Myoma of the uterus is called a benign tumor that grows from the uterine muscular layer, the growth of which depends on the hormones of the woman.
- 1 Epidemiology
- 2 Etiology and pathogenesis of fibroid formation
- 3 Classification
- 4 Clinical signs of uterine fibroids
- 5 Complications of fibroid
- 6 Treatment of
This pathology is most often found in women in the reproductive period .The highest incidence rate is, as a rule, for an age of about forty years. Young girls do not have this pathology, and this education is never formed before the sexual development begins. After the onset of menopause, the myomatous node grows no longer and then its gradual resorption occurs. The percentage of detection of uterine fibroids is up to 30% of the entire gynecological pathology, in 3% of women it is detected during a preventive gynecological examination. Approximately in 50% of detected tumors, the growth process began a long time ago and for their elimination they require prompt treatment.
Etiology and pathogenesis of the formation of fibroids
According to modern ideas, the basis for the development of fibroids are the hormonal changes of .As a result of the disruption of excretion and changes in the process of the metabolism of female hormones of estrogens, as well as the ratio of their fractions( an increase in the concentration of estrone and estradiol in the first phase of the cycle, and estriol in the second phase), morphological changes occur in the structure of the muscular layer of the uterus( myometrium).The mass and volume of muscles are increased in two ways: either as a result of an increase in the number of cells that make fibers of the smooth muscle layer, or with an increase in the size of these cells. Together with the influence of estrogens on the growth of education, the hormone progesterone also has a stimulating effect.
The process of enlarging the cells that make up the fibers of the smooth muscles of the uterus is similar to the same phenomenon in pregnancy and occurs only with the simultaneous exposure of sufficiently high amounts of estradiol hormones and progesterone. During the second phase, progesterone increases the ability of the myometrium to divide, and it also enhances tumor growth by stimulating and enhancing the activity of cell growth factors. Growing fibroid has a much larger number of hormonal receptors in its structure than normal uterine muscle tissue. As a result of the disturbed metabolism of sex hormones in the tumor nodes, cells stimulate growth factors.
The causes of myoma of the uterus , along with hormonal changes, suggest also in the existing violations of the immune response in the body, the appearance of which contributes to chronic foci of infection, severe pathological processes in the circulatory system of the pelvic organs and genetic predisposition. In these cases, the formation of growth zones of myomatous nodes occurs near the formed inflammatory compaction. Also, in the process of increasing the size of fibroids, the change in cells due to disturbance of microcirculation and nutrition plays a rather significant role. In addition to all of the above, at the initial stage of embryonic development, the formation of rudiments of myomatous nodes is possible. And in the future, the growth of these cells occurs over the years against the background of increased active ovarian activity, as a result of the action of progesterone and estrogen.
All benign uterine structures are heterogeneous in structure. And, depending on the number of muscle or connective tissue fibers in them, fibroids are divided into fibroids and fibroids proper.
Depending on the morphological features, simple tumors( the development of which results from an increase in the size of smooth muscle cells) and fibroids proliferating, which have signs of a true neoplasm of benign nature, are isolated. In 25% of patients, myoma has a proliferating character, and its nodes grow quite rapidly.
Depending on where the formation is localized and how the growth of its nodes occurs, distinguish:
- The submucous uterine myoma , which is located on the side of the muscular layer under the mucous membrane, grows into the uterine cavity and deforms it;
- Sub-serous( subperitoneal) - it is localized under the peritoneum and its growth occurs towards the abdominal cavity;
- Intraligametic - this is the name of myoma, which grows by delaminating two sheets of the broad ligament of the uterus;
- The intermuscular( or interstitial) tumor grows from the middle layer of muscles and is completely located in the thickness of the myometrium.
The submucosal myomatous nodes are characterized by a different arrangement. Depending on it, on the thickness of the base of the tumor and on the relation to the wall of the uterus, three types are distinguished:
- 0 type - knot on the stem, distant from the uterine wall;
- 1 type - the base of the node is wide, is recessed into the wall of the uterus by less than half;
- 2 type - the unit is recessed into the uterine wall by more than half.
