In modern women, benign tumor diseases in the field of reproductive organs occur with high frequency. Leiomyoma of the uterus is a benign type of neoplasm. It occurs in women aged 25 to 45 years. It is often detected spontaneously in the course of a preventive examination, since in most cases it does not give the expressed symptoms. Leiomyoma of the uterus body is characterized by a stable little progressive growth and after the treatment( with the exception of surgical removal) is maintained throughout life.
Causes of uterine leiomyoma
Currently, doctors do not know for sure the causes of uterine leiomyoma in women. There are practical observations that indicate the presence of a hereditary factor of influence. Usually, cases are diagnosed in women whose family history has similar neoplasms in grandmothers and mothers. Progression usually begins after a sudden abortion, which allows us to talk about the hormonal dependence of pathological changes on the composition of the blood.
Recently, there are certain clinical data on the dependence of the state of the reproductive function and the risk of developing such a tumor. In particular, attention is given to the fertility of a woman( the ability to conceive and bear a child).The lower this parameter, the higher the risk of developing the uterine body's leiomyoma.
Another negative factor is the presence of varicose veins in the pelvic cavity. Due to the constant venous stasis, there is a general puffiness in the endometrial mucosal layer. With significant lymphostasis, pathological processes can be triggered in the formation of serous nodules and the growth of an excessive number of modified cells.
Other risk factors include:
- long-term smoking, including passive;
- excess body weight with a hormonal component( when fatty tissue has the ability to produce female sex hormones and enhance the process of accumulation of fatty deposits);
- is a sedentary lifestyle;
- use of improperly selected products for hormonal oral contraception;
- hormonal imbalance;
- permanent stressful situations;
- frequent interruptions of the coming pregnancy by medical means.
Experts believe that the most likely cause of the leiomyoma of the womb body is a violation of the balance of hormones in the body of a woman. Therefore, in order to prevent such changes, care should be taken to select the means of oral contraception. Especially it concerns preparations for long reception. Do this only after consulting with your doctor.
Intramural, submucous, subserous submucosal nodal leiomyoma of the uterus
There are various forms of this pathology. The primary classification is carried out at the site of the localization of the neoplasm. The most commonly diagnosed is a tumor of the uterus. Usually it has a kind of base, which is based in the muscular layer of the uterus.
By type of growth direction, the following forms of pathology can be identified:
- intramural uterine leiomyoma or nodal leiomyoma of the uterus - characterized by the location of the neoplasm in the thickness of the muscular layer( this is the most common form);
- submucous leiomyoma of the uterus is a node that grows under the mucous membrane inside the cavity of this organ;
- , the subserous leiomyoma of the uterus is distinguished by the growth of the node in the outer mucous layer, with the sides leaving the abdominal cavity.
There are mixed, cystic, localized and diffuse types of this disease. Submucosal uterine leiomyoma in the neck area is rare. The frequency of diagnosis of such cases does not exceed 5% of the total number of pathologies.
To recognize this or that form of neoplasm without special diagnostic methods is very difficult. An ultrasound examination is necessary. As necessary, you can use computer scanning, which allows you to define clear boundaries and localization of the tumor process. In differential diagnosis, the most important is the elimination of oncological processes and a tendency to malignancy of the neoplasm.
uterine leiomyoma and pregnancy
Particularly relevant for women of childbearing age is the uterine leiomyoma and pregnancy. During the period of conception and gestation, the number of female sex hormones produced increases dramatically. This can cause a sharp and rapid growth of the neoplasm. In most cases, this leads to the formation of defects in the intrauterine development of the child. The newborn can be determined by various destructive changes in the spine, brain structure, anacephaly, insufficient development of the thorax and its internal organs.
Leiomyoma can have another pathological effect on pregnancy. There are bleeding, premature interruption, various complications in the form of placental abruption and fetal hypoxia. It is recommended for patients with a similar diagnosis in the planning of pregnancy to undergo special treatment. It can consist in the surgical removal of the node and thromboembolism of the uterine veins.
