Uterine fibroids signs, causes, symptoms, consequences and treatment

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In gynecology, one of the serious problems is uterine fibroids. Due to its prevalence, this disease frightens many women, because... the first word they see when deciphering a diagnosis via the Internet is “tumor.” Indeed, uterine fibroids are a tumor, but benign. There are time-tested approaches to treating this uterine lesion. The patient needs to confirm the diagnosis through a thorough examination and begin the treatment process.

The essence of the disease

Uterine fibroids are a pathology of the female genital system. Its course is characterized by the formation and active growth of a benign neoplasm from the muscular layer of the uterus. Mostly, uterine fibroids are found in women aged 30-40 years or older, but the disease is “younger”, and therefore cases of formation in girls aged 20-25 are not uncommon.

A tumor that forms within the uterus is often located inside the body of the organ (in only 5% it is located in the cervix). The basis for the occurrence of a neoplasm can be not only muscle cells, but also connective tissue.

The doctor (the specialized specialist is an obstetrician-gynecologist) determines the size of the fibroids both geometrically (in centimeters) and over time. In the latter case, the size of the organ affected by fibroids is assessed, and the tumor is assigned an age of several weeks - equivalent to the gestational age of a healthy uterus of the same size.

Classification of the main types of fibroids

Multiple cases of the disease indicate different locations of fibroids in the uterus. There is the following classification of the location of fibroids:

• intermuscular – the tumor forms inside the muscle layer;
• subperitoneal - the nodal element is localized under the mucous membrane on the outside of the uterus near the abdominal zone;
• submucosal - on the contrary, from the inside in the cavity structure of the uterus;
• interligamentous – between the broad ligaments of the genital organ.

In some cases, the formation of fibroids can occur in such a way that they are supported by small legs, but the classification remains the same. If there is no tumor compaction as such, but the myometrium grows, the patient is diagnosed with a diffuse form of uterine fibroids.

It was previously said that the tumor is formed not only from the muscle layer, but also from the connective layer. It is worth noting that the predominant connective fibers require a specialist to diagnose not myoma, but fibroids, or fibroids when the muscle structure is not affected at all.

Myths:

1. Myoma will definitely turn into cancer and must be removed as quickly as possible.

In fact, uterine fibroids are not a cancer. At the initial stage of development of the disease, regular observation is simply necessary.

2. A woman will never be able to get pregnant.

This is far from the case, and even if at the moment fibroids are the cause of infertility and miscarriage, then with the help of treatment everything can be corrected.

3. You cannot plan a pregnancy with fibroids.

Most often, nodes located in the muscle layer do not interfere with conception, subsequent pregnancy and birth of a child. But the very presence of fibroids on the uterus indicates that malfunctions are occurring in this organ.

Such a pregnancy needs to be given more attention. But if the nodes cause deformation of the uterine cavity, then sometimes they require removal before planning a pregnancy.

Symptoms of uterine fibroids

The severity of the main signs of the disease is influenced by various factors. Symptoms indicating the formation of uterine fibroids depend on the following parameters:

• timing of formation of the nodal element;
• patient's age;
• size and location of the tumor;
• growth rate;
• the presence of concomitant chronic diseases.

Quite often, uterine fibroids are completely asymptomatic, which excludes the possibility of its detection until the next medical examination.

Severe symptoms of the disease:

• pain syndrome during the intermenstrual period, varying in strength and duration of sensations (in the lower abdomen, occasionally moving to the lumbar area, upper abdomen or lower extremities);
• impaired menstrual function (change in cycle length, increased pain, increased blood loss during menstruation and the appearance of unusual intermenstrual bleeding);
• problem of the reproductive system (there is a risk of developing infertility).

When uterine fibroids actively grow and the nodular element becomes quite large in size, the volume of the abdomen may increase, but the body weight will remain the same. In the same part of the body, discomfort and pain will appear, intensifying after physical activity or emotional and psychological stress.

If the nodal element in fibroids puts pressure on organs located near the uterus, then there is a high risk of constipation and difficulty urinating with severe pain.

A critical case is the twisting of the leg of the node element, which leads to necrosis (necrosis) of fibroids. In this case, the patient experiences an “acute abdomen” effect with the following symptoms:

• sharp pain in the abdominal area;
• increased heart rate (HR);
• heavy sweating (cold, sticky discharge);
• fainting.

In this case, prompt medical care with unconditional surgical intervention is important.

Among other symptoms that are indirect:

• anemia (with excessive bleeding);
• clouding of mind;
• frequent migraines;
• chest pain;
• neuroses and neurosis-like conditions caused by negative thoughts about the growing formation and its danger.

