Myoma of the uterus with menopause

Myoma of the uterus with menopause is a very frequent pathology among older women. This disease occurs in every fifth woman of reproductive age and every third woman in menopause. This is due to the fact that the hormonal background of a woman changes throughout her life, which leads to such changes in the reproductive sphere. But do not be upset if this diagnosis is established, since this disease is benign with high treatment efficiency.

[1], [2]

Causes of the uterine fibroids with menopause

Myoma of the uterus or fibromioma is a benign uterine disease, which is accompanied by high proliferative activity of myometrium cells with the formation of a volume structure in the uterine cavity. This disease is hormone-dependent, that is, the stimulus of such active reproduction is female sex hormones.

Therefore, the main cause can be considered hormonal imbalance, which occurs with the onset of menopause, so the development of these diseases is more typical of the climacteric period.

[3], [4], [5], [6]

Pathogenesis

In pathogenesis, the main role in the development of uterine fibroids in menopause belongs to the violation of the level of hormones. During menopause, the level of estrogen decreases, their regulatory effect on the first phase of the menstrual cycle decreases, which is accompanied by a decrease in the proliferation of endometrial cells. This, in turn, entails a compensatory increase in the proliferation of myometrium cells, which is accompanied by hyperplasia of these cells with the development of different types of uterine fibroids. If the fibers of connective tissue prevail in the structure of benign formation, then they speak of the concept of fibromyoma. Clinically, these two forms are no different, such differentiation is possible only according to a histological examination.

There are other reasons for the development of fibroids in menopause - a group of non-hormonal causes. The basis of these all causes is the natural physiological involution of myometrium cells in menopause in a woman, which is accompanied by changes in metabolism in myocyte cells, their antigenic changes. In this case, normal growth and multiplication of a cell with an increased tendency to proliferation may occur, as well as specific cytokines and vascular growth factors that further stimulate abnormal differentiation of these cells. As a result, uncontrolled division of cells, their multiplication and an increase in the volume of myometrium occurs, which may be local or diffuse. If the effect of etiological factors continues, then the myoma rapidly grows and grows in size, which requires some medical tactic. Depending on where the primary focus of pathological cells is located, which began its anomalous division, the growth of the tumor can be diffuse - on the entire surface of the myometrium with a uniform increase in the entire uterus, and also local - then a myoma node is formed. This site can also be located in different ways - submucous, sub-serous and intramural, which affects the features of the clinic of the disease in these different forms. There may be a different number of such nodes, and, depending on this, a single knotty myoma and multiple nodular fibroids are isolated.

These are the main pathogenetic mechanisms that affect the development of uterine fibroids in menopause.

[7], [8], [9], [10], [11]

Symptoms of the uterine fibroids with menopause

Myoma of the uterus can begin in women even before the climacteric, and with the onset of menopause, the clinic can actively manifest itself. Very often there is an asymptomatic course of uterine fibroids, until the formation becomes huge or until complications arise. Therefore, often this diagnosis is put at the peak of the clinical picture.

It is known that the climax in its current has several stages:

1. premenopause - the period from 45 years to the onset of menopause;
2. Menopause is the period of the last menstruation, the average age is about fifty years;
3. Postmenopause - the period from the last menstruation to the end of a woman's life.

If the uterine myoma begins in the premenopausal period, then the symptoms of the menstrual cycle can develop, which is associated with a violation of the structure of the endometrium due to the presence of nodes or with initial changes in the level of hormones. At this point, given the age, a woman may not pay due attention to this condition, since these violations ovario-menstrual cycle can be explained by the onset of menopause. But it should be remembered that in this case, on the contrary, it is necessary to consult a doctor so that he confirms or refutes thoughts about menopause. After all, early diagnosis of fibroids is much better treated.

The first signs of uterine myoma in menopause may also be diverse - bleeding, lower abdominal pain or a feeling of heaviness in the pelvis, violation of sexual intercourse, decreased libido, impaired bladder or rectum function, secondary chronic iron deficiency anemia. These symptoms often appear even with significant amounts of fibroids due to the fact that the course is asymptomatic. There are some features of the uterine fibroids clinic in menopause depending on the location and form of education.

With the nodular form of uterine fibroids, clinical manifestations directly depend on the site of the node. In the formation of subserous nodules, the menstrual function is not compromised if it is preserved in the premenopause. Often there is a clinic of the acute abdomen, because such nodes are very labile in their position and can be displaced, forming a torsion or necrosis of the knee's leg. Sometimes the pains are not sharp, but stupid, aching, permanent, if the knot irritates the peritoneum or nerve endings, then there may also be a heaviness in the abdomen. If the subserous myomatous node is of considerable size, then it can cause compression syndrome of neighboring organs with difficulty of defecation with compression of the rectum, with difficulty of urination or reactivity of the bladder, and compression can disrupt the outflow of venous blood and lymph with stagnation in the small pelvis and development hemorrhoids. It is not uncommon for a subserous arrangement of the fibromatous node in uterine myomas when the climax is observed local neurological symptoms due to the compression of the nervous structures with the development of disorders like paresthesia or osteochondrosis of the lumbar spine. Then it is very important to correctly diagnose pathology, and not treat these neurological disorders.