It is also recommended to pay attention to the correct choice of the method of protection, which must take into account the danger of rapid growth of the tumor with the use of any hormonal preparations.
Symptoms of uterine leiomyoma
Specific symptoms of uterine leiomyoma may appear in later stages of pathological tumor growth. In the initial stages, the woman does not experience any unpleasant sensations. The first signs may be irregular menstruation with an increase in their duration. In the future, there is an increase in the volume of blood loss.
Against the background of regular bleeding, exceeding in volume physiological norm, the complexes of symptoms of anemia can form:
- dimness and brittle hair and nail plates;
- dizziness, weakness, diffuse attention;
- pallor of the skin;
- increased heart rate with minimal physical exertion;
- lack of appetite and frequent attacks of nausea.
As the myomatous node grows, there may be signs of abnormality of the internal organs of the abdominal cavity. There can be frequent urination without changing the volume of diuresis. This is due to the physical pressure on the muscles of the pelvic floor and directly on the bladder itself.
If there is a violation of the intestinal peristalsis, spastic and atonic constipation may occur. Violated the process of venous blood flow in the cavity of the small pelvis. This leads to the development of hemorrhoids.
In later stages, amenorrhea may occur as a preventive therapy for gonadotropin antagonists. This condition is no less a danger to the health of a woman than profuse bleeding during menstruation. With an increase in the level of hematocrit and hemoglobin, conditions are associated with a high percentage of serum iron.
Treatment of uterine leiomyoma
Initial treatment of uterine leiomyoma is aimed at stopping and freezing further growth of the tumor. Such a tactic implies a treatment, which is carried out until the climacteric period in the life of a woman. During the menopause, the endometrium is reversed. It decreases in volume and loses its contractile function. There is a physiological decrease in the level of blood supply to the tissues of the uterus. In the end, all this provokes the reverse process of tumor development. It significantly decreases in size. In a number of cases, there is complete independent elimination without external surgical intervention.
Surgical treatment of uterine leiomyoma is indicated in certain cases.
The main indications for the operation include:
- persistent anemia for 6 or more months, which occurred against the background of metrorrhagia;
- bleeding that occurs between menstruation;
- pain in the lower abdomen, violation of the blood supply of neighboring organs;
- increased urge to urinate up to 15 times a day;
- presence of symptoms of impaired intestinal and renal function;
- acceleration of growth of neoplasm( exceeds the volume of up to 4 weeks of gestation in the last 12 months);
- large total volume of myoma node;
- planned pregnancy;
- is a cystic form of a leiomyoma with the risk of twisting its legs.
An immediate decision to take an operative measure is taken when there are two or more signs of a tumor passing into a malignant form.
During the surgical operation, a different volume of medical care may be provided. A desirable intervention is the partial removal of the muscular layer, altered by the nodal form of the tumor. The most favorable prognosis for submucous and subserous forms of pathology. In this case, a rapid recovery of the external and internal serous and mucous layer is observed. With the development of an intramural node type, the prognosis is aggravated by frequent relapses of the pathology during the first two years after the operation.
Alternative methods for the treatment of uterine leiomyoma are now widely used. This, above all, vacuum embolization of the arteries, which perform blood supply to the muscular layer of the uterus. The method is effective against all types, shapes and sizes of tumors. The only contraindication for embolization is the cystic form of the neoplasm.
After surgical intervention or removal of nodes by the method of embolization of arteries, anti-relapse therapy is necessary to suppress the function of the pituitary gland. To control the production of the gonadotropin hormone, its antagonists and substances that suppress the chemical process of its production are assigned. Most often, for this purpose, drugs are used: "Goserelin" and "Buserelin."Both are administered subcutaneously at 3.5 mg 1 time during the menstrual cycle. The course of treatment is 6 - 8 months. Sometimes up to 10 injections are prescribed. A similar drug "Nafarelin" is available in the form of a nasal spray. It is used for irrigation of the nasal mucosa. It is used once in the beginning of each menstrual cycle for 1 dose 3 times a day. The course is repeated for 10 - 12 menstrual cycles.