Primary symptoms appear at the stage of development when uterine fibroids measure 2-6 centimeters or more.

Symptoms

Myoma does not always have obvious symptoms, the most characteristic of which, occurring in most patients, are the following:

• disturbance, abnormal course of the cycle - increased duration (8 or more days), pain, blood clots;
• pain in the pelvic area;
• feeling of heaviness, pressure in the MT area (pelvis);
• pain in the legs and back;
• pain, discomfort during intimacy;
• frequent urination with little emptying of the bladder, which is associated with compression of the organ;
• constipation due to tight intestines;
• increase in abdominal volume.

If you have at least one symptom, you should urgently contact an antenatal clinic. If a visual examination and palpation are not enough, the doctor will prescribe an ultrasound, blood test, urine test, or smear test. Depending on the result, additional examination methods may be used.

Causes of the disease

As such, there is no 100% method for preventing the development of uterine fibroids. Numerous studies allow us to identify a list of the main reasons that most likely influence the process of tumor appearance:

• heredity;
• hormonal imbalance;
• pathological changes in the structure of the endometrium, causing its growth;
• multiple abortions or frequent use of intrauterine devices;
• taking hormonal contraception;
• spread of infections or inflammatory process occurring within the reproductive system;
• chronic stress;
• endocrine diseases, in particular obesity (especially the upper type) and diabetes mellitus;
• other chronic diseases, in particular cardiovascular pathologies;
• poor physical activity;
• lack of regular sex life and sexual satisfaction;
• mechanical damage and concomitant diseases of the reproductive system;
• excessive consumption of UV rays when receiving natural or artificial (solar) tanning.

Some causes of uterine fibroids need to be considered in more detail.

Hormonal disorders

The hormone dependence of fibroids manifests itself as follows: they do not form in girls before the onset of menstruation and in women during the menopausal or postmenopausal periods. A critical disorder is considered to be an excess of estrogen against the background of a lack of progesterone. Some of the reasons for the development of uterine fibroids, in particular obesity, are indicated precisely because of the influence they have on the process of hormone production. If there is suspicion, fibroids can be detected by analyzing hormonal status.

Labor activity and abortions

Serious mechanical impact on the body of the uterus increases the risk of it being affected by fibroids. In this regard, the doctor specifies the number of pregnancies and their outcome. It is worth noting that successful childbirth followed by breastfeeding reduces the risk of the disease.

Daily diet

The diet that a woman follows can also disrupt the previously mentioned hormonal balance. Negatively affects the body:

• abundance of refined products;
• consumption of trans fats;
• lack of fiber.

Again, don't forget about obesity. It is recommended to reduce the amount of fat and sugar consumed, while increasing the content of plant foods, seafood and complex carbohydrates in the menu.

Lack of orgasms

It is not just the lack of sexual activity that has a bad effect on the condition of the uterus, but also dissatisfaction, which can occur even in the case of regular relationships with the opposite sex. As a result of the lack of orgasms, venous blood stagnates in the area of ​​the pelvic organs. If this condition persists, the risk of uterine fibroids will increase.

Permitted and prohibited products

If the doctor has not given permission to take synthetic supplements and use traditional recipes, you need to make changes to your diet. Certain foods can speed up the process of reducing the size of the tumor. The basis of the diet for fibroids should be:

• fatty fish: salmon, mackerel, tuna;
• red berries;
• green vegetables;
• leaf salads;
• citrus fruits (especially lemons and limes).

If you plan to treat myomatosis without surgery, especially with medication, it is necessary to exclude estrogen-containing products from the menu. The hormone stimulates the development of the mucous membrane lining the uterus. Too much estrogen obtained from the daily menu can negate the effect of medications and provoke the growth of fibroids. It is worth excluding from the diet:

• soy products;
• flax seeds, sesame seeds;
• walnuts, peanuts, almonds;
• red meat;
• animal fats;
• dried fruits.

Proper nutrition will contribute to treatment and speed up the healing process.

Key risks of uterine fibroids

The main danger that uterine fibroids pose is possible complications. If a woman is constantly examined by a specialized specialist and unquestioningly follows all recommendations regarding maintaining her own health, then possible negative consequences are much easier to avoid.

In addition to the previously mentioned complications (bleeding, twisting of the leg of the nodal element, necrosis of fibroids, infertility and complications of pregnancy up to its premature termination), it is worth noting:

• malignancy of the uterine fibroid node (transformation of the tumor into malignant), occurring in 1.5-3% of cases;
• formation of a myomatous node against the background of uterine inversion;
• purulent processes inside the node and nearby tissues (timely treatment is necessary, since uncontrolled inflammation is extremely dangerous).

