Fibroids of the uterus
Last reviewed: 23.04.2024
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Fibrotic tumors of the uterus are benign tumors of smooth muscle origin. Fibrous tumors often cause pathological uterine bleeding (menorrhagia, menometrorrhagia), pelvic pain, dysuric disorders, intestinal disorders and lead to complications of pregnancy. The diagnosis is established on the basis of examination of the pelvic organs. Treatment depends on whether the patient wants to have children and wants to maintain reproductive function. Such patients are prescribed conservative treatment using combined oral contraceptives, in preparation for the operation, GnRH is prescribed to reduce fibrotic nodes. Perform the following types of surgery: conservative myomectomy, hysterectomy, ablation of the endometrium.
[What causes fibroids of the uterus?
Fibrous tumors are the most common benign tumors of the female reproductive system and are noted in about 70% of patients. However, often fibroids have an asymptomatic course and small size. Approximately 25% of white and 50% of dark-skinned women have symptomatic fibroids. Risk factors for the development of fibroids are skin color and the presence of a high body mass index in patients. Potentially protective factors include pre-existing childbirth and cigarette smoking.
By classification, the following types of arrangement of fibromatous nodes in the uterus are distinguished: submucosal (located in the uterine cavity); intraligamentary (interconnected), most common in the wide ligament of the uterus; superserous nodes (located in the direction of the abdominal cavity); intramural nodes (located in the thickness of the myometrium); cervical nodes. Fibrous tumors are often multiple, but all nodes develop from a single individual monoclonal smooth muscle cell. Because tumors have estrogen receptors, they tend to increase throughout the reproductive period of the patients and regress in the postmenopausal period.
Degeneration of the nodes is accompanied by bloody discharge from the vagina. In the tumor are found hyaline, myxomatous, calcified areas with cystic fat and red degeneration (usually only during pregnancy). Patients often worry about the presence of cancer in the fibrous nodes, but malignancy of these tumors is extremely rare.
Symptoms of fibroids of the uterus
Fibroids of the uterus can cause menorrhagia or menometrorrhagia. Characterized by the presence of pain with tumor growth or node degeneration, pain intensification is noted when the subserosity of the knee is twisted. With large tumors, violations of adjacent organs are noted: dysuric disorders, painful urination at tumor pressure on the bladder. There are also violations of the intestine (tenesmus, constipation) when it is squeezed by a tumor. The presence of fibroids and pregnancy leads to abortion, premature birth, miscarriage and presentation of the fetus, which is an indication for caesarean section.
Diagnosis of uterine fibroids
In bimanual examination, an enlarged, mobile uterus with nodes is revealed. The uterus is palpable above the heart. At the present stage, ultrasonography, especially Sonogetherography, is widely used for diagnostics, in which the saline solution is introduced into the uterus, which allows the specialist in ultrasound diagnostics to more specifically determine the location of the fibrous nodes in the uterus. If the information is insufficient, ultrasound can be used.
Treatment of uterine fibroids
Asymptomatic fibroids of the uterus do not require special treatment. For symptomatic fibroids of the uterus, GnRH agonists are widely used at this stage to stop bleeding and to prepare for surgical treatment to reduce myomatous nodes.
The main drugs used for conservative treatment. To suppress the growth of myomatous nodes and suppress estrogen, synthetic progestins are used. Medroxyprogesterone acetate acetate is used 5-10 mg orally once a day or megestrol acetate 10-20 mg orally once a day for 10-14 days of each menstrual cycle, which can reduce bleeding after 12 cycles of taking the drug. The above drugs can be administered continuously in the daily for a month, which leads to a reduction in bleeding and provides a contraceptive effect. Medroxyprogesterone Depot acetate is administered intramuscularly at 150 mg once a month (No.3) and provides a similar effect. Before prescribing progestins, patients should be warned about side effects: for example, about weight gain, depression and irregular bleeding.
Danazol is an androgenic agonist and can suppress fibrotic growth. However, this drug has many side effects (for example, weight gain, acne, hirsutism, swelling, baldness, voice coarsening, sweating, dryness in the vagina) and, thus, less acceptable for patients.
GnRH agonists (eg, leuprorelin 3.75 mg intramuscularly once a month, goserelin 3.6 mg under the skin of the abdomen once in 28 days or using a nasal spray) can reduce the production of estrogens. GnRH agonists are the most promising in terms of preoperative preparation to reduce the size of fibrous nodes, which makes the operation technically more feasible with reduced blood loss. In general, these drugs should not be used for a long time, because after 6 months the original tumor size is restored and bone loss is noted. In patients under 35 years after GnRH therapy is discontinued, bone mass is reimbursed itself, in patients after 35 years of age - no. It is assumed that the appointment of estrogen to them can prevent osteoporosis.
Surgery
Indications for surgical treatment are fast growing fibroids of the uterus, uterine bleeding, not amenable to conservative therapy, constant aching or intolerable pain, as well as disruption of the urinary system and intestines. Surgical treatment includes myomectomy and hysterectomy. However, myomectomy is performed only in patients who want to maintain the reproductive function or want to preserve the uterus. In 55% of women with infertility due to fibroids, myomectomy can restore reproductive function and lead to pregnancy 15 months after the operation. Multiple myomectomy is a more difficult surgical intervention than hysterectomy. It is necessary to give complete information to patients about the expected difficulties and complications in performing myomectomy and hysterectomy. Hysterectomy can worsen the quality of life.
Modern methods of treatment include laparoscopic surgery. Of great importance is resectoscopy, in which a tool with a wide-angle telescope and an electric wire loop is used to excise the nodes located in the uterine cavity. These surgical procedures can be used to treat patients who want to save the uterus. If the risk of surgical intervention is very high, the operation of choice is uterine artery embolization.