The subserous uterine myoma is subdivided according to the same principle.
Depending on the location in relation to the uterine axis,
- is distinguished by cervical fibroids, the growth of which occurs in the vaginal cavity;
- is permeable, often causing pain and disturbances in the process of urine output;
- corporeal, localized in the body of the uterus( found most often).
Clinical signs of uterine fibroids
Myoma nodes are often plural. About 94% of all myomas are found in the body of the uterus and 6% grow in the uterine neck.
Women should be aware that in the early stages of the disease the disease is cured quite quickly and easily, but in this period the fibroid almost does not manifest clinically .Most often, it is detected only when carrying out a preventive examination, when it is found that the uterus is dense and enlarged. As grows, the uterine fibroid develops alarming signs, which must be taken into account. First of all, there is an increase in the volume of discharge during menstruation and their duration( this phenomenon is called menorrhagia).As the disease develops, the abundant pattern of bleeding increases, and many women cease to perceive this as a pathology, although this phenomenon requires consultation with a gynecologist. The danger of it is that a prolonged condition can cause anemia. The increase in the number of secretions is due to the fact that the existing myoma prevents normal muscle contraction, and this process begins to occur all the worse. In addition to menorrhagia, the appearance of another important sign of the presence of myoma - metrorrhagia( irregular, occurring outside the cycle, uterine bleeding) is also characteristic. Metrorrhagia does not arise from the fact that the neoplasm is bleeding, but from the secretions of the mucous membrane of the uterus, which becomes irritated by the presence of the tumor.
Along with bleeding, uterine fibroids will also be characterized by the appearance of a pain syndrome, for which pains of a different nature will be typical. The most frequent localization is the lower back and lower abdomen. The painful attack becomes acute and sudden when the development of the myomatous node reaches the stage of impaired blood circulation in it. In the case of slow growth of education and its significant size, a woman most often feels pains of a pulling and aching nature, as a rule, during the entire menstrual cycle. A stitch-like painful attack becomes when the fibroid develops in the thickness of the uterine mucosa. Pain is characterized by the appearance only after a certain stage of the disease, at the initial stages this syndrome is absent.
Also a significant place among the manifestations of myomas are the symptoms of impaired function of neighboring organs and systems, most often the rectum and bladder. If there is a neoplasm growing towards these organs, there are signs of their compression. There are problems with the process of urination: it becomes more frequent and becomes difficult. In the presence of subserous nodes of large sizes located in the middle third of the lateral wall of the uterus, a change in the ureteral flow is possible, which will lead to disruption of the urine flow, stagnation and the formation of the ureter dilatation and the renal pelvis with the development of hydronephrosis. Due to the pressure of myoma and compression of the rectum, chronic constipation occurs.
In addition to all of the above, there is a direct link between the tumor and the functioning of the cardiovascular system. Very often, during the growth of fibroids, women complain of pain in the heart, heart palpitations. At a significant size, formation can cause an increase in venous pressure, which significantly worsens the course of hypertension or heart failure.
Complications of fibroids
The most frequent complication of myoma is the trophism of the node with further necrosis .Much less often there is a torsion of the leg of myomatous formation, located subperitoneally, the symptoms of which are: acute pain, the appearance of signs of irritation of the peritoneum and acute abdomen, bleeding and the development of anemia. Also, at the submucosal node, its birth and eversion of the uterus is possible. Malignant degeneration of fibroids into cancer is likely in 1% of cases.
Among therapeutic methods of tumor, therapeutic and surgical are distinguished. For therapeutic treatment, drugs are used that are designed to stop the pathology - hormonal( the main are progesterone derivatives), inhibiting the growth of education. However, they can not completely remove the myoma, they are only able to restrain it until the menopause, after which it dissolves independently.
The need for surgery depends on the size of the node, the length of its presence, the age of the patient and the symptoms that the disease causes. There are conservative operations that allow the organ to be preserved, and radical ones, in which either the entire uterus is removed or some part thereof. Indications for surgical intervention and types of operations deserve a separate discussion.