction of blood loss;
• anemia treatment;
• impact of folk remedies.

With multiple leiomyoma of medium size, combination therapy is used. At stage 1, it is necessary to remove the dominant node, at stage 2 - use drug treatment and therapy with folk remedies. In some cases, according to indications, the method of embolization of the uterine arteries is used, which allows to reduce the size of the uterus without surgery.

Large leiomyoma is an indication for surgical intervention. Folk remedies and hormone treatment is useless. With such a uterus, it is impossible to conceive and endure pregnancy, therefore it is optimal to remove the defective reproductive organ.

An important condition for the successful treatment of multiple leiomyomas is the timely initiation of therapeutic measures. As long as the nodes do not exceed 20 mm, the chances of recovery are optimal. This is especially true for women who want to fulfill their dream and give birth to a baby.