With a submucous site, the clinic is less pronounced in terms of compression symptoms, but local manifestations are more pronounced. Metrorhagia may be observed, even if the menstrual period is not complete with the menopause, then such excretions can occur when the uterus is myomoid with menopause. These discharges are painful, accompanied by aching pain in the lower abdomen. Allocations for uterine myomas during menopause can also be in case of infection of the node, then infectious inflammation develops with yellow-green discharge with an unpleasant odor, which is also accompanied by symptoms of intoxication.

Another frequent site localization of the uterine myoma in menopause is intraligamentary - between the ligament of the uterus and the ovaries. In this case, the clinic of such a node will be accompanied by symptoms of ureteral compression with possible development of renal colic, hydronephrosis, pyelonephritis. Diagnosis of such a node is very problematic.

As for the diffuse form of uterine fibroids, this form is most often asymptomatic, which is due to its location in the thickness of the entire myometrium and the same increase in the entire uterus. Then the uterus grows in size and the woman can feel an increase in the abdomen or unpleasant pressure in the small pelvis. Such a myoma most often reaches a large size and its treatment is then radical. Therefore, a comprehensive gynecological screening annual examination is needed even during the menopause.

These are the main clinical manifestations of uterine myoma in menopause and should pay attention to any such symptoms for timely diagnosis and treatment.

Complications and consequences

The main complications that can occur in uterine myoma are bleeding in the submucous location of the myomatous node, which requires immediate medication, infection of the myomatous node, which requires anti-inflammatory therapy. There may also be complications in the form of "birth" of the myomatous node, placed submucous or its necrosis, which is accompanied by symptoms of an acute abdomen and requires immediate therapeutic actions and timely differential diagnosis.

[12]

Diagnostics of the uterine fibroids with menopause

Diagnosis of fibroids should be timely, therefore, a comprehensive examination of a woman is necessary if this diagnosis is suspected. It is necessary to carefully collect an anamnesis with details of complaints and an accurate definition of the obstetrical anamnesis. You should find out when the climacteric began, the characteristics of the menstrual cycle, the presence of an active sexual life. Then proceed to the examination.

In a bimanual examination of a woman, a tumor-like formation of various sizes and localization is determined, it is painless, mobile - in case of nodal uterine myoma. If the myoma is diffuse, then the entire uterus increases, which corresponds to a certain period of pregnancy, the uterus is dense, inactive and painless. These are the main objective methods of examination, which allow you to suspect this diagnosis with further conducting additional research methods.

Instrumental diagnosis is the first in the diagnosis of uterine fibroids with menopause, which is associated with the high information content of most methods.

Hysterography is one of the methods of special diagnostics, which is performed by filling the uterus with a contrast fluid in a volume of 5-7 milliliters with further registration of the changes. In this case, there may be a filling defect, which corresponds to the location of the site, as well as a decrease in the uterine cavity. Another examination - hysteroscopy. This is a special method for examining the uterine cavity with a special device with a video camera at the end that allows you to see the uterine cavity, and also to conduct a biopsy with further examination of the punctate for accurate verification of the diagnosis.

The "gold standard" for the diagnosis of uterine fibroids in menopause is ultrasound. This method allows one to see anehogenous formation in the case of a myomatous node with an accurate determination of the location of this formation, its size, structure, and the degree of uterine enlargement in the case of a diffuse form of fibroids.

Analyzes that are specific for uterine myoma, as such, do not exist. Conduct general tests with the determination of hemoglobin, hematocrit, erythrocytes in chronic posthemorrhagic anemia, if the myoma is symptomatic, that is, bleeding. If there is a suspicion of suppuration of the myomatous node, then in the general blood test, characteristic changes will be determined in the form of leukocytosis, an increase in ESR and a shift of the leukocyte formula to the left. Special analysis is the histological examination of the punctate of the myomatous node or already post-operative formation. Such a study allows you to accurately establish the diagnosis, exclude its malignant nature and find out further tactics of treatment.