When diagnosing uterine fibroids, it is necessary to ensure regular visits to your doctor. You should contact a specialist if there are any changes in the patient’s condition that correspond to the symptoms indicated above.

Treatment approaches

Remember! Any personal prescriptions and recommendations received from the attending physician must be followed unquestioningly. Self-medication based on recommendations received from incompetent individuals or specialists on the Internet who do not have a complete understanding of the clinical picture of the disease is another factor that increases the risk of complications or the emergence of new health problems.

When treating detected uterine fibroids, the following methods can be used:

• conservative – the use of medications and non-invasive procedures;
• operative – surgical operation.

One method or another is selected based on:

• existing symptoms and their severity;
• size of the myomatous node;
• patient's age;
• her intentions regarding childbearing in the future, etc.

Each treatment approach has its own nuances that can increase the effectiveness of the procedures performed or vice versa.

The essence of conservative treatment

The basis of the conservative effect on fibroids is the use of hormonal drugs taken orally or administered by injection. Accompanying therapy is also prescribed (according to symptoms):

• anesthesia;
• treatment of anemia;
• reduction in blood loss, etc.

However, all these measures do not allow the complete disappearance of uterine fibroids. They only hold back its growth. The advantage of treatment without surgery is given to women of advanced childbearing age. Myoma is contained until the patient reaches menopause, when the chance of spontaneous resorption of the formation increases.

A set of conservative measures includes:

• strict diet;
• taking immunomodulators;
• herbal medicine;
• physiotherapeutic procedures;
• course of hormonal drugs.

The treatment itself has a step-by-step structure, based on the following tasks:

• relieving inflammation and eliminating infections;
• activation of immune defense;
• normalization of nutrition (diet);
• restoration of stable functioning of the endocrine system;
• alignment of the psycho-emotional background;
• blocking bleeding and treating resulting anemia;
• stabilization of the menstrual cycle.

However, as already mentioned, if the patient wants to get rid of uterine fibroids forever, then sooner or later she will have to undergo surgery to excise the tumor.

Indications for surgical treatment

In practice, a gynecologist is guided by a number of rules. The same applies when prescribing a surgical procedure to excise uterine fibroids. Having assessed the existing symptoms, carried out the necessary laboratory and instrumental tests, and also personally discussed the prospects for treatment with the patient, the doctor can resort to a radical method, based on the following indications:

• the size of fibroids is 12 weeks or more (the tumor has a mechanical effect on neighboring organs and systems, disrupting their functioning);
• the growth of the myomatous node is accelerated (4 or more weeks per year);
• frequent and heavy bleeding;
• severity of pain syndrome;
• twisting of the leg and death of the nodal element;
• formation of a submucosal myomatous node;
• endometriosis is combined with active progression of uterine fibroids;
• there are suspicions that the tumor ceases to be a classic fibroid and turns into a malignant formation.

With fibroids, it is extremely important to respond in a timely manner to functional changes in the formation. Surgical treatment often saves the life and health of the patient.

Hysteroscopic myomectomy

An operation to remove internal myomatous nodes located in the submucosa and having a base. Access to the uterus is through the vagina. A hyteroscope device is inserted inside and the tumor is removed using surgical instruments.

The procedure can be performed on an outpatient basis under general anesthesia. Contraindications include infectious and inflammatory diseases of the genitourinary system, suspicion of cancer of internal organs, and a depth of the uterine cavity of more than 10 cm.

Alternative Treatments

Due to the personal fears of patients and in the presence of physiological capabilities, doctors allow atypical procedures to eliminate uterine fibroids.

Uterine artery embolization

This is a modern technique that is not only unique, but also effective. It consists of blocking blood flow through the arteries that feed the myomatous node. The procedure is carried out under X-ray equipment, which allows you to control the accuracy of the surgeon’s actions. A special catheter is installed that conducts embolic agents through the femoral artery, causing blockage of the vessel. Under local anesthesia, the woman does not feel anything at all.

The essence of this treatment is that without blood supply, the formation first decreases in size and then disappears altogether. There are no cases of relapse of the disease.

FUS ablation

As part of this technique, neoplasm cells are heated by pulsed ultrasound, which has a destructive effect on them. In several sessions of FUS ablation, carried out under the control of an MRI machine, the doctor achieves complete cell death. Based on the degree of growth of uterine fibroids, the number of procedures increases. At the final stage, an MRI test is performed with the introduction of an X-ray contrast agent, which makes it possible to verify the success of the procedures performed.

