Myoma of the uterus is diagnosed in almost a quarter of all cases of gynecological diseases. This benign tumor in rare cases flows into a malignant one. With timely diagnosis and proper treatment of uterine fibroids, a woman does not lose her reproductive functions. It is very important that ultrasound examination reveals even tiny knots, and become a target for quality therapy.
Types and symptoms of uterine fibroids
Myoma or fibroids of the uterus is superfluous, a tumor tissue that should not be normal. It is a tumor from the muscular layer of the uterus, with a greater or lesser degree of connective, fibrous tissue( fibromyoma or leiomyoma, white fibroids, or completely fibroids, without a muscle component).Myoma - a benign tumor, cases of its malignant transformation - casuistry( medical rarity).
There are several types of uterine fibroids: it can be located in the body of the uterus, on the front, back, side walls. There is also a variant of the location of this tumor in the cervix. In depth, fibromiomas distinguish between intra-wall fibroids, under the outer cover of the uterus, a tumor of this arrangement distorts the outer contour of the uterus.
And the most dangerous and unfavorable location of myoma - under the endometrium, the inner lining of the uterus, in the uterine cavity. Distortion of the uterine cavity can cause bleeding not associated with the cycle, menstrual bleeding. These symptoms often reveal such a form of fibroid.
And, of course, deformation of the walls of the uterus, possible deformation of the uterine cavity, a changed function of the ovaries, the absence of ovulation leads to infertility.
But such infertility is relatively, in some cases, if there is a fibroid, pregnancy occurs. But these two processes, illness and pregnancy, mutually burdens each other. A high percentage of miscarriage is a miscarriage associated with impaired attachment of the fetal egg to the altered walls of the uterus. The growth of the uterus during pregnancy provokes the growth of fibroids, necrosis, when the blood flow in the node is poisoned by the fetus. He can die from this in the womb.
Often the myoma is multiple, several dissimilar nodes grow at once, in different walls of the uterus, at different depths.
Myoma is like a tangle of threads, a disorderly heap of muscle and fibrous fibers. Therefore, in such a tangle hardly penetrate blood vessels. The most common complication of fibroids is circulatory disturbance in the myomatous node with subsequent necrosis, myocardial infarction. On ultrasound research, often find such sites in the node, they are called secondary changes.
Progression of tumor size complicates the treatment of uterine fibroids, and such symptoms and signs as disorders of the cycle, bleeding, pain, with impoverishment of blood circulation, pressure on the nerve plexus, interference in the work of neighboring organs - the bladder and rectum - intensify.
There are different methods of treating myoma - medicinal and surgical.
Methods of surgical treatment of uterine fibroids
When the first signs of uterine fibroids are revealed, treatment should be started immediately. For about five years there has been an anti-hormonal drug for the treatment of uterine fibroids, which directly affects the myomatous nodes, which reduces the size of the myoma until it is fully resorbed. And it's not a secret, the information has been widely covered in many medical journals and conferences.
There is also a method for treating uterine fibroids with monthly exclusion and the formation of an artificial menopause, when fibroids resolve. But such treatment is very poorly tolerated, the symptoms of artificial menopause are no less than those of real, age-related menopause. And you can help only by prescribing herbal remedies, which only relieve the symptoms of menopause in part.
Surgical treatment of uterine fibroids is different in terms of the volume of tissues removed, by access to the internal organ, essentially the operation itself.
Traditional large surgery with dissection of the anterior abdominal wall - removal of the uterus. In recent years, laparoscopic access has developed in the treatment of uterine fibroids: three holes are made in the abdominal wall, one is used to examine the internal organs, and two others are performed. And the percentage of so-called conservative myomectomy increased - the removal of not the uterus, but only the myomatous nodes.
In the treatment of nodal uterine fibroids inside the cavity, the method of hysteroscopy is used, with the help of which it becomes possible to look inside the uterus and act to remove the tumor. But the removal of fibroids is not a treatment for the tumor process. In the next cycle, after removal of the fibroids, new nodes may begin to grow. Therefore, it becomes necessary to combine the removal of nodes and conservative treatment of uterine myoma, which prevents the formation of new fibroids. It's just a long reception of hormonal drugs( contraceptives), which helps treat uterine fibroids and prevent negative consequences.
In the last decade, a new method for the surgical treatment of uterine fibroids has been developed by removing myomatous nodes. This is not even an operation, but the procedure of uterine artery embolization. Embolus - an obstacle to blood circulation, a vial plug. Doctors took a complication of fibroids - circulatory disturbance and necrosis of the node - and created a technique on this basis. When determining the artery feeding the myomatous node, the embolus is inserted into it, which causes necrosis not of the part of the node, but of the entire site as a whole. Severe pain and poisoning of the body with rotting products are treated within two to three days by powerful analgesic and detoxifying poisons of putrefaction with medicines.
For five years, careful monitoring of patients undergoing uterine artery embolization procedure was carried out. None of these women had a recurrent growth of the uterine tumor. Necrosis of the whole node is such a shock to the uterus that paralyzes tumor growth. Many of these patients were cured of infertility, became pregnant and were safely resolved by healthy babies.
Indications for surgical treatment of uterine fibroids
Unfortunately, most doctors are limited to simply monitoring the growth of a tumor until its magnitude or symptoms cause them to send a woman to an operation where the uterus is most often removed, often to women in their reproductive yearspregnancy).
Indications for surgical treatment of uterine fibroids arise with an increase in symptoms caused by the presence of a tumor:
- reaching the tumor size of more than 12 weeks of pregnancy( this is the estimate of the size of the uterus so that any gynecologist can imagine it);
- compression of myoma of neighboring organs;
- frequent bleeding, causing a decrease in the carrier of oxygen - hemoglobin and the formation of anemia( anemia);
- marked painful component of this disease;
- rapid growth of fibroids;
- circulatory disturbance, necrosis of a large fibroids node;
- node of myoma, which breaks the uterine cavity;
- a combination of fibroids with another variant of growth of superfluous tissues of genitals.
Treatment of nodal fibroids of the uterus by laser
In the last three to five years, a new method for controlling myoma of the uterus has appeared - laser "evaporation" of the myomatous node. A powerful laser beam purposely destroys myoma, raising the temperature of the tumor so much that the node literally evaporates. Such treatment of a myoma of a uterus by the laser does not give a poisoning with products of a necrosis. But the injury to the uterus is also great. True, the observation of such patients has not yet reached the five-year period.
The growth of uterine fibroids is often combined with the growth of excess endometrium. And if the myoma is a benign tumor that rarely degenerates into a malignant variant, the process of growth of excess endometrium is very prone to malignancy, because the new endometrium is formed in every cycle, it grows and multiplies all the time. In this case, there is a high probability of forming a number of atypical cells( incorrectly formed).Not always the immune system can reject them all.
The reason for the growth of excess endometrium is the same - a changed function of the ovaries with a delay in egg growth and an increase in estrogen hormones. But there is another view of the cause of growth of excess endometrium - a chronic inflammation, when the healing process "overflows" and grows excess tissue.
With the growth of superfluous endometrium, individual points of even more active growth can be formed in it - polyps of the endometrium. Excess endometrium and polyps are observed in a quarter( 25%!) Of gynecological patients. Extra, thick layer of the endometrium and polyps stretch the uterus cavity - there are bloody discharges that are not associated with the cycle, contact bleeding at intimacy, examination of the gynecologist. Again, there are abundant periods.
In such a modified endometrium, a fetal egg can not attach, and ovulation does not occur. There is infertility.
To detect such a disease is easy. With standard ultrasound, the thickness of the endometrium is measured, its uniformity is estimated( absence of polyps).An exhaustive method of treatment is therapeutic and diagnostic curettage of the uterine cavity. Treatment is the cessation of bleeding. Diagnosis - the definition of the type of endometrium, the definition of polyps with microscopy of a remote tissue. For clarification, hysteroscopy is frequently used - examination inside the uterus, performed with the aid of an optical fiber device.
Treatment of uterine fibroids with hormonal drugs
When hormone treatment for uterine fibroids, replacing the wrong, tumor-causing growth, ovarian function with an ideally selected dose of artificial hormones precludes the possibility of tumor growth.
Treatment of uterine fibroids with hormonal preparations begins on the day of scraping, this will prevent the growth of excess endometrium and the formation of polyps. These drugs are the same hormonal contraceptives. The growth of the endometrium depends on the ovarian hormones. Again, the ideal dose of artificial hormones contraceptive can not cause the growth of excess tissue.
And it also requires a long, at least a year, to take contraceptives to suppress the oncogenic tendency( inclination to malignant growth).
If atypical cells are detected in the excess endometrium or its polyps, a procedure of hysteroscopic removal of the entire endometrium with cauterization of its base can be performed.
Restoration of fertility after removal of the endometrium becomes problematic, since for the restoration of the mucous membrane of the uterus, hormonal stimulation is needed, which can lead to a recurrence of growth of superfluous and atypical endometrial tissue.