[13], [14]

Differential diagnosis

Differential diagnosis of uterine fibroids with menopause in the case of manifestation of the clinic in the form of bleeding should be carried out with malignant uterine formations - endometrial cancer. The cancer of the endometrium is characterized by the appearance of bloody discharge a few years after the onset of menopause. But for a hysteromyoma periodic bleeding is characteristic, and at inspection the site is precisely defined. In case of doubt in the nature of education in the uterus, diagnostic scraping of the uterine cavity is performed with a histological examination of this material, which allows to establish accurately the benign or malignant nature of the formation. Also, differential diagnosis should be performed with the uterine cyst. With ultrasound, the cyst has an anechoic structure, an oval shape, distinct edges with a thin capsule and a uniform content. The myomatous node is also anechoic, but it is non-uniform and in density corresponds to myometrium, often has a pedicle and is well-blooded, in contrast to the cyst, which is avascular.

The myomatous node also needs to be differentiated with internal endometriosis, which can also be accompanied by the formation of myomatous areas in the uterine cavity. But with endometriosis there is a characteristic anamnesis in the form of bleeding that corresponds to menstruation, and uterine fibroids do not have regular bleeding during menopause. It is possible to accurately verify these two diagnoses with the help of histology, after all, they can often be combined in one uterus.

Given the climax period, that is not the young age of the woman, it is necessary to carefully diagnose uterine fibroids and differential diagnosis, since different malignant processes at this age are possible, which must be diagnosed as early as possible with the start of appropriate treatment.

[15], [16], [17]

Treatment of the uterine fibroids with menopause

Treatment of uterine fibroids with menopause may be medicated with the use of special hormonal and non-hormonal drugs, and also operational, which has clear indications, which are revealed individually.

Conservative treatment is carried out in the following cases:

1. the desire of a woman to conservative treatment without surgery;
2. malosymptomnoe or asymptomatic clinical course of pathology;
3. uterine myoma less than twelve weeks of pregnancy in case of intramural placement and diffuse forms;
4. slow growth of the nodes or an increase in the entire uterus;
5. site localization, subserous or intramural on a broad basis without complications and symptoms of compression of neighboring organs;
6. uterine fibroids with menopause, which may be accompanied by a high risk of intraoperative complications;
7. drug therapy as a preparatory stage for the operation or as an integral part of complex treatment in the postoperative period.

Conservative treatment can not be considered as an alternative to surgical treatment, if there are indications for surgery, then it is necessary to conduct it.

Among the drug treatment methods are allocated non-hormonal and hormonal methods of treatment. Nonhormonal methods of treatment include:

1. symptomatic therapy with complications or pain syndrome, which includes hemostatics and uterotonics in bleeding, antispasmodics and NSAIDs with pain syndrome, iron preparations, vitamins and trace elements in chronic posthemoragic anemia. Sedation therapy is recommended as an integrated therapy for pain syndrome.
2. Normalization of metabolism in myocytes - use antioxidants, antiplatelet agents, multivitamin complexes.
3. Measures aimed at correcting those diseases that can contribute to the further development and increase of uterine myoma are a diffuse toxic goiter associated with inflammatory processes of the internal genital organs.

Hormonal therapy is used to reduce myomatous nodes in volume and regression of clinical symptoms. Hormonal therapy for uterine fibroids may include several groups of drugs:

• Gonadotropin-releasing agonists whose representative is Diferelin or Tryptorelin - the drug is used from 3 days of the menstrual cycle for six months to 3.75 milligrams.
  • Goserelin - applied for six months to 3.6 milligrams subcutaneously
  • Buserelin - 200 micrograms per nose twice a day with a course of six months
  • Zoladex - from the 1st to the 5th day of the cycle injectively.
• The antagonists of gonadotropic hormones, of which the drug Danazol is a drug, is used 400-800 milligrams per day, also with a six-month course of treatment.
• Preparations progesterene series - a variety of drugs that are able to regulate ovario-menstrual cycle in the failure of its second luteal phase. The main representatives of this series are:
  • Norethysterone acetate - is applied from the fifth day of the menstrual cycle to 5-10 milligrams twice a day for six months.
  • Medroxyprogesterone acetate is used in the same dose and the same course.
  • The Mirena system is an intrauterine device that is placed for five years with a status check.
  • Norkolut and Primoluth are drugs that are used from the 16th to the 25th day of the menstrual cycle for three to six months.

You can also use combined oral gonomalous preparations dvuhzaznye with a large amount of progesterone.

It should be remembered that hormonal therapy can reduce the size of fibroids by regulating the hormonal background, but after the termination of therapy throughout the year, the myoma can reach the previous dimensions.