Attention! Experts note many advantages of the method, but it remains individual. Let us remind you that the final treatment plan can only be developed and implemented by a specialized doctor who has a complete understanding of the clinical picture of the diseases of a particular patient.

Laparoscopic myomectomy

The essence of the operation is to penetrate the uterine cavity using punctures in several places in the abdominal cavity. Instruments equipped with lights and cameras are inserted through the punctures. This device allows the operation to be performed under visual control. The minimal area of ​​tissue trauma with small incisions reduces the likelihood of complications and shortens the rehabilitation period.

In the preoperative period, you should pay attention to your health - cure colds, examine the body for contraindications.

Prevention of uterine fibroids

Based on all of the above, we can talk about the importance of prevention. There are no clear rules to avoid the appearance of symptoms of the disease, but by following the advice presented below, you will definitely have a positive effect on your body and increase your chances of avoiding uterine fibroids.

1. Try to avoid stressful conditions. In any organism, the owner of which is “gnawed” by various experiences, negative physiological processes occur, which only contributes to the damage of uterine fibroids.
2. Everyone has heard about a healthy lifestyle, but you still need to stick to it. The main recommendations include: a balanced diet, regular physical activity at a sufficient level, walks in the fresh air, hardening, adherence to a daily routine, etc. All these truisms will help you never face the need to choose the optimal treatment method for uterine fibroids.
3. Regular (1-2 times a year) examinations with a gynecologist are something that should become a rule for any woman. The absence of any symptoms indicating disturbances in the functioning of the uterus is not a reason to refuse ultrasound scanning and other types of examination. Timely detection of uterine fibroids (in the early stages) allows you to avoid surgery, limiting yourself to non-invasive or conservative treatment.
4. It is necessary to use contraception wisely to avoid unwanted pregnancy and, as a result, abortion. When examined by a specialized doctor, you can choose the optimal contraceptive. An important condition for women with a predisposition to uterine fibroids is to maintain the first pregnancy.
5. Harmonious sex life. Regular sex with the obligatory achievement of a state of orgasm is one of the key preventive measures that determines the intensity of blood flow throughout the body. Also, constant sex life normalizes the psychological state and improves the functioning of the endocrine system.
6. Hypothermia should be avoided in any part of the body, in particular the pelvic area, hips, gluteal muscles and feet. It is unacceptable to wear wet clothes for a long time, sit on wet ground, stones or other cold surfaces.
7. When choosing underwear, you should give preference to natural, breathable fabrics. Outerwear should be loose and comfortable, which will allow you to maintain normal heat exchange, both in the cold season and in the heat.
8. Treatment of any inflammatory processes should be carried out in a timely manner. Girls and women should immediately respond to negative symptoms by going to their doctor.
9. You should protect your skin from ultraviolet radiation by using special creams and limiting the time you spend under natural (sun) or artificial (solarium) rays.
10. Fortification of the diet - in addition to properly selected products, it is necessary to consume complexes of useful substances. A qualified gynecologist will be able to select the optimal list of vitamins and minerals that accompany preventive measures and treatment. Among the most popular components: iodine, iron, copper, selenium, zinc, vitamins A, C and E, which have antioxidant properties.

By following these tips, as well as following your doctor’s recommendations regarding treatment and prevention, you can forget about the fear of being affected by uterine fibroids. At the very least, your lifestyle will become as correct as possible, and any negative manifestations will be much easier to track in order to subsequently promptly begin treatment for the identified disease.

What can the doctor prescribe?

In conservative therapy, several groups of medications are used. Let's look at each in more detail.

Combined oral contraceptives

Combination of ethinyl estradiol and desogestrel:

Treatment with contraceptive drugs containing combinations of 2 hormones is effective in reducing the severity of pain and bleeding. Therapy with such drugs can be expected to reduce the size of only those tumors that were initially up to 1.5 cm in size.

Gonadotropin-releasing hormone agonists

The action of these drugs is based on creating a temporary “artificial menopause” in a woman’s body. Under the influence of hormones, ovarian function is suppressed. Agonist drugs (analogues) of natural gonadotropin-releasing hormones (AGRH) inhibit the production of sex hormones of the pituitary gland, which affect the functioning of the ovaries.

Under the influence of AHRH, the ovaries “fall asleep”, ovulation does not occur, the uterine mucosa does not change cyclically - menstruation stops. This process is completely reversible; after discontinuation of the drugs, all functions are restored. Treatment lasts no more than 6 months. During this period, the size of the tumor can decrease by up to 50%, and the symptoms of fibroids become less pronounced.

Disadvantages of using drugs:

• Possible complete restoration of tumor size after cessation of treatment;
• Long-term (longer than 6 months) use of drugs is prohibited due to the high risk of osteoporosis and other complications of insufficient estrogen levels.

It is advisable to prescribe AGRH before surgery for uterine fibroids in order to reduce the size of the tumor.

Antiprogestogens

Like GnRH agonists, drugs in this group are used before surgery to remove uterine fibroids. Under the influence of hormonal therapy, myomatous nodes decrease in size, and the symptoms of uterine fibroids weaken.

Antigonadotropins

The effect of antigonadotropins is to reduce the intensity of symptoms without reducing the size of the tumor. Often, when using them, undesirable side effects occur (increased hair growth on the face and body, changes in the timbre of the voice, the appearance of rashes).

Antigonadotropins are used to treat uterine fibroids quite rarely, only in the absence of effect from treatment with other hormonal drugs.

Gestagens

Today, the use of gestagens is becoming less and less justified. Some gynecologists consider the use of gestagens to be effective because... With a lack of progesterone, tumor growth occurs. Many doctors, on the contrary, are categorically against the use of any gestagens for the treatment of fibroids. The mechanism of tumor formation is not based on the amount of any hormone, but on the imbalance of the woman’s entire hormonal system.

Currently, the use of gestagens is prescribed for the combination of uterine fibroids and endometrial hyperplasia.

Latest Research

Scientists at the University of Brussels conducted research at St. Luke's Hospital to understand how the contraceptive drug Esmya acts on uterine fibroids. The main active ingredient in Esmiya tablets is ulipristal acetate. And since in the process of development and growth of fibroids, the level of not only estrogen, but also progesterone, is important, it was decided to study the effect of the drug Esmya and gestagen blockers.

The experiment involved 550 women who were indicated for surgical treatment of uterine fibroids. All subjects were divided into two groups. One group was given a placebo as “treatment” for 3 months, the other was given Esmiya tablets.

At the same time, another study was conducted: a comparison of the effect of the drug Esmya and injections of gestagen hormone blockers.

The results of two experiments revealed the following:

• After using the drug Esmya, the size of uterine fibroids is reduced, the intensity of the symptoms of the disease decreases;
• 90% of the patients studied noted a positive effect from taking Esmiya tablets;
• In 50% of patients taking Esmya, there was no need for surgical treatment (the effect is similar to the use of injections of gestagen blockers);
• After taking Esmiya tablets, there are no such side effects as when using injections of hormone blockers - hot flashes, bone degeneration;
• After treatment for 6 months, no resumption of tumor growth was observed, whereas after stopping injections of hormone blockers, myomatous nodes began to grow again.

It is likely that thanks to the efforts of scientists, the problem of uterine fibroids will soon be solved much faster and easier than at present.

FAQ

Is pregnancy and childbirth possible with uterine fibroids? Yes. If the size of the nodal element and its location do not interfere with the natural course of the fertilization process, then getting pregnant will not be difficult. The entire process of bearing a fetus must take place under the strict supervision of the attending physician. In this case, optimal accompanying treatment will be provided, and the specialist will be able to decide which method of delivery will be relevant after 9 months (traditional or cesarean section).

Is it possible to take contraceptives if you have uterine fibroids? This is acceptable, but the choice of a specific drug should be discussed with the attending physician individually. Some substances will have a positive effect on regulating the menstrual cycle and combating bleeding. Spiral contraception can be carried out exclusively using the Mirena spiral, which helps treat the tumor.

Is it possible to go for a massage if you have uterine fibroids? This is only possible if there are no complications. If the tumor is actively growing, its “life activity” is accompanied by pain and bleeding, or it transforms into malignant – massage procedures are unacceptable.

Please read this article carefully and get answers to your questions regarding uterine fibroids. If you have not found the relevant information, then you can always ask your question to the specialists of our Center.

Contacting the Center for Endovascular Surgery

Professor Kapranov Medical Center is a professional institution staffed by a team of competent and responsible doctors. Profile specialists and medical staff do everything possible to effectively carry out treatment. We are ready to help in the fight not only against uterine fibroids, but also against other diseases, including cancer.

Carefully study our website to have a complete understanding of the technical capabilities of the institution, the treatment methods used, the qualification level of specialists, etc. You can read a number of other articles devoted not only to uterine fibroids, but also to related diseases. All of them are published in the relevant sections of our resource. Find out an expert opinion about a particular disease in a timely manner

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