Surgical treatment of uterine fibroids in some cases has its priorities, and in some cases is the only method of treatment indicated. Indications for surgical treatment include:

1. symptomatic uterine myoma, which is accompanied by:
   • hemorrhagic syndrome in the form of uterine bleeding or massive discharge;
   • intense pain symptoms;
   • signs of chronic posthemoragic anemia;
   • signs of compression and impaired function of neighboring organs - the bladder, nerves and vessels, rectum, ureters.
2. Dimensions of fibroids 12 or more weeks even in the absence of any complaints.
3. Submucous uterine myoma, regardless of size, is accompanied by a high risk of complications, and therefore requires prompt treatment immediately without prior medical therapy.
4. Rapid growth of the tumor in the climacteric period can often be associated with the malignant nature of the process. The term "rapid growth" is an increase of 2-3 weeks in six months or 4-5 weeks per year.
5. Subseroznye knots on a high leg in connection with possible complications in the form of torsion of the leg.
6. Necrosis of the myomatous node.
7. The presence of nodes that are located in an atypical location - intraligamentary
8. Nodes that grow from the vaginal part of the uterus due to their frequent trauma.
9. The combination of uterine fibroids in menopause with other pathologies of internal genitalia, which also require surgical treatment - cysts of the uterus and ovaries, polyps, prolapse of the uterus
10. Insensibility of myoma to hormonal treatment.

Operative treatment can be carried out in the amount of organ-preserving intervention and radical intervention. Tactics depends on the type of myoma, its size, location, as well as the duration of the operation. Organ-saving operations are myomectomy - removal of the myomatous node within healthy tissues - and embolization of uterine arteries, which disrupts the blood supply of the node and it regresses.

Radical operations are supravaginal amputation of the uterus, subtotal hysterectomy and uterine extirpation, which also depends on the size and location of the myoma and the age of the woman.

There are many methods of alternative medicine to treat the treatment of uterine fibroids in menopause.

The main ones are:

1. The leaves of aloe, which has a pronounced anti-inflammatory and regenerating effect, are squeezed into a glass and dipped in a tampon, inserted into the vagina, repeating the procedure once a day for a whole month.
2. The membranes or shells of walnuts must be crushed, pour boiling water and insist 20 minutes, and then boil for another 10 minutes and let the broth cool. Take such a decoction you need to inside three times a day for a tablespoon for no yen of the week.
3. Juice burdock perfectly removes irritation, swelling and has an antiproliferative effect, which increases the ability of the cyst to resolve. To do this, from the burdock leaves pre-washed, it is necessary to squeeze out the juice and take five days for one teaspoon three times a day, and then one teaspoon twice a day for five more days.
4. Honey has the properties to enhance local immunity and stimulate regeneration. To create a medicine from honey, it is necessary to take the core of the bulb and place it in a glass with honey so that it is completely filled with it. This solution must be insisted overnight and moistened with a tampon in the given solution and introduced into the vagina at night, which should be repeated for 10 days, after which the myoma should decrease.
5. Prepare a herb collection of currant leaves, nettles, mugs and mumps - take them in equal quantities, pour hot water and boil for another 5 minutes, after which they cool and drink half a glass a day through the day for a month.

To treat this pathology also use homeopathic remedies. Their main effect is aimed at regulating the normal hormonal background and this contributes to a decrease in the size of uterine fibroids.

The main homeopathic remedies are:

• Cyclodinone is a homeopathic preparation that normalizes the ovario-menstrual cycle when its second phase is inadequate. The drug is used for 1 tablet in the morning or 40 drops once a day. The course of treatment is not less than three months.
• Dysmenorm is a complex homeopathic preparation that affects hormonal imbalance, including benign uterine formations. The drug is used for 1 tablet 3 times a day for half an hour before meals.

Prevention

The method of specific prophylaxis of the development of uterine fibroids is the prevention of the formation of conditions of hormonal homeostasis, in which there is a local hyperestrogenism:

• prevention of ectopic pregnancy;
• constant prevention of chronic stressful situations, which contribute to the violation of metabolism and ovario-menstrual cycle;
• timely diagnosis and correction of insufficiency of the second ovarian phase;
• timely and adequate treatment of diseases of the ovaries and uterus of inflammatory and non-inflammatory etiology;
• timely correction of hormonal imbalances associated with disruption of the hypothalamic-pituitary-ovarian system.

With the aim of preventing precancerous diseases and uterine tumors, it is recommended to undergo prophylactic examinations to women under 30 years of age once a year, after 30 years - twice a year with cytological examination of the contents of the cervical canal, ultrasound, timely treatment of the diagnosed diseases.

[18], [19], [20]

Forecast

The prognosis for uterine myoma for recovery is unfavorable, since myoma is not capable of complete regression, but for life it is favorable, since it is not malignant and is not dangerous with proper treatment.

Myoma of the uterus in menopause is a pathology that often occurs asymptomatically, but regular preventive examinations allow a timely diagnosis. Sometimes there are serious complications that need to be prevented by the timely treatment of uterine fibroids, especially with menopause. Treatment of uterine fibroids with menopause may be medicated and operative, which is decided individually in each case. Sometimes complex treatment is used in the form of a combination of several methods. You need to take care of your health and contact the doctor in a timely manner if you have any complaints.

[